Editors note: This post was originally published in October 2020 and has been revamped and updated for accuracy and comprehensiveness in April 2021.
It’s been a year of change, challenges and pushing many of us to our limits. Us humans don’t do so well with rapid change, social isolation, and far-reaching uncertainty all rolled into one. I’ve had many, many conversations with loved ones, colleagues and clients about how our mental health is being tested like never before. My husband Orlando is a trauma psychologist on the frontlines, so our household hasn’t been short of stories of how trying these circumstances have been as a collective.
While I’m not a mental health professional, as a naturopath and herbalist, I know how deeply our mental, emotional, spiritual and physical health are in entwined. We cannot separate them. And today, I would love to share with you a holistic model of mental health care that I have found both personally and clinically useful.
It can help simplify the complexity, provide a natural order in what changes and interventions to try and (what I hope) are some soothing and reassuring words that you will come out the other side of this. You may even find that you feel stronger and more fortified than before.
Starting with the basics, what is anxiety?
Anxiety in and of itself is a normal and healthy human emotion. It’s a feeling of worry, nervousness or unease about something with an uncertain outcome. Generalised Anxiety Disorder is a medical diagnosis, and occurs when the emotion anxiety embeds itself deeply into our nervous system. It’s defined as a nervous disorder marked by excessive uneasiness and apprehension, typically with compulsive behaviour or panic attacks.
How do I know if I’m anxious or have an anxiety disorder?
Generalised Anxiety Disorder needs to be diagnosed by a medical professional. They use criteria from the DSM-V (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) to determine a diagnosis. The diagnostic criteria include:
- You’re experiencing excessive anxiety and worry occurring on most days for at least six months.
- You find it challenging to control worrying thoughts and calm your mind.
- Your anxiety is accompanied by three or more of the following six symptoms – with some of the symptoms being on most days for at least 6 months:
II. Fatigue and lethargy
III. Difficulty concentrating or focusing; or finding that your mind goes blank
IV. Easily irritated/mood swings
V. Experiencing muscle tension
VI. Difficulty sleeping; either going to sleep, staying asleep or waking up feeling unrefreshed.
- The anxiety, worry and other symptoms are impacting your ability “to do life” a.k.a they’re affecting your ability to function at work, school or your social life.
- These symptoms are not connected with using a substance (i.e. medication or recreational drugs) or another medical condition (such as hyperthyroidism or chronic pain).
- The symptoms are not better explained by another medical diagnosis – i.e. such as ADHD, panic disorder, OCD, social phobia, depression, among others.
As you can see, it’s a spectrum. If you’re feeling anxious and you’re beginning to experience these other constellations of symptoms, you don’t need to wait for 6 months. Begin now.
TIP: A convenient self-assessment tool you can use (I use this in clinic when determining what kind of referral is required) is the DASS–42. It’s a primary healthcare assessment tool developed by psychologists that can help you differentiate if the pattern of your symptoms is most akin to depression, anxiety or stress. It’s also a handy tool for assessing your progress as you undertake a treatment plan and therapy. I like this one.
Developing Your Mental Health “Recipe”
I always love a good food metaphor! And crafting a holistic mental health plan can be done with a little bit of ingredient know-how. I encourage you to start small and go gently. Tiny changes can lead to significant shifts.
The ALPS Model – Holistic Mental Health Care
This is a model that I learned from Dr Jerome Sarris, a naturopath and mental health researcher, and I have found it so useful for explaining a holistic approach to clients and for guiding my treatment suggestions.
ALPS Stands For:
- A – Antidepressant/anti-anxiety medication. In this category, we can also use herbs.
- L – Lifestyle change (exercise, sleep and nourishment)
- P – Psychology (or counselling)
- S – Social support
Let’s take a more in-depth look at each one.
A – Antidepressant/anti-anxiety medication and herbs.
Some folks are surprised when they learn that I advocate medication as a naturopath and herbalist. Even though these are my professional titles, I see myself far more as a holistic healthcare practitioner. All options that could be beneficial are to be considered and understood.
The therapeutic hierarchy guides my suggestion for sequencing. Starting with gentle interventions, and then moving up the hierarchy as required until relief is experienced. I have seen time and time again that these medications can make a big difference. I encourage you to have a conversation with your medical provider if these other changes don’t bring significant relief.
Nature’s Anti-Anxiety Botanicals
You may like to consider working with a herb (or a couple) for a month alongside the other steps of the ALPS model to see if this is enough to bring some balance and relief. If you’d like to go Marie Curie on it, complete a DASS–42 at the beginning – make a note of your score in your diary or journal. Then at the end of the month working with your botanicals, retake it and see if you’re headed in the right direction.
Let me introduce you to some of my favourite soothing herbal friends…
St John’s Wort (Hypericum perforatum) – this plant has got a lot of attention in the domain of depression, but it’s also excellent for anxiety and insomnia. If you have a combination of both anxiety and depression, it’s worth considering. This plant blooms around the summer solstice, and its disposition is strengthening to the entire nervous system. There is also extensive research on this herb in the realm of mental health. While St John’s Wort is very safe when taken alone, it’s not suitable to be taken alongside SSRI medications as it can have an additive effect. It has a good safety profile in both pregnancy and breastfeeding.
Chamomile (Matricaria recuitita) – Humble chamomile is not one to ever be underestimated. If anxiety manifests in you as irritability, insomnia and digestive upsets – welcome this one into your teapot. Safe to take during pregnancy and breastfeeding.
Tulsi (Ocimum sanctum) – There is always so much to say about this plant. Tulsi lifts the spirits, fortifies the nervous system and adrenals in the face of stress, helps us connect with our heart and settle the mind. It is my favourite plant to use alongside many pharmaceutical anti-anxiety medications, as it has a low interaction profile and is very helpful to transitioning off medication. It can be used as a treatment in its own right—limited safety data for pregnancy and breastfeeding. To read more about Tulsi, visit this post.
Lemon Balm (Melissa officinalis) – It is such a beauty for when stress ties us up into tangled knots, and doom and gloom begin to set in. ⠀It’s a plant that reminds us to not take ourselves or life too seriously. Drinking a strong cup of lemon balm tea (even better if you can have it fresh) is a feeling of opening a window in a dark room to bring in the crisp air and warm sun. ⠀It will lift your mood, settle your stomach and possesses a host of anti-viral qualities. If your someone whose signs of stress of being run down are cold sores, mood swings and/or digestive upsets, bring this plant into your life. ⠀Safe to take during pregnancy and breastfeeding.
Motherwort (Leonarus cardiaca) – This is the most restorative and nurturing herb in my herbal medicine chest. Motherwort is a beautiful plant with a significant presence. She has many similarities to mugwort and tulsi, but what makes a difference is that she can cool and calm you down very quickly. There are not too many herbs that you can feel working so instantly. If you’re going through any kind of transition, whether that’s settling into womanhood, preparing for birth, motherhood, menopause, moving cities, a new job or the end of a relationship, using motherwort as an ally is like having a loving mother’s arms to support you through. Read more about Motherwort over here.
L – Lifestyle and Nourishment
This is a broad category, so it’s essential to not get overwhelmed by all the “things you can do” or listicles you find on Instagram and Pinterest. In the spirit of simplicity, here are a couple of suggestions of tried and true habits that can have significant impacts.
B-Vitamins and Magnesium – it’s not new knowledge that nutrition profoundly impacts brain function and mental health. While there are many useful nutrients, the most effective place to begin is to invest in a good quality B-vitamin complex and Magnesium. These nutrients are all involved in the creation of calming brain chemicals and are depleted by stress.
Music – music therapy is powerful! Spend some time gathering together a playlist of songs on your music app of choice that makes you feel happy, grounded and calm. Listen to as often as needed!
Grounding Panic Attacks with the 54321 Technique – If you’re experiencing panic attacks, learning the 5,4,3,2,1 Grounding technique is a powerful mindfulness practise that helps you drop back into your body. Like sending roots down into the ground, this method grounds you back to earth.
First, take a moment to become mindful of your breath. Take a few deep breaths allowing everything to slow down. Then direct your awareness to your surrounds.
Look For 5 Things You Can See: Notice the colour of the wall. The texture of the ground. What items are in the room? Gaze at the lines on the inside on your hands.
Become Aware Of 4 Things You Can Touch: Touch the fabric you’re wearing. Feel the solid ground beneath you. Are there any objects in front of you? Pick them up and note to yourself how they feel.
Acknowledge 3 Things You Can Hear: Distant traffic. Voices in the next room. The silence between the sounds.
Notice 2 Things You Can Smell: If you can’t smell anything, just try to sense the gentle fragrance of the air around you, you may like to keep a small bottle of essential oil in your handbag that you find calming. Peppermint or lavender are lovely for this.
Become Aware Of 1 Thing You Can Taste: The lingering suggestion of what you just drank or ate? Like the fragrance, you may like to keep a small snack in your bag that you can taste when you’re having a panic. Even a breath mint is useful.
Meditation/mindfulness – Developing a meditation practice is one of the most powerful habits to adopt for re-wiring your brain for peace. There are many apps out there that make this oh so easy to begin. I love Insight Timer (although I hear HeadSpace and Calm App are excellent too). You can browse thousands of meditations and learn from incredible teachers. I recommend:
- Tara Brach – 40-day intro (she also has a fantastic podcast, weaving together psychology and Buddhism)
- Sarah Blondin
- The Wong Janice
- I teach a 21-day online course, The Peace Protocol, which gently guides you in developing a meditation practice (as well as a whole treasure trove of holistic tools).
Movement – exercise is equally, if not more effective, than mood stabilising medications. Exercise floods your body with endorphins (feel-good brain chemicals), gives your serotonin a boost and helps sleep. Find something you love and start oh so small. Some suggestions to get started:
- Dance to one song. Next week dance to two songs if you’re feeling it.
- Walk around your block. Next week add a few 1-minute jogs in there.
- Take a 10-minute yoga class on YouTube. Next week make it 15 minutes.
Nature – Nature is the most potent anti-anxiety therapeutic for me, personally. An afternoon coast walk followed by an Epsom Salt and lavender bath is enough to turn a week of insomnia into a restful night’s sleep for me. Where in your town can you soak in some greenery? Can you meet up with a friend and go for a walk?
P – Psychology (or counselling)
There are so many options for mental health support available. If you work for a company or attend university – look into what mental health support services you may have access to.
Receiving a referral for a wonderful psychologist, therapist or counsellor who works locally and is aligned to your values is invaluable. I also have had an excellent experience and have referred many others (with happy experiences) to online therapy. In our pandemic times, it’s not always possible to see therapists face to face, so why not take advantage of services that have perfected the online mode of delivery for years?
TalkSpace is the service I recommend. There are different levels of care you can access, each of them having Monday – Friday audio message support. They only hire licensed professions, they have an impressive onboarding and clinical assessment process…you can have a therapist in your pocket.
If this is not available to your financially – journalling is essentially a free, useful therapeutic tool— “Morning Pages” by Julia Cameron is my favourite technique.
S – Social support
The final piece of the ALPS model is “S – social”. If you’re experiencing social isolation or an extrovert that is finding our pandemic world a torture chamber of social deprivation, focus on the ways that you can connect with people you love safely and make this a part of your weekly schedule.
- Walk with a friend in the park or out in nature.
- Zoom trivia night with friends
- Nominate a couple of evenings a week that you call a friend or family member
Allowing a New Order to Emerge
In healing, chaos is seen to always brings the opportunity for a new possibility. It is a great re-arranger whose pressure will show what parts of our life need strengthening and redesigning. Anxiety is a very real physiological experience that can feel scary, exhausting and out of control. I invite you to see this anxiety as an invitation to shift into a new mode of being, deepen compassion for yourself and those who are also struggling and discover new ways to tend to yourself. Remember to start small, seek help and trust that you will find a way.
If you’re currently feeling overloaded or overwhelmed, make sure you take my “Are you burning bright or burning out?” Quiz. Depending on your results, you’ll receive some love letters from me with gentle recommendations on how to nourish yourself and start thriving after a season of surviving. And if you have a loved one that you think will enjoy this, please send them the link to the blog.
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Anxiety Resources & References
Bland, J. S. (1995). Psychoneuro-nutritional medicine: An advancing paradigm. Alternative Therapies in Health and Medicine, 1(2), 22–27.
Camfield, D., McIntyre, E., & Sarris, J. (Eds.). (2017). Evidence-Based Herbal and Nutritional Treatments for Anxiety in Psychiatric Disorders (1st ed. 2017). Springer International Publishing : Imprint: Springer. https://doi.org/10.1007/978-3-319-42307-4
Firth, J., Marx, W., Dash, S., Carney, R., Teasdale, S. B., Solmi, M., Stubbs, B., Schuch, F. B., Carvalho, A. F., Jacka, F., & Sarris, J. (2019). The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta-Analysis of Randomized Controlled Trials. Psychosomatic Medicine, 81(3), 265–280. https://doi.org/10.1097/PSY.0000000000000673
Firth, J., Torous, J., Carney, R., Newby, J., Cosco, T. D., Christensen, H., & Sarris, J. (2018). Digital Technologies in the Treatment of Anxiety: Recent Innovations and Future Directions. Current Psychiatry Reports, 20(6), 44. https://doi.org/10.1007/s11920-018-0910-2
Savage, K., Firth, J., Stough, C., & Sarris, J. (2018). GABA-modulating phytomedicines for anxiety: A systematic review of preclinical and clinical evidence. Phytotherapy Research, 32(1), 3–18. https://doi.org/10.1002/ptr.5940
Selye, H. (1976). Stress without Distress. In G. Serban (Ed.), Psychopathology of Human Adaptation (pp. 137–146). Springer US. https://doi.org/10.1007/978-1-4684-2238-2_9
Survival Mode and Evolutionary Mismatch. (n.d.). Psychology Today. Retrieved December 2, 2019, from http://www.psychologytoday.com/blog/the-embodied-mind/201212/survival-mode-and-evolutionary-mismatch
Wardle, J., & Sarris, J. (2014). Clinical Naturopathy: An evidence-based guide to practice. Elsevier Health Sciences.