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  • Zuzana Kučerová

What constitutes self-care and why can it be difficult to engage in self-care?

What I will be presenting here is quite a well-known knowledge that we can find in thousands of self-help books and websites. However, I will also briefly explain WHY these self-care strategies work and also why it is sometimes difficult to engage in self-care.


Therapy

There is an extensive body of research that indicates that the therapeutic relationship is one of the most important factors in determining successful outcomes of psychotherapy. Why is that? Perhaps because we are social creatures and we suffer most when we feel disconnected, isolated, lonely, irrelevant, and invaluable. Therefore, it is important to choose a therapist with whom we feel comfortable, and who will help us reconnect with ourselves and others. Having said that, what needs to be taken into consideration is the fact that people who seek therapy have often lost trust in people who were most important to them, and it takes a while for the trust in anyone (including the therapist) to develop. So, please, give the therapeutic relationship a bit of time to develop. However, if after a few sessions you do not feel understood and validated, if you do not feel you can be open and honest, and the therapist does not help you understand yourself and make you feel hopeful, perhaps it is time to search for a new therapist.


Exercise

In basic biological terms, exercise releases chemicals like endorphins and serotonin that improve mood and sleep. It increases the size of the hippocampus (the part of the brain responsible for memory) and thus improves cognitive functioning and memory. Studies have shown that if exercise is done in a joyful way (rather than as a ‘must’), it enhances the productions of brain-derived neurotrophic factor, also known as BDNF, which is a protein that acts on certain neurons of the central and the peripheral nervous system. This helps to support the survival of existing neurons, and encourage the growth of new neurons and synapses, as well as neuroplasticity. Besides the biological advantages, exercise gets us out in the world, which helps to reduce any feelings of loneliness and isolation. Furthermore, it helps us reconnect with our body and positively influences our self-esteem.


Nutrition


Not only does mood affect how we eat, but how we eat affects our mood. It is a two-way street.

Tryptophan-rich foods

You may have heard about serotonin - the neurotransmitter that makes us feel good. It is believed to help regulate mood and social behaviour, appetite and digestion, sleep, memory, and sexual desire and function. You may have also heard that low levels of serotonin lead to depression and anxiety. What you might not know is that 95 percent of serotonin is created in our gut. There is the so-called enteric nervous system within the wall of the gastrointestinal tract that contains 200-600 million neurons (Furnes et al., 2014). For that reason, the gut is often called the 'second brain', and the heart (which contains around 40,000 neurons called sensory neurites) the 'third brain'. There is a constant information flow between the gut, the heart, and the brain, mainly via the vagus nerve. Why is this important to know? Because there are certain foods that will increase the production of serotonin and thus make us feel better and sleep better.


The highest concentrations of serotonin are found in walnuts, pineapples, bananas, plantains, kiwis, plums, tomatoes. These foods can boost serotonin levels in the gut, ensuring rapid communication between gut cells. But because serotonin in its complete form cannot pass through the blood-brain barrier, we have to also include foods that are rich in tryptophan, which is an amino acid that travels into the brain and gets converted into serotonin in the brain. Tryptophan-rich foods include turkey, chicken, lamb, fish, eggs, seeds & nuts, lentils & beans, soy beans, oats, yoghurt, cheese.


GABA

GABA (Gamma-Aminobutyric acid) is another neurotransmitter that is directly linked to mental wellbeing, anxiety & depression. GABA is an amino acid produced naturally in the brain that facilitates communication among brain cells. GABA’s big role in the body is to reduce the activity of neurons in the brain and central nervous system, which in turn has a broad range of effects on the body and mind, such as relaxation, pain relief, stress and anxiety reduction, lower blood pressure and improved sleep.


Alcohol is believed to mimic GABA's effect in the brain, binding to GABA receptors and inhibiting neuronal signalling. No surprise that so many of us enjoy drinking alcohol!


Barbiturates, anesthetics, benzodiazepines, antidepressants, and anti-seizure medications are some of the medications that target GABA. GABA supplements and some herbs are also believed to boost GABA production, however, the jury is still out on their effectiveness. The downside to GABA supplements is that they, like pharmaceutical drugs, may have unpleasant side effects. So, I would personally opt for more natural products like green, black, oolong, and white tea, fermented foods including kefir, yoghurt, kimchi, miso, and tempeh. Other foods that may boost the production of GABA in the body include whole grains, soy, and other beans, lentils, nuts and seeds, tomatoes, berries, spinach, buckwheat, broccoli, sweet potatoes, cruciferous vegetables (broccoli, cabbage, cauliflower, Brussels sprouts) and cocoa.


Supplements

The sad reality is that the quality of food these days is worse than in the old days, even organic foods do not have as many nutrients and vitamins as home-grown foods used to have. I think that the need for vitamin supplements varies between individuals. However, research studies indicate that individuals experiencing depression and anxiety might benefit from taking Omega 3, B-complex (especially B6 and B12), and vitamin D supplements. However, it’s important to discuss this with your doctor before you begin using vitamin B and D supplements in large doses or long-term.


Good-quality sleep

The importance of good-quality sleep is increasingly emphasised. I will not go into real depth here, but will just state some reasons why we need to take care of our brain and body at night. Sleep is important for :

  • Physical wellbeing

  • Mental wellbeing - depression, anxiety and sleep problems go hand-in-hand. However, the relationship is bi-directional - in the same way that depression and anxiety lead to sleep disorders, lack of sleep may lead to depression and anxiety.

  • Emotional wellbeing - brain imaging methods reveal that sleep deprivation can lead to irrational emotional responses.

  • The production of serotonin

  • Cognitive functioning - from cognition & attention to decision-making

  • Memory consolidation - One of the brain areas that suffers dramatically from sleep deprivation is the hippocampus – a region critical for the storing of new memories. When people are deprived of sleep for even one night, their ability to memorise new information drops significantly.

  • Toxins, including those associated with Alzheimer’s disease, are cleared during sleep. The brain clears out toxins much more rapidly while we are asleep than when we are awake. β-amyloid protein, which is a precursor to the plaques in Alzheimer’s disease, as well as other toxins seem to accumulate during the day, and are cleared during sleep (National Institutes of Health).


Mindfulness & meditation

Please, see my post termed ‘How useful is mindfulness?


Yoga

When we experience stress, this has a toll on our body and our major organs. For example, when we experience prolonged grief, we might feel pain in and around our heart or tightness in our chest. Prolonged stress can also trigger and worsen gastrointestinal pain, such as cramping or inflammation/feeling bloated. Another physiological change that the stress response brings is that it causes the muscles in the body to contract (tighten). Tight muscles make the body more resilient to attack when in dangerous situations. Thus, whenever you are stressed or anxious, you can experience muscle tension. Yoga postures are very useful in releasing any tightness in the muscles and organs, and it also releases neuropeptides in the cells of our body that were produced by certain emotions (for more info on neuropeptides, see my post ‘Thoughts versus emotions & feelings’). Furthermore, yoga helps us become aware of our body, it reconnects the mind and the body, and helps us feel centered and grounded.



Social support

Given that we are social creatures hard-wired for connection, it goes without saying that social support is a huge buffer against mental struggles. This, however, does not mean that we need hundreds of friends. In fact, the latest research shows that it is not about the number of friends that we have, but about the depth of the friendship. One or two friends with whom we feel connected on a deeper level is more than a hundred friends/acquaintances. During my masters’ studies, I came across a large-scale study that aimed to reveal why urbanicity (i.e., living in a city) was a risk factor for mental health disorders. The researchers concluded that the reason was a lack of social support because living in a city goes hand in hand with living a more individualistic rather than communal way, which inevitably leads to disconnection and loneliness. It is not surprising then, that lack of social support is a greater predictor of mental health difficulties than poverty.


So, reaching out to others for support (even if you think that you can manage by yourself, that you don’t want to bother anybody, that you don’t deserve to have friends, or that you don’t deserve help), is immensely important.


Being in nature

Johann Hari in his book called ‘Lost connections. Why You’re Depressed and How to Find Hope’ talks about a well-conducted study into the importance of being in nature. Despite the fact that our lifestyle has changed in the last hundred years and we had to adapt to a more urban lifestyle, we are still hard-wired for living in, and with, nature. And when we are disconnected from nature for a longer period of time, we suffer. So, go out into green areas, even if they are just parks in your city, and reconnect with what is fundamentally so close to you.


Gratitude

Numerous research studies into the benefits of gratitude for mental health have shown that expressing gratitude lessens depression and anxiety, contributes to feelings of wellbeing, and reverses negative thinking. Although I have not come across an explanation that underlies these findings, my theory is that expressing gratitude is not a matter of the mind, but of the heart. Giving thanks is not just uttering words, but feeling appreciation. It is an emotion, rather than a thought. And when we feel something with our heart, we also produce oxytocin (known as the love or connection hormone), which has the opposite effect on our nervous system than the stress hormone cortisol.


The opposite of gratitude is feeling a lack of something, seeing what we don’t have rather than what we have, which produces stress hormones, rather than oxytocin, that inevitably lead to feeling emotional pain. This is because

complaining and longing equals suffering.

So, before you fall asleep, go through the day and think of five things you are grateful for (from just being alive, having a bed to sleep on, to achieving something, or having a lovely conversation with someone. Or it could be something that you had found challenging - something that contributed to your personal growth.)


Embracing the unknown and the uncertain

The truth is that we all like certainty and sometimes we wish that we had a crystal ball that would prepare us for tomorrow(s). The reality, however, is that there is no way of knowing what the future holds. Fearing the unknown makes sense from the evolutionary point of view because when we were cave dwellers, sticking to the familiar (e.g., familiar foods) would often save our lives. Thus, it is understandable that we fear what we do not understand. Another reason for staying in the familiar is insecurity and self-limiting beliefs. These may prevent us from exploring something new as it poses a risk of failure (which for individuals who are not that secure in themselves is a number one fear). From the psychodynamic point of view, we stay in the same, familiar and often non-optimal or painful situations (e.g., in a relationship that is abusive) because of our tendency to follow our familiar script. Furthermore, there is a defence mechanism termed 'compulsion to repeat', which is a tendency to repeat the old because we hope that the next time it will have a different outcome. One of the aims of therapy is to help clients embrace and feel comfortable with the unknown and uncertain, and to step out of the familiar into a world of new opportunities.


Acknowledging our mortality

We have a false sense of being immortal, perhaps as a defence mechanism, because the thought of dying is frightening. However, unless we realise that our life is final (and it can end at any moment), we will continually fool ourselves that we have many years ahead. We will keep saying to ourselves: 'I will make changes in life and be happy when the right person comes, when I get promoted, when I have children/house/more money, etc.'


What often happens, however, is that we make changes when we experience something traumatic (e.g., a disaster, an accident, death of a close one). And we learn the hard way. But do we have to wait and learn the hard way?


If we fail to comprehend and appreciate our mortality, we fail to make the most of our life. And we turn our backs on the most important duty that we possess – to live a life that is rich in experience. We have never been as close to death as we are every single moment.


HOWEVER, why is it that despite knowing what is good for us, we find it difficult to engage in self-care?


I might not have the full answer, but I will make a suggestion. Based on my observations in my therapy practice, individuals who struggle with their self-worth are disconnected from their 'self' and often also their body. This makes sense because if you feel like you are worthless and unlovable, and if you don't like your mind & body, self-care feels pointless. Some of my clients even told me: ‘I don’t want to heal, I feel I still need to suffer.’ And even that makes sense. Firstly, they have suffered for many years, so this is the norm that they know. And secondly, they feel that unless they do something really good, they do not deserve to feel better. Some might call it self-sabotage, I would call it 'unreadiness'. I think that it is only when we feel that we have been heard, seen, understood and validated enough, when we gain self-awareness, that we are ready to heal, to feel deserving, to get our self-worth back, and to become optimistic about future possibilities.


This brings us back to the number one self-care strategy in this post – therapy, which often sparks the desire in people to take care of themselves. So, find the right therapist and start the journey of healing and living.



Reference:


Furness JB1, Callaghan BP, Rivera LR, Cho HJ. (2014). The enteric nervous system and gastrointestinal innervation: integrated local and central control. Adv Exp Med Biol., 817, pp.39-71