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Blending Science and Wisdom to Sustain a Healthy Mind, Mood and

Heart Henry Emmons, MD

www.partnersinresilience.com

What’s the one thing you can do?

Joy

“Surely joy is the condition of life.”

-Thoreau

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A Holistic Disease?

Depression and Anxiety • 100 years

• Increased 10% per decade

• Seligman • 10 times higher risk

• Disability • US • WHO

Causes of Depression and Anxiety

If not just genetics, then…

Why?

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Why Zebras Don’t Get Ulcers…

Because they don’t suffer from chronic stress

…But People Do

“We’ve evolved to be smart enough to make ourselves sick.”

-Robert Sapolsky

The Enemies of Joy

� Body Imbalance and Toxicity

� An Unsettled Mind

� The Illusion of Separation

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Minnesota Healthscores �  How are we doing with depression treatment?

�  115 Minnesota clinics measured PHQ-9 scores:

�  Treatment indicated if score >9

�  Remission if score <5 at 6 months

�  Best rate of remission: 36%

�  Only 8 clinics have >10% remission. Average is 4%

Source: mnhealthscores.org

Treating Depression/Anxiety We can do better! � Depression and anxiety are complex

conditions.

� They require more complex, sophisticated solutions.

� Patients want to know what they can do for themselves.

The Resilience Training Program

Fitness

Mindfulness

Nutrition

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Resilience Training: Building a Healthier Brain

• Context • Supplements • Medication?

Holistic Psychiatry

• Stress Response

• Digestion • Food Sensitivity

Functional Nutrition • Fitness Profile

• Individualized Program

Integrative Fitness

Psychology of Mindfulness Groups

� 8 Week Group meets 2 ½ hours per week

� 16-18 participants � Not a replacement

for therapy � A skills-based

program � Creating a circle of

trust

Resilience Training Study ●  A non-randomized trial design was used to: ●  To determine the feasibility of conducting the

Resilience Training (RT) program in working employees of Allina Hospitals and Clinics.

●  To assess whether an 8-week RT intervention reduces depressive symptomology, anxiety, stress, quality of life, and work productivity in employees compared to wait list group.

●  Evaluate if the wait list group improves after receiving RT.

December 8, 2009

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RT Study Design � The first 20 eligible employees were assigned to

Immediate RT (n=20) and the second 20 employees were assigned to the control group (n=20).

� Outcomes included self-report questionnaires for depressive symptomology (PHQ-9), quality of life (SF-12), perceived stress (PSS), anxiety (STAI), healthy lifestyle (HPLPII) and workplace productivity- presenteeism (WPAI).

December 8, 2009

RT Study Results: PHQ-9 (Patient Health Questionnaire-9)

Analysis between RT vs control indicates a significant improvement for RT. More than 60% of employees achieved remission of their depression without the addition of any medications. When control receives RT (now called RT2), we observed identical improvements.

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Time1- PHQ-9 Time2- PHQ-9

RT2

RT

CON

December 8, 2009

2 4 6 8 10 12 14 16 Time1- PHQ-9 Time2- PHQ-9

RT Study Results: Quality of Life RT vs control indicates a significant improvement for RT on mental subscale of SF-12. RT2 had identical improvements.

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Time1- SF12- MCS Time2- SF12- MCS

December 8, 2009

2 4 6 8 10 12 14 16 Time1- PHQ-9 Time2- PHQ-9

RT2

RT

CON

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RT Study Results: Perceived Stress Scale

The RT groups reported a more significant decrease: 8.8 to 4.7 (less than 6 considered ideal). RT2 had identical improvements.

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Time1- PSS Time2- PSS

December 8, 2009

2 4 6 8 10 12 14 16 Time1- PHQ-9 Time2- PHQ-9

RT2

RT

CON

RT Study Results: Speilberger’s State Trait Anxiety Inventory

RT vs control indicates a significant improvement for RT on State Anxiety. RT2 had identical improvements.

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Time1- State Time2- StateDecember 8, 2009

2 4 6 8 10 12 14 16 Time1- PHQ-9 Time2- PHQ-9

RT2

RT

CON

RT Study Results: Speilberger’s State Trait Anxiety Inventory

The RT groups scores decreased from 45.1 to 32.0 (less than 38 is considered ideal) on Trait Anxiety. RT2 had identical improvements.

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Time1- trait Time2- Trait

RT2

RT

CON

December 8, 2009

2 4 6 8 10 12 14 16 Time1- PHQ-9 Time2- PHQ-9

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RT Study Results: Health Promoting Lifestyle Profile

RT vs control indicates a significant improvement for RT on Healthy Lifestyle profile. RT2 had identical improvements.

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Time1- Lifestyle Profile Time2- Lifestyle Prof ile

December 8, 2009

2 4 6 8 10 12 14 16 Time1- PHQ-9 Time2- PHQ-9

RT2

RT

CON

RT Study Results: Sleep Quality (0-10 scale)

RT vs control indicates a significant improvement for RT on sleep question. RT2 had identical improvements.

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Time1- Sleep Time2- Sleep

December 8, 2009

2 4 6 8 10 12 14 16 Time1- PHQ-9 Time2- PHQ-9

RT2

RT

CON

RT Study Results: Work Productivity and Activity Impairment Questionnaire

RT group versus control demonstrates an improvement in the % time of self-reported presenteeism by over 50%. Results from RT2 mirror the improvements of the RT group. Return on investment of 2.42 ($2181 saved/$900 spent per participant)

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T1- Presenteeism T2- Presenteeism

December 8, 2009

2 4 6 8 10 12 14 16 Time1- PHQ-9 Time2- PHQ-9

RT2

RT

CON

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The Science of Hope

� Neuroplasticity

� Gene Expression

� Cell Turnover

Neuroplasticity The brain is capable of change.

Neuroplasticity “the possession of a structure weak enough to

yield to an influence, but strong enough not to yield all at once…. A path once traversed by a nerve-current might be expected to follow the law of most of the paths we know, and to be scooped out and made more permeable than before; and this ought to be repeated with each new passage of the current.”

-William James

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Neuroplasticity 5 Finger Keyboard � 2 hours daily for 2 weeks

� Corresponding growth in motor area

� Second group: Practiced the movement in their minds

Neuroplasticity Studies on: � OCD � PTSD � Spider Phobias

All show that mindfulness training can rewire the brain

Neuroplasticity Richard Davidson: � Affective Style: how we respond emotionally

to challenges � Emotional Set-Point: baseline mood that we

return to after emotional reactions

� Neither is as permanent as we thought

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Neuroplasticity Pre-Frontal Cortex Asymmetry � Right PFC: negative emotions �  Left PFC: sense of well-being, enthusiasm,

happiness �  Improved with an 8 week mindfulness class �  The greater the improvement in well-being, the

better the immune system functioned (influenza antibody titers

� Monk studies

Neurogenesis The brain creates new cells. It can heal itself.

Neurogenesis 1983: female canaries The “neurogenesis we have observed in the

adult brain is both provocative and reassuring of the plasticity that may reside in adult nervous systems.”

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Neurogenesis 1998: Swedish Researchers looked at cancer

patients. Proved neurogenesis in the hippocampus even

into old age and with terminal illness.

Neurogenesis Brain-Derived Neurotrophic Factor (BDNF) � promotes the growth of new cells �  improves memory and learning � enhances the survival of existing neurons �  Influences the process of neuroplasticity

Neurogenesis Low levels of BDNF are found in:

� Alzheimer’s � Parkinson’s � Depression � Anxiety

Prolonged elevation of cortisol reduces the effect of BDNF—and shrinks the hippocampus

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Neurogenesis BDNF activity is enhanced by: �  Exercise: low level, non-strenuous, helps cells

grow �  Enriched environment: learning helps cells

connect �  Diet: helps cells survive

�  calorie restriction Phytonutrients Omega 3 fatty acids

�  Serotonin works as a partner with BDNF �  social connection and the power to heal

Genetic Expression Genes can be turned on or off.

Gene Expression What impacts epigenetics? � Negative factors:

�  Alcohol and tobacco �  Endocrine disrupters (plastics or chemical

fertilizers) �  Long-term Stress

� Positive modifiers: �  Phytonutrients in fruits and vegetables. �  Exercise �  Cultivating positive emotions

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Resilience Keeping the container full.

What’s the one thing you can do?

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There Is One Thing We Can Do “There is one thing we can do, and the happiest people are those who can do it to the limit of their ability. We can be completely present. We can be all here. We can…give all our attention to the opportunity before us.”

Mark Van Doren

There Is One Thing We Can Do “There is one thing we can do, and the happiest people are those who can do it to the limit of their ability. We can be completely present. We can be all here. We can…give all our attention to the opportunity before us.”

-Mark Van Doren