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Why Zebras Don't Get Ulcers...

Integrative Therapies for Anxiety

Henry Emmons, MD

Consulting Psychiatrist, Penny George Institute for Health and Healing

Because they don't suffer from chronic stress

...But People Do

The Costs of Anxiety

-- 1 in 5 Americans per year -- 30% lifetime prevalence

"We've evolved to be smart enough to make ourselves sick." Robert Sapolsky

-- 40 million Americans per

year with diagnosable conditions

-- Costs US economy $50

Billion per year in lost productivity

The Spiral of Fear

-- "I'm having Round 2 of PTSD. I haven't slept in 7 months!" -- Diagnosed with Cancer nd -- 2 Episode in 9 years


"Is there any hope for me?"

-- Fear reaction locked in the "on" position -- A normal response gone awry

Sleeping meds had helped in past Numerous doctors 6 med trials unhelpful Sleep study

-- Now sleeping only 34 hours

-- -- --

-- Kept alive by thinking too much and sleeping

too little



Breaking the Cycle

-- Unlock the brain

-- B vitamins -- Magnesium -- 5 HTP


Keeping the tank full.

-- Improve sleep

-- Melatonin -- Tryptophan

-- Dampen the stress

-- Within 5 days felt


dramatically better

-- Then look at improving


"Let food be your medicine and medicine be your food." Hippocrates

A Resilient Diet in 7 Words

"Eat food. Not too much. Mostly vegetables." Michael Pollan

Eat whole, natural foods

What to do:

Buy unprocessed, organic food as much as possible


-- Higher in micronutrients from soil -- Less processing leaves more nutrients in the food -- More fiber reduces blood sugar fluctuation -- Fewer chemicals from farming and food processing



Eat a wider variety of foods

What to do:

-- Eat more seasonal, local foods -- Discover new kinds of meats, vegetables, grains, nuts and seeds

Eat fewer toxic foods

What to do:

-- Avoid food with chemical additives -- Be sure certain fruits and vegetables are organic -- Buy hormonefree meat and dairy -- Avoid certain seafood products


-- Closer to how we evolved to eat. -- Greater number of nutrients -- Less likelihood of food sensitivities like gluten intolerance


-- Some chemicals are neurotoxic -- Certain produce is known to carry more risk -- Hormones will impact brain function -- Oceans are polluted; not all fish are safe to eat.

Eat brainprotective foods

What to do:

-- Look for colorful fruits and vegetables (beans, dark berries, leafy greens) -- Eat a cruciferous vegetable daily: e.g. Broccoli, cauliflower and cabbage

Eat brainnourishing foods

-- Build diet around complex carbohydrates. -- Eat only modest amounts of lean protein. -- Get plenty of healthy fats, mostly omega3: -- Olive oil; nuts; seeds, fish -- A plantbased diet improves brain health and longevity. -- Need some protein for amino acids, but less than we usually eat. -- Neurons are mostly fatty cells; need healthy fats to function, as well as reduce inflammation


-- Phytonutrients are potent antioxidants that reduce the negative impact of stress -- These help the body detoxify

Basic Supplements

-- Multivitamin or BComplex -- Take half the dose twice daily -- Look for minimum 50 mg B6 per day -- Omega 3 -- 1000 mg Fish Oil twice daily -- And/or 2 T. ground flaxseed -- Vitamin D3 -- 20004000 IU daily from October through April -- Calcium/Magnesium:

-- 1000 mg Calcium (women only)/500 mg Magnesium (men and women)

Therapeutic Supplement: Ltheanine

ØDerived from green tea ØSupports dopamine and

norepinephrine function

ØMay improve focus ØCan also calm and help sleep Ø100200 mg twice daily ØUse just at night if sedating



Therapeutic Supplement: NAC

-- Nacetylcysteine -- 600 mg up to 3 or 4 times daily. -- A potent antioxidant -- May help treat OCD.

Therapeutic Supplement: Taurine

-- 500 mg once or twice daily -- Improves glutamate/GABA function

Therapeutic Supplement: Inositol

-- Dried beans contain inositol. -- 5001000 mg 2 to 3 times daily. Studies use 1218 g per day. -- Often considered a B vitamin, it can effectively treat panic, OCD and phobic anxiety.

Therapeutic Supplement: GABA

-- 250750 mg up to 3 times daily -- Does not cross easily into the brain, so other measures may have more effect on GABA

Therapeutic Herb: Rhodiola

-- 100500 mg -- An herbal adaptogen, this may improve the body's general response to stress

Therapeutic Herb: Passionflower

ØGentle sleep and

antianxiety aid Ø12 droppersful or freezedried capsules before bed, or up to 4 times a day



Therapeutic Herb: Valerian Root

-- 12 droppersful in a small amount of water before bed or up to 4 times per day

"The energy of the mind is the essence of life." Aristotle

The Energy Thieves

-- Insulin Resistance -- Inflammation -- Food Sensitivity

Insulin Resistance

Starving in a world of excess

Insulin and the Brain

-- Sugars have multiple effects on the brain. -- Insulin sensitivity is required to produce dopamine. -- Excess sugars and neurotransmission. -- High sugar intake can promote aggression, anxiety,


Brain on fire.

hyperactivity and fatigue.

-- Postprandial dysmetabolism



Inflammation and the Brain

-- Hypothalamicpituitaryadrenal (HPA)axis

Food Sensitivity

A hidden source of inflammation

hyperactivity (the stress response)

-- Effects thyroid function -- Effects serotonin and dopamine, glutamate and


-- Inflammatory messengers signal the brain to produce

neurochemical, neuroendocrine, neuroimmune, and behavioral changes.

Modified Elimination Diet

-- Wheat -- Corn -- Dairy 1 (milk, cream) -- Dairy 2 (cheese, yogurt) -- Nightshade vegetables -- Tomatoes -- Potatoes -- Peppers -- Eggplant -- 10 Days off all. -- 1 day challenge (1 at a time) -- 2 days off (observe) -- Keep rotating until all 5 categories have been challenged. -- Avoid reactive foods for 23 months.

"Sometimes the cure for restlessness is rest." ­Colleen Wainwright

Natural Sleep

ØSleep problems are

Natural Sleep: How much?

ØAverage in 1900 ØAverage today ØTiming ØNaps

a common trigger

ØThere is no way to

recover fully unless sleep improves



Natural Sleep: What Helps?

Natural Sleep: What Helps?

Natural Sleep: What Helps?

Dawn Simulator

Natural Sleep: What Helps?

Sublingual Melatonin

·Use plain melatonin for

Northernlighttechnologies. com

trouble falling asleep

·Add other components

for trouble staying asleep

Natural Sleep: What Helps?


ØGentle sleep aid ØUse as a tincture,

Natural Sleep: What Helps?


Ø100200 mg at bedtime ØMay be added to other


tea or freezedried capsule



Natural Sleep: What Helps?


ØAmino acid precursor to

The Psychology of Mindfulness

Mindfulness (Vipassana) (The Mind Run Rampant) Heartfulness (Metta) (The Illusion of Separation)


ØLtryptophan is more sedating

than 5 HTP

Ø5001000 mg at bedtime (or 50

Ø The practice of seeing and accepting things as they really are Ø Learning to do less harm

Ø The practice of learning to love well

Ø Cultivating a larger self

100 mg of 5HTP)

ØCaution if on an SSRI

The Nature of Mind

"We are what we think. All that we are arises with our thoughts. With our thoughts we make the world. Speak or act with an impure mind And trouble will follow you As surely as the wheel follows the ox that draws the cart. "We are what we think. All that we are arises with our thoughts. With our thoughts we make the world. Speak or act with a pure mind And happiness will follow you As closely as your shadow, unshakable."

" Mind is the forerunner of all things. Begin with mind." The Dhammapada

--The Dhammapada


Ø Awareness Ø Moment to moment Ø Intentional Ø NonJudging and Acceptance Ø Slowing down, honoring the rhythms of nature Ø Observing the mind from a ringside seat

Adventitious Suffering

Some suffering is inevitable

The Second Arrow



The Nature of Mind


ØGrasping ØRejecting ØDisconnecting


--Disconnection from self and others --Agitation --Fear --Anxiety --Self Destructive Behaviors --Depression


ØFear ØAnger ØFlat/Dull

Relief From Suffering

--We can transform suffering and develop the capacity for joy. --The key is mindful, nonjudging acceptance --Mindfulness practices develop the skills and habitual ways of being present in this full and liberating way.

The Medicine of Mindfulness

-- Foundations of Mindfulness -- Mindfulness of body/breath -- Mindfulness of mind -- Mindfulness of emotion -- Mindfulness Practices: formal and informal -- Seated and walking meditation (formal) -- Mindfulness in daily living (informal)

Calming the Mind

-- Mindfulness of body and breath -- Pausing: Mindful Breathing -- Mindfulness meditation -- Recognizing "monkey mind", "wild mind", "puppy mind" -- Developing "observing self

"Thoughts tend, then, to awaken their most recent as well as their most habitual associates." William James



Favorite Flavors


ØGrasping ØAversion ØDenial

Turn Toward the Feeling


ØFear ØAnger ØFlat/Dull

"Tears are the river of life washing away the old to make way

for the new."

- Unknown

-- Experiencing emotions as body sensation -- "Riding the wave" -- Dropping the story line -- Staying with the experience


Let everything happen to you: beauty and terror. Just keep going. No feeling Is final.


Emotional Storms

Emotional Steadiness

ØGrounding ØNonAttachment ØOpportunities for


"Love is the great work Though every heart is first an apprentice...." Hafiz



A Larger Container


"I am now the most miserable man living."

-Abraham Lincoln January 1, 1841

Acceptance of Self

"Half of any person is wrong and weak and off the beaten path. Half! The other half is dancing and swimming and laughing in the invisible joy!" Rumi

Caring About Others

"Be kind. Everyone you meet is fighting a great battle." Philo of Alexandria

Cultivating a Good Heart

Heart Opening Practices : Getting Beyond the Small Self


Loving kindness meditation

-- Beginning with Self -- Extending and enlarging the circle

"We can live without religion and meditation, but we cannot survive without human affection." The Dalai Lama



The Illusion of Separation

Shared Suffering, Shared Joy

There is no house like the house of belonging. ~ David Whyte

Cultivating Deep Connections

-- Dissolving the boundaries -- Sympathetic Joy -- Creating our "House of Belonging" -- Connection with our inner wisdom -- Connection with sources of spiritual nourishment

Encountering Soul

"This is the first, wildest, and wisest thing I know, that the soul exists, and that it is built entirely out of attention."

-Mary Oliver

The Benefits of Mindfulness Practice

-- Clear mind -- "Observing Self" buffer -- Freedom from habitual selfharming -- Full presence in the moment -- Recognizing impermanence -- Hope

The Benefits of Mindfulness Practice

-- Self acceptance: the core of resilience -- Acceptance of life as it is ­ suffering and all -- Greater capacity for joy, a one learns to live in the present moment, rather than the past or the future -- A sense of connection with self, others, and the larger order of things



Spiritual Experience and Fruits

-- From fear to courage and empowerment -- From anxiety to peace of mind -- From judging to compassion & empathy -- From isolation to connection with self & others -- From despair to hopefulness -- From shame to freedom from selfconsciousness -- FROM SMALL SELF TO THE UNIVERSAL

What's the one thing you can do?

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

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