The Big Four

If you’ve ever stayed up late watching television, you know that most regularly aired programs fall by the wayside after 2:00 AM, replaced with channel after channel of infomercials advertising miscellaneous products. Therapeutic pillows, weight loss shakes, pills to improve libido, fitness machines, aerobic videos, and dietary supplements are but a few examples. As diverse as these products are, they all insinuate one thing—the possibility of a healthier, more enjoyable, more self-empowered life.

With so many options available for better living, you’d think humanity would struggle less. For most, however, satisfaction remains elusive because the problems people face are just as numerous, unique, and unusual as the plethora of products on the market. Therapeutic pillows claim to align your spine and allow for a better night’s sleep. Diet pills promote improved self-esteem and enhanced performance for shedding pounds. Fitness machine ads lead to fantasies about having a chiseled body like the models on the screen, and dietary supplements make claims of just about every kind. 

With so many options out there, who could blame you for feeling overwhelmed and insecure when it comes to purchasing what you need. If you take a closer look, however, you’ll notice that most of these products make promises that fall into one or more of the categories referred to in this chapter as The Big Four: sleep, exercise, nutrition, and recreation.

What’s so Special About the Big Four?

In comparison to other forms of homework, the Big Four are unique, distinguished as “outer-work”—physical actions and activities that improve how you function, both bodily and mentally. Whereas, the other assignments are better described as “inner-work”—practices intended to improve how you think and stimulate mental stability. When deciding which homework assignments to tackle first, it’s possible you’ll feel more drawn to The Big Four simply because they’re more commonplace. Certain inner-work methods like affirmation, mindfulness, or journaling may seem a bit foreign, or just not something you feel comfortable doing. If so, that’s fine. Begin with the Big Four, keep and open mind, and let the rest of your therapy unfold.

#1 Sleep

A recent survey found that 75% of people sleep less than six hours per night, and also experience sleep difficulties multiple nights per week. This likely comes as no surprise to you. Chances are you’re one of the countless folks who toss and turn until your alarm clock blares its unwelcome racket. Normal nightly restlessness can grow out of control, especially when influenced by the very sources of pain that brought you to counseling in the first place, like memories of a traumatic event and/or overwhelming stress. Troubles at home or work, worries about loss of possessions or relationships, a tanking economy—you name it. These are just a handful of any number of distractions that can keep your mind from releasing your body into rest. As unnerving as this is, there are even bigger concerns regarding the numerous health risks associated with prolonged sleep loss:

  • Cardiovascular health: long-term lack of sleep can lead to hypertension, increased stress hormone levels, high blood pressure, and irregular heartbeat.
  • Disease: Sleep deprivation alters immune function, increasing your chance of illness.
  • Brain Health: Sleep helps the brain process and commit important information to memory.
  • Metabolism and weight: Not sleeping can affect the way your body processes and stores carbohydrates. Also, appetite can be affected by shifting hormone levels—all of which can result in unwanted weight gain.
  • Mood: Lack of sleep can lead to irritability, impatience, moodiness, and inability to concentrate. This can also greatly affect what you do with your free time, making you too tired to enjoy the things you love to do for recreation.
  • Certainly, you’re familiar with health risks associated with losing sleep, but have you ever considered the flipside. In most cases, a side effect of restlessness can also be the reason you’re loosing sleep in the first place. The most obvious example is your mood. Sure, if you toss and turn all night, your state of mind will likely sour the next day, but chances are you’re fighting sleep because you’re upset by memories of something that happened previously. As the night drags on—staring at the ceiling—your mood grows worse, frustrated by the fact you’re still awake.

Perhaps you resist sleep due to fears about your health, but have you ever considered that your troubled mind and its resulting restlessness could cause your physical body to deteriorate much faster than it would if it were rested? Worries about your health become a greater threat, as frustration raises your blood pressure, causes your heart to flutter, and decreases immune and cardiovascular functions.

A vicious cycle begins. You grow to dread bedtime. You find yourself in a nightly struggle to fall asleep and stay asleep. You force yourself out of bed in the morning feeling even worse than when you attempted slumber. The cycle repeats.

Any advice on how to fall asleep? A recent national survey of 1,000 working adults found that nearly 25% of these individuals admitted to often doing tasks related to their jobs in the final sixty minutes before heading to sleep. If you’re having difficulty falling asleep, you should know that working right up until the moment you slip into bed, or even while you’re in bed, is one of the worst things you can do. The same can be said if you’re a student or parent.

You can improve your ability to fall asleep by developing a nighttime ritual. In much the same way as you would get a young child ready for bed, develop steps for your body to memorize as clues that you’re unwinding for the day. Example: about an hour before bed, take a warm bath, then put on some cozy pajamas and curl up on your sofa or in your bed with a good book and a cup of chamomile tea. Over time your body will become trained to respond to these actions, just as a newborn learns that after a bath, a bottle, and a few minutes of being rocked, it’s bedtime. If you wish to designate time to sleep, it’s important you also designate time to unwind, calming your mind, and warming your body.

Once you’ve prepared yourself for bed, your final step is to ready your bedroom by removing all distractions. Perhaps you watch TV, or browse on your laptop or cell phone to induce drowsiness. Instead, try turning off these electronic devices. Such mental stimuli may actually be contributing to your sleeplessness. Give an intentional effort to shake off your cares and distractions before going to bed.  Make your bedroom your sanctuary of slumber.

What about staying asleep? On nights when you fight tooth and nail to fall asleep, there’s nothing more frustrating than finally drifting into slumber only to abruptly snap back to wakefulness in a panic. Your thoughts pick right back up where they left off and tension returns to your body. Unless you experienced physical injury that currently causes you pain, you may find that the majority of problems that hinder sleep are all in your head. It is the complicated things in life that keep you awake—things like looming unemployment, rocky relationships, debt, death of a loved one, or an unpleasant desire for things to be different than they are. Your body wants to sleep but your brain won’t shut off long enough to let it rest.  One way to combat complicated thoughts is to fixate your mind on mundane things.

This is why people count sheep. There’s nothing special about sheep, but there is something about the exercise that works well to induce boredom. Imagining a never-ending series of identical sheep jumping over a fence, counting them each as they pass occupies the mind with simplicity, repetition, and rhythm—all things that help lull you to sleep. Perhaps you can develop your own mundane ritual. Some people count backward from 1,000, or imagine they’re mowing the lawn, passing back and forth, back and forth, slipping into slumber with each imaginary blade of grass passing under foot. Focusing on the mundane allows your body to relax and helps you fall into sleep instead of staying keyed up with things you can’t change or let go.  

There’s no right or wrong way to fantasize about boring things. Experiment until you find something that works for you, and as you practice the mundane, stay at ease.

Some sleep problems can be attributed to medical conditions like thyroid problems. If the problem does not go away after trying other sleep methods, you may want to contact your physician.

#2 Exercise

Extensive studies have revealed a great deal about the benefits of regular, moderate exercise. You may be surprised how strongly mental and physical discipline run hand-in-hand. The goal of therapy is for you to become a healthier person, and being that you’re seeing a mental health professional, a strong emphasis will naturally be placed on improving your mental health, but in order to be successful and secure lasting results, your physical body must come along for the ride.

How can exercise help my depression? It’s hard to believe, but recent reports say antidepressant prescribing has soared as high as 400% since 1988. One out of every ten people over the age of twelve now takes some kind medication for depression. Unfortunately, in many cases such medications are the only mental healthcare people ever receive. Over the past couple generations, pills have been handed out more and more like candy, as other valuable methods like the Big Four have been pushed to the back burner, while easier alternatives are developed in the form of tablets and capsules. If you suffer from severe depression, medication is likely your best way to progress toward mental stability, but if you suffer from mild or moderate depression, it may be worth exploring another, more natural and time-tested method rather than—or in addition to—antidepressants.

You may be surprised to know that clinical trials have shown the effects of exercise to be a rival to antidepressants in the treatment of depression, showing the same rate of improvement, and in some cases even surpassing them. These results are being embraced by a growing number of mental health professionals and physicians who now encourage exercise in treating people with anxiety, depression, and eating disorders. Some examples are:

  • Studies have shown that ten months of consistent, moderate exercise have out performed some leading antidepressants in reducing symptoms of major depressive disorder (MDD).
  • Studies have shown that thirty-minute workouts done three times a week cut symptoms of depression by 50% in young adults.
  • Daily, thirty-minute, walks have been seen to reduce symptoms even faster than some leading antidepressants, especially in older adults.

The benefits are clear, the side effects are less, and both exercise and antidepressants stimulate the body to alleviate depression in much the same way. Here’s how:

  • Both antidepressants and exercise increase chemicals in your brain called neurotransmitters, specifically norepinephrine, serotonin, and dopamine. In fact, research indicates that the very root of depression comes from insufficient amounts of norepinephrine and serotonin, or an imbalance between these two types of neurotransmitters.
  • Both antidepressants and exercise improve neurochemistry by promoting neurogenesis (the birth of new brain cells).

It’s imperative you talk with your counselor and physician about any new physical activities and/or exercise programs to find a safe routine that works not only to enhance your physical health, but to also stimulate an improved outlook on life. Also, don’t assume exercise is the only treatment you require. Be candid with your doctor about whether or not you’re a good candidate for antidepressants if you’re not already on them. If you’re currently taking medication for depression, do not make any changes without the direction of your physician and mental health professional.

How can exercise help my anxiety? All dog owners have experienced a similar scenario: you come home after a long, hard day at work. Your feet are throbbing and your mind is set on one goal—kicking back and relaxing. You slide your key into your front door lock, but something doesn’t seem quite right. Usually your dog comes running to the sound of your jingling keys, but not this time. The house is quiet. You shudder as you anticipate what’s on the other side of the door. You crack open the door and peek in. Your assumptions were correct: chewed up shoes and couch cushions are spread all about your living room floor, tiny shreds of toilet paper and soggy bits that used to be the cardboard tube are scattered all over, and your dog is nowhere to be seen. Why is he hiding? It’s because he knows he’s in deep trouble. As you gaze across the room in disapproval, you can almost imagine what must have been going through your dog’s mind as he was doing this. He knew his destruction was unacceptable—proven by the fact he’s hiding—but even still, he just couldn’t help himself. Why? His acting out was the result of anxiety.

Anxiety leads to an excess of nervous energy that must be released. In fact, it will be released one way or another, but when this energy builds up faster than the body can release it, your state of mind becomes toxic. Imagine your body expelling nervous energy like it flushes out waste of any kind. Dead cells are discharged after blood is filtered through the kidneys. In much the same way, your body ousts anxious energy by fidgeting, and increasing your heart rate and blood pressure. When you become extremely upset, you may release the surplus by crying, trembling, increasing respiratory rate, hyperventilating, undergoing panic attacks, or acting on mood swings. The problem is your innate physical responses are often not enough, and only lead to a build up of tension and anxiety.

If your dog is acting out by chewing on furniture or being aggressive, the first thing an obedience trainer will tell you is to take Fido for a walk, or put him on a treadmill everyday because the trainer knows your dog needs to expel energy, and will anyway it can—better at a dog park than in your living room while you’re away. “Man’s best friends” aren’t much different than their masters in this regard. If a dog is cooped up, eventually it will act out. In the same way, keeping yourself cooped up physically and emotionally will lead to negative behaviors, painful bodily tension, and poor decision-making.

In times of mental unrest and/or physical tension, you may need to aid your body in its attempt to purge nervous waste. Walking, aerobics, stretching, weight training, basketball, dancing—it doesn’t matter. Find a physical activity you enjoy, and turn to it anytime you notice nervous excess. You don’t need a gym to exercise. When anxiety and tension surface, find a private place to do jumping jacks, pushups, or run in place—anything to increase your heart and respiratory rates and burn calories to exhaust and bring the body and mind to a rested state. The point is to move. Be active. It’s definitely worth a shot because it might just improve how you feel and think.

Make sure you talk to your counselor and physician to confirm if you’re fit to participate in any new physical activities.

#3 Nutrition

In the 1970’s and 1980’s, studies were actively done, documenting nutritional therapies for the treatment of mental disorders, although many of these studies were discontinued due to lack of funding. In the decades since, nutritional therapies have been pushed aside as pharmaceutical companies directed more of their attention and money to investigating synthetic drugs they could patent and sell. Consumer interest, however, has shifted over the past few years, seeking more natural and holistic therapies. Due to the demand, nutritional therapy is once again growing in acceptance with mental health professionals, supported by a resurgence of clinical studies published daily on the positive effects of improved diet and dietary supplements.

A proper diagnosis and treatment plan should be the first tactic when regarding mental disorders, although you, the client, need to be proactive about the type of therapy you wish to receive. Perhaps synthetic medication is your preference. If not, nutritional therapy may be a better fit for your lifestyle—as long as your counselor and physician concur.

Studies have shown that deficiencies of essential vitamins, minerals, amino acids, and omega-3 fatty acids can contribute to mental disorders. In many cases, simply adding daily supplements and eating better may effectively reduce symptoms, and based on emerging scientific evidence, this type of holistic therapy may be appropriate for controlling a number of disorders, including major depression, anxiety disorders, bipolar disorder, schizophrenia, eating disorders, addiction, and attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD).

A handful of fun facts:

  • Researchers have observed an increase in mental health disorders in connection to a deterioration of the Western Diet.
  • Studies show that populations with high fish consumption (a diet high in omega-3 fatty acid intake) have a low frequency of mental disorders.
  • The most common nutritional deficiencies that contribute to mental disorders are omega-3 fatty acids, B vitamins, minerals, and amino acids that are foundations of the neurotransmitters norepinephrine, serotonin, and dopamine.
  • Omega-3 fatty acids, B vitamins, and magnesium deficiencies have been linked to depression.

Some things are just common sense. Since your early years in elementary school, you’ve been taught how to eat a balanced, healthy diet. You know that processed foods are bad for you; you shouldn’t turn to food for comfort from stress; you shouldn’t overeat; too much caffeine is bad for you; you should eat a healthy breakfast everyday; chicken and fish are better for you than red meat; you shouldn’t eat fast food every meal; etc.

The point of this section on nutrition is simply to educate and hopefully encourage you to consider how you eat, not to develop dietary/nutritional plans. Let your mental health professional, physician, or nutritionist set up a nutritional plan that’s tailor made for what you’re going through, and do not begin any new diets or take any supplements without consulting with them first. But on the flipside, eating better is never a bad idea. Making good decisions about what you put in your body could enhance your life for years to come, both mentally and physically.

#4 Recreation

Recreation—defined as a pastime, diversion, or exercise affording relaxation and enjoyment—is an essential element of the human experience, and can be just about any activity. Everyone has something they love to do, something where problems seem to disappear. The downside for most people is a lack of hours in the day to do enjoyable things, and this is a travesty considering just how important recreation is to mental and physical well-being, even if only a little “me time” is devoted two or three times a week.

Before you move on to the next paragraph, pause for a second. What’s your favorite hobby or past time? What do you do to cast your cares aside temporarily? What makes you laugh or smile? What makes time seem to stand still?  Whatever it is, keep it in mind as you progress through the rest of this section. Maybe you were reminded of something fun you did when you were younger, and are considering picking it back up. If you just now realized you actually have no recreational activity of choice, it’s time to consider exploring your options. Perhaps the next few paragraphs will bring something to mind.

Is laughter really the best medicine? You’ve certainly heard the adage, “Laughter is the best medicine.” This saying has been around for ages, long before the medical community began taking interest in the actual healing power of a good time. People have always understood that laughter is a cure-all—lightening burdens, inspiring hope, and bringing together people of all types with its universal language—but now medical science can show us why.

Laughter significantly decreases stress levels and stimulates dopamine—a neurotransmitter known as the “feel good chemical”—that reduces depression, as well as improves memory and motor control. 

  • Laughter strengthens your immune system, boosts energy, diminishes pain, and protects you from the harmful effects associated with long-term stress. 
  • Boisterous laughter relieves tension in your body, relaxing muscles for up to forty-five minutes after.
  • Laughter activates the release of endorphins that promote a general sense of well-being.
  • Laughter increases blood flow and the proficiency of blood vessels.

With so much power to heal, a sense of humor and the ability to laugh is a tremendous advantage during troubling times. This is too easily forgotten when life comes down strong enough to drive you to counseling. As difficult as it is to believe at times, you have to know that laughter is your birthright—perhaps the most innate gift of life. Newborn babies begin smiling and laughing only a few short weeks outside the womb. It’s something you are born to do and intended to continue throughout your days. Even in the most difficult times, simple moments when you let go of pain and laugh a little can go a long way, allowing you to see your condition more clearly in a less threatening light.

What do I do if laughter is hard to come by these days? Seek it out. Watch a funny movie or television show, preferably with at least one friend or loved one, as laughter is contagious and easier to get lost in with other people around. Examples of group activities would be visiting a comedy club, hosting game night, going to a karaoke club, participating in team sports, and playing with children. You may need to set aside time and energy to seek out a good time, even if it seems like a chore at first. It’s like anything else that takes work to see results. You have to commit to exercising on a regular basis before you notice changes in your body, just as you must do with studying to increase knowledge. It may be hard initially, but diligently pursuing opportunities to laugh is key to improving your outlook on life.  Eventually with practice, enjoyment will become second nature, incorporated into the very fabric of your life.

What about hobbies? “What would you do if you had a million dollars?” This is a common question asked by school counselors everyday, but it’s actually a great way to find out your hobby of choice. By definition, a hobby is something you do for enjoyment that isn’t what you do for a living. It’s an enjoyable activity you would do all the time if money were taken out of the equation to stimulate your mind, body, or both.

You’ve already learned, and will continually be reminded in this book, that a healthy mind is dependent on a health body, and vice versa. It’s a balancing act. If your hobby is playing basketball, going out dancing at a nightclub, or doing any other physical exertion on a regular basis, feel free to reference the “Exercise” section above as a reminder on how the brain is affected by frequent physical activity. 

Other hobbies add a different take on the word “exercise”. Just as physical activities keep your body strong and limber, mental activities—ones that require problem-solving and memory recall—keep your mind sharp and agile. Without something to encourage mental stimulation, your brain can atrophy, as would muscles that get little use. This can lead to a fall in cognitive function regardless of age. Such mental exercises include:

  • Working puzzles
  • Traveling
  • Reading books and writing
  • Playing cards, checkers, chess, crosswords, bingo, board games like scrabble, and other games that require thought
  • Stamp or coin collecting
  • Restoring old cars and antiques
  • Woodworking and metalworking
  • Doing crafts like painting, drawing, or ceramics

If you love something, chances are someone else loves it too. Why not seek out like-minded people who share your passion? Adding social interaction to a hobby is a double whammy for both the mind and body, not to mention it will increase your odds of enjoying the positive effects of laughing with others. In fact, studies have even linked strong, regular social ties to lower blood pressure and longer life expectancy, as well as boosting cognitive functioning, memory, and intellectual performance. This just goes to show: people are good medicine too.

Just because sleep, exercise, nutrition, and recreation are lumped together as “The Big Four” doesn’t mean they need to be treated as one overarching homework assignment. Instead, treat each one individually—the Big Four broken up into “four smaller 1’s”—and don’t be afraid to take baby steps. Pick one you feel you can currently take on, and actively work on it. As you gain ground in one area, others are bound to fall in line. There are lots of things you can do to improve mental health and reduce stress, but the biggest bang for the buck is going to come from the Big Four.