Kerry Reller 0:28

Welcome to the Get Healthy Tampa Bay podcast. I'm Dr. Kerry Reller. Today we're continuing my conversation with psychiatrist Dr. Angelo Camacho-Durán about the connection between our mental and physical health. In part one, we talked about chronic stress, the body's stress response, and something called allostatic load, essentially the wear and tear that can happen when our stress response stays activated without enough time to recover. But knowing that chronic stress affects our health leads to an important question: What can we actually do about

Introduction to Part 2 and Managing Chronic Stress

Kerry Reller 0:56

it? So in part two, we're getting practical. We're talking about realistic ways to manage stress, mindfulness and meditation, how to find strategies that actually work for you, when it may be time to seek professional help, and the stigma that still surrounds mental health care. So let's jump back in to my conversation with Dr. Camacho. so if we can't really eliminate stress from our lives what should the goal really be?

Angela (Florida) 1:22

So yes, definitely

Why Managing Stress Matters More Than Eliminating It

Angela (Florida) 1:23

is-- it is almost impossible to eliminate stress from our lives. I think, again it is a human experience. It's part of life. We need it or we can live with it. But how to manage it in a healthy way is really the, the name of the game. So how to have a good relationship with the stress in a way that is more helpful than really managing or being the boss of our day-to-day experience. One example that I wanna give is also for someone who has been through a traumatic event. Yes? So for example, somebody who has had childhood traumatic experiences of different kinds, or somebody who has been maybe through civilian trauma or military trauma or like a vehicle accident, the, the-- a major, motor vehicle accident. They're all major traumatic experiences. So for some of these, these were repeated for an amount of time, or they were one big event. There may be some physical sequela of it, like injuries and things like that, that somebody lives with. But the, the mental health symptoms are hidden. You don't show, you, you-- it's not a scar, but it does show in the way you relate to others the way you relate to other adults, to your partners, the way you behave if you go to an event or to the grocery store the way you enjoy life, the way you look for pleasure in life. A, a lot of these times there is kind of use of substances to cope with risk for addiction, alcohol and other psychoactive drugs. Where I'm going with this is that in those situations, definitely, we need to treat from the psychiatric perspective. But I wanna just send a message of hope that, Medications, yes, we may need medications to help the system regulate and come back to that reset point. When you are on fight or flight all the time because of those previous experiences, you may need to get under medi- on medications to help you at first. But a lot of the times it's teaching new pathways in the brain or, like what we do in therapy and with lifestyle modifications is teaching new neural, neural pathways to use when you are triggered in situations of stress. So for those major traumatic events or for the stress that we face, for example, as parents or with work we do use different science-based or evidence-based strategies. And I wanted to start with this because a lot of the times people are not very open to try these behavioral modifications, and a lot of times we think that we need more of a quick fix because the experience is so uncomfortable. But I like to say, something that you've been experiencing for months or years is not gonna benefit from a quick fix, right? You want to put some effort in learning and allowing time for that brain, for those brain pathways to form, and then to practice walking them, so that the old pathways are less used in the future. So some of the things that we use are now for example, meditation or mindfulness techniques in order to manage stress. And that's one of the ones with more evidence for stress management. And, definitely in therapy we use other techniques, but in terms of lifestyle modifications, meditation and mindfulness, relaxation are the ones with a lot of evidence for stress management that is very... can be personalized, is, on the is very affordable. So it's one of the things that I like to use a lot

Kerry Reller 6:16

And if someone is trying to try med- meditation or mindfulness for chronic stress, how would you have them go about doing that, on their own maybe before they would be coming to someone like you?

Getting Started with Mindfulness and Meditation

Angela (Florida) 6:29

Okay. It depends. So I first have a con- a conversation to see, for example, if there is a lot of symptoms of trauma, like flashbacks, things like that, maybe they are not ready for this type of technique or strategy. But in most cases, it just starts with doing very short practices teaching them what meditation or mindfulness is. So it's not the same I just think mindful meditation is one of the biggest ones with the most evidence, but there is different kinds of meditation. So meditation is basically a technique to learn how to stay calm and breathe those two elements, and stay maybe, in a quiet, safe space for a short time, that you can just allow the parasympathetic system to be more present and to let the sympathetic system go to rest, right? So that's the main goal, and then when we do it specifically with mindfulness, that, that is more about your thoughts. So being still and practicing how to be present while everything else is happening around you, and you can focus on your thoughts passing by without... or even sometimes your feelings. If, for example, you have a shoulder pain or certain back pain or any physical discomfort, that you can be present with that while you focus mainly on your breathing and let-- and you can observe and let other things pass without necessarily thinking about it or making stories about it. So I start... it is an education. There is an education process to it. I think the main or the most important thing is to be open, to have an open mind to learn something new and to practice at least three minutes, maybe five minutes every day in a safe space and feel okay with yourself, with your breathing, so that you can actually develop a practice and use it when you need it, when- in times of distress, before a test, before speaking in public, before having a difficult conversation with someone or with your boss with a difficult person, and things like that

Kerry Reller 9:13

So you can practice it like on your own. Like usually people say they may meditate each morning or something like that, right? And then when these certain cases come up, it's a g- another way to re- I guess, reintroduce it or do it so that you're ready to relax and, act upon whatever needs to be done. Is that

Angela (Florida) 9:31

Definitely. Yes, so you can learn it with with a provider like me. You can-- I can also, recommend sometimes certain apps that I like and that I use or, recordings that I have, and then practice on your own. Pr- first practice in the session with me so you can feel safe, Then once that happens, you can practice on your own. I think the goal is to know that it doesn't have to be long. You start slow and short, so it's not something imposed, but something that is actually more like a little respite or a snack a restful snack throughout your day

Kerry Reller 10:23

That's funny. I always talk about exercise snacks, and now we're gonna have restful snacks. That's great. What are the specific apps that you suggest?

Helpful Apps and Other Stress Management Techniques

Angela (Florida) 10:33

The one that I use the most and I like is Insight Timer.

Kerry Reller 10:39

उहम्।

Angela (Florida) 10:39

I'm pretty sure there is a free version that I started using because it has plenty of practices. So if you want breathing or relaxation techniques, they have it. If you want more in-depth mindfulness meditation, they have it. Some of the things that I really like are compassion, self-compassion meditation they have that as well. When I work with patients who have like a very perfectionistic style or a lot of inner critic- criticism, I like the self-compassion meditations a lot. Other things and since you mentioned exercise in terms of the list of strategies that, that we use other than mindful mindfulness and meditation, there is also other things like that have shown some, some evidence, like qigong and tai chi practices, yoga for sure relax- breathing techniques, and then exercise. Exercise is one of the most helpful things we can do for emotional regulation. It's funny I thought, after you have use so much energy and you have used your sympathetic system. Exercising I think, that kind of makes us more put us at ease to have certain conversations or, definitely to sleep better for a lot of people, just to have a more relaxed approach and that carries over when you practice exercise with regularity. And then other things w- with less evidence but also very useful and also very affordable and can be personalized are things like gratitude practices journaling. Those two also I use a lot in my practice with my patients. I think they enjoy it a lot. Music, exposure to nature is huge, to use your both green and blue spaces, so forest and mountains and then lakes and the ocean. All of that helps a lot. And some of us use in our therapy sessions a lot of positive psychology approach as well which comes from Dr. Viktor Frankl studies on this very well-known quote, "If there is a why, there is a how." Finding ways to, to trouble, to problem solve and do what fits you best in your current situation

Kerry Reller 13:34

He was the one that was in the concentration camp,

Angela (Florida) 13:38

Correct. Who wrote the book, The Man in Search of Meaning, I think it is.

Kerry Reller 13:45

I forget. But yeah, you- it's mentioned in lots of books that I listen to and read, but his book, but I haven't read his own book 'cause it's not on Kindle.

Angela (Florida) 13:54

It's not okay. It's great. It's great

Kerry Reller 13:56

It's a little old. But yeah, that, those are great recommendations. And, I do recommend these things to my patients too, right? Obviously exercise, right? Journaling, a gratitude journal or, going out in nature, all those things that you're saying too. I'm not so good at meditation, but I do recommend it to people. But I think these are all excellent things that can people, implement. But now what if they're having stress from saying, "Oh man, now I gotta meditate, I gotta exercise, I gotta do yoga, I gotta journal." So how do we make treating stress and managing stress more realistic and sustainable?

Making Stress Management Realistic and Sustainable

Angela (Florida) 14:33

Oh, I lo- I love that question. So yes, I think, a lot of these ideas makes us think that we need a lot of time to devote to every little, to eating healthy, to carve out time to, to incorporate exercise in our lives, and then how often. And then on top of that, we have to sleep enough, and then on top of that, carve out some time to meditate. So yes I love that question because I would say that the first thing is to ask yourself what seems the easiest, the, the low-hanging fruit right now, what seems the easiest For you. F- One, one question would be what do you think would be the one that gives you the most benefit, right? Like for example, journaling may feel very useful for me, but not necessarily for someone else at this time of their lives, right? And it depends. So it depends what you're trying... what your goal is. If you have a metabolic condition, for example, you may want to decide is it diet, exercise, or sleep, which is the one that is gonna give me the most benefit right now that I want to focus on. So I recently attended a conference, and one of the doctors in the audience was asking how to make her patient exercise, because she had spent so much time and energy teaching the patient the importance of exercise, and she still wasn't following her advice. And I thought, so m- my point was, maybe she's not ready for it. We all know it w- is very good and it's gonna help her. Maybe... I think she also knows that, right? The patient. But maybe she's not ready for that and, maybe we wanna start in a different place. Ask her what seems, for you, what seems to be the easiest thing to be, to do right now. Maybe it's something in her diet. There's more changes that she can do. For stress management, I think the body is the body itself is so grateful and responsive that anything that we do for it is gonna create a positive change. So for stress, like even for people who are not, who feel they're not good at meditation, I say, "Okay. Do you know that there is also walking meditation?" You don't have to sit really. If you are somebody who's more like active, you can, and you like nature, maybe going out to walk in the in your n- neighborhood if it's, if it is safe, or just going for a walk outside in the hospital grounds, or whatever it is. Or maybe just opening the window if you happen to have a decent, view, and just enjoy that for a moment and breathe three times deeply. And that alone can be good to reset before you, you have a conversation with your doctor or with your partner. So that Alone can help, and I think when you start feeling the benefits of it, you are more prone to practice it regularly. What else? For stress management, exercise

Finding Joy Through Movement and Meaningful Activities

Angela (Florida) 18:11

is a big help. So if you're somebody who don't like to medi- doesn't like to meditate, but you like exercising, just find a physical activity that brings you joy, that doesn't feel imposed. Like for me, I always say I never liked the gym, and I have been to the gyms in different times of my life, but a lot of times it felt like a, an imposition, and I didn't enjoy it as much until I finally found... I finally sat with myself and said, "What do you really like? What are the things that you really enjoy to move your body?" And I found two, and I narrowed it down to two things, and I said, "These are the main ways I can move my body and enjoy it." And once I started doing-- And I pick one. When I-- Once I started doing that I really, it really took off. And then I also found a group. Like for me, practicing something with others is easier Than doing it by myself. So is it, can be more like a trial and error thing for a lot of us. So I encourage, the, the people listening ju- just to trial and error, sit down with yourself, find what maybe what you used to enjoy as a child, if it was dancing or swimming or running or jumping and try to go with that. And that is a good start.

Kerry Reller 19:45

They have-- had a lot of, maybe not a lot of patients, a few patients who, do these very interesting exercises, and I think it's 'cause it's bringing them back to the childhood thing. It was like the trampoline jump exercises or one patient does like cardio drumming and things like that. So there's all these different things that may bring them joy, and I'm like, "What? Is that really like a thing?" But, they, it, they're moving their body and they are enjoying it, so sometimes it just takes a little bit more thought and reflection to feel realize what it is that either you or that patient wants to be doing i- instead of the traditional things, which is totally fine, right?

Angela (Florida) 20:23

Yeah.

Kerry Reller 20:24

Yeah.

Angela (Florida) 20:24

have a nice anecdote if we have time, Dr. Reller for this. It just-- I've been thinking a lot about it. I had a patient who... she used to be, she used to play an instrument as a child. She has a significant trauma history, and at some point in her youth, she became very good and devoted to an instrument. I think it was the violin. And anyway, that phased out. Now, as an adult I was trying to talk to her about finding ways to enjoy herself 'cause she has some depression and anxiety. And I suggested the instrument to go back and she told me that was actually a very painful experience in her youth. The, the instrument was more of an escape thing for her pain. And I thought, "Okay, so it made me think of many artists for example, Frida Kahlo or Van Gogh, that in their art, they really show a lot of pain, right? A lot of traumatic experiences, body accidents and things. But that ins- And I talked to her about it, but that inspire, is inspire her to go to an art exhibit w- around where she lives that she really enjoyed because it was an artist kind of depicting her heritage in a very restful way. This artist paints a lot of women just resting and relaxing, and for her, that was a major cultural shift that her heritage could be depicted in this way resting, enjoying themselves. So I think, that yes, sometimes, we may have things in our childhood that, that are painful, but channeling that to something that as adults now we can think in a-- or see from a different light can be healing, can be a healing experience. And so again, I think if you can find that with your doctor or your psychiatrist or your psychologist, it can be a very healing experience. It can help to manage your stress day to day and move you closer to all these well-being goals.

Kerry Reller 22:50

So what-- is there anything that you would say that you would want patients or listeners to understand about the relationship between physical and mental health we haven't targeted yet or to just reinforce?

Angela (Florida) 23:07

One major

Breaking the Stigma Around Mental Health

Angela (Florida) 23:08

thing was stigma is a big thing still in our culture, stigma for mental health conditions. A lot of people feel ashamed maybe of talking about their emotional symptoms of distress. Eh, while I think, a lot of this is very personal you are still entitled to, to say, "I don't feel well." Just a lot of people go to the doctor for diabetes, for chest pain, for high blood pressure I think all of us are entitled to go to someone because emotionally we don't feel well. We have difficulties or we're struggling, and I encourage everybody to, to give themselves that opportunity if they feel like they are not, they're going through a difficult life transition, or they are struggling with certain emotional symptoms, and maybe they are experiencing physical symptoms, and they're not quite aware that this could be related. Discuss it with your doctor, with your primary care, your family medicine doctor. Bring it up and be open to, to talk about that. It can be very helpful in, in, in healing

Kerry Reller 24:35

Yeah, I'm glad you brought up stigma. It's still a thing. It's gotten better, I would think. But there's definitely, that guess they don't want-- they don't think they're sick enough to see a psychiatrist, or they don't think that they're bad enough to see a psychiatrist, or these are just everyday issues that they should be able to manage. But, really, how do you help someone kinda get over that and direct them other than, saying, "Okay, yes, talk to your, primary care and family doctor"? And that's typically when I would say, "Okay, now you really need to go see someone that can help you with more, time and really focus on these things."

Why Mental Health Symptoms Are Not Just in Your Head

Angela (Florida) 25:07

So one of the things I used to hear was patients being upset or offended when their medical doctor would send them to see the psychiatrist. They would tell me, "Oh, the doctor thinks it's all in my head." In in a... They see that as something derogatory or something yeah, stigmatizing or embarrassing or shaming. But the thing that I wanna tell you is Being having emotional struggles along with a medical or physical condition does not diminish the experience of your suffering. When you go to the doctor because, for example, you have palpitations, a lot of palpitations, or feel like your chest i- is closing, they do all the medical workup and the EKG, and they find that your heart luckily is healthy, is a healthy muscle. They say maybe you, you have anxiety. Maybe you're suffering panic attacks, and it would be good for you to see the psychiatrist or to get some, some counseling. Then, you come to me. It doesn't mean that your pain is less, right? I know it still hurts. It still worries you a lot, and you're still very scared of what could happen, of something bad happening. So what we do is really dig a little deeper on why your body is reacting as in this way. I think your body's talking to you, and we need to listen, right? The body is trying to tell you something. So my job is to have a conversation to see what is happening in your life that you know, now that we know that medically you're safe and things are working properly, let's see what's happening in your mind that is causing your body to react in this way. Having conversations, asking questions, allowing you to open and explore some places in the mind that can have some, some information about your experience. But also, we can talk about other things that may be, for example, your sleep, right? If you're not sleeping well and how that is showing in your physical health and why are you not sleeping well. What's going on? Is it something in your schedule? Is it something that worries you? Some fears. So I don't th- you know, I think we are not immune to these day-to-day things. We all go through that type of experience depending on our, the stage in our life. So it's very warranted to talk about it

Kerry Reller 28:10

Yeah. I think that phrase, all in your head is very, I guess misleading. One are they not gonna wanna reach out because of the stigma to working with someone like yourself? Or are they trying... Or is it really-- Are they afraid that there could be some sort of medical condition relating the mental stress relating to the physical, symptoms and things like that. So it's I guess crossing over everything that we've discussed today, right? That whole manifestation of physical symptoms of, the stress or the sleep. You're not sleeping well. You've got the trauma in the li- in your life or whatever is going on, whether it's, normal day-to-day things or something that has now escalated or something like that.

Angela (Florida) 28:51

Yes. It is most helpful to, to have an approach like, from head to toe, right? Explore what's going on at every level because as we said before everything is working in synchrony, right? Your hormones, your defense or immune system, your nervous system. So if one thing is out of balance, it's gonna affect the other. You may be having a brain fog and difficulties with attention and concentration for something that you're not aware of, so we need to explore that, again, if you're not sleeping well and or if you're worried or depressed it could definitely have an effect on your levels of attention and concentration. And definitely everything is related

Rapid-Fire Mental Health Tips

Kerry Reller 29:43

Let's do some rapid fire questions. What's one thing that someone can start doing today to manage their chronic stress?

Angela (Florida) 29:51

Breathing deeply for three minutes in their chair in a protected, quiet space

Kerry Reller 30:00

I like it. Okay. What's one mental health warning sign that you don't want people to ignore?

Angela (Florida) 30:07

Decreased ability to enjoy the things, people, activities that you used to enjoy before and less relating to the-- isolating yourself

Kerry Reller 30:22

Yeah, that question I ask a lot in a different way 'cause it's on one of our screeners, right? Okay, what's one misconception about psychiatry that you wish you could eliminate?

Angela (Florida) 30:33

That we are medication pushers

Kerry Reller 30:35

Oh, yeah. That's a good one. All right, finally, what is your favorite health tip that you want our listeners to remember?

Connecting with Dr. Camacho and Final Thoughts

Angela (Florida) 30:43

My favorite tip is do something that is gonna, that seems easy and that you can accommodate in your current life schedule. If it is exercise or diet, those two are for me one of my favorite, start with a very small change that seems doable, not because somebody else told you, but because you know you can do it, as short as it is, but that you can do it the amount of times that you set for yourself, and you can keep it going

Kerry Reller 31:24

Awesome. Yeah, I like that. The least friction path, right? Okay. So where, if somebody wants to work with you, where can they find you?

Angela (Florida) 31:33

Okay, so my practice is called Camacho Duran Integrative Psychiatry, and I have a website, it's drcamachopsychiatry.com. That is D-R-C-A-M-A-C-H-O P-S-Y-C-H-I-A-T-R-Y.com. And you can schedule a free consultation with me to get, to get some details about the practice and to tell me what's going on, and we can discuss the best ways to approach it. My telephone number is 813-485-5929. That is my office number. You can call me, leave a voicemail or send me a text message. I will respond within 24 hours. Like Dr. Reller said, I am bilingual, so I'm happy to see you in English or Spanish. And yeah, I think those are the main things.

Kerry Reller 32:32

Awesome. Okay. will definitely put all that in our show notes, and would like to end, or you to end one of yours things with one of the phrases that you said earlier, and I think that was, "There is no health without mental health," right? So I thought that was a good really lesson of the overall, discussion today. But thank you so much for being on the podcast. Thank you everybody for tuning in, and please stay tuned next week for next week's episode

Angela (Florida) 32:59

Thank you, Dr. Reller. It's been a pleasure

Kerry Reller 33:02

Awesome. Thank you.