By Erin Ellis, Vancouver Sun April 20, 2012

© Copyright (c) The Vancouver Sun

Brent Seal (right) says that he was fortunate to get treatment and to have the support of his family and friends

By Gail Johnson, April 10, 2012, Georgia Straight

Brent Seal was in his first year of university in 2004 when he started feeling overwhelmed by stress. The business student went on to feel excruciatingly paranoid in social situations. Things got worse.

“I started losing track of reality,” Seal says in an interview with the Georgia Straight. “It led to psychosis.”

Ultimately, he tried to kill himself and was diagnosed with schizophrenia.

Seal, who’s now a peer support worker at F.O.R.C.E. (Families Organized for Recognition and Care Equality) Society for Kids, says he was fortunate to finally get treatment and to have a supportive family and circle of friends by his side. But he says a new online resource for youth struggling with mental-health problems and substance use could have been just the kind of help he needed to get help sooner.

Mindcheck.ca also has the support of the Vancouver Canucks, with Kevin Bieksa being a vocal advocate of reaching out to young people facing mental-health challenges.

“A lot of youth don’t get any support,” says Seal, who graduated from SFU as valedictorian in 2010. “I think there’s a lack of understanding, lack of awareness; people are still afraid to talk openly about mental-health challenges. It’s seen as embarrassing, a shameful thing to talk about. Mindcheck is a safe place for people to get help.

“I’m such a big supporter of this website,” he adds. “Had a friend told me about it, maybe I could have got help a year earlier and avoided what happened, which was a suicide attempt.”

Mindcheck—a Fraser Health initiative that now reaches people throughout B.C. with the support of the Provincial Health Services Authority (PHSA)—aims to help people in their teens and early 20s identify the signs of conditions such as depression, anxiety, stress, psychosis, and problem substance use through self-assessment quizzes. It then points them in the direction of help, resources, and support.

“We know that mental-health and substance-use problems are the primary health concern for young people, and more than half of those who need help are not getting the help that they need,” says Karen Tee, manager of Fraser Health’s child, youth, and young adult mental-health and substance-use services. “Youth and young adults go to the Internet first before picking up books on mental-health and substance-use problems or going to a counsellor.

“Our goal was to help young people find intervention earlier by giving them interesting and nonstigmatizing content about mental-health and substance-use issues in a way that can help them learn the signs and symptoms, seek help, and hopefully prevent emerging problems from getting worse.”

According to Mindcheck, 75 percent of all mental-health conditions begin by age 24. One in five youth and young adults in B.C. experiences distressing feelings and thoughts that cause problems with school, work, family, and friendships. However, symptoms or behaviours are often mislabelled as being just a phase or part of someone’s personality.

Canucks defenceman Bieksa appears on the Mindcheck site in a video about his late friend Rick Rypien.

“I’m the friend of somebody who experienced depression,” Bieksa says in the Mindcheck pledge to support mental health. “I know it isn’t a choice. It’s not a weakness, self-inflicted, or a result of not trying. Sometimes you just can’t get over it. It won’t just go away. Pretending it isn’t happening doesn’t help. Talking about it does. I pledge to learn the signs. I will not judge. I will have compassion. I will reach out, listen, talk, help, and find help. My name is Kevin Bieksa, and I will not stay silent.”

Connie Coniglio, executive director for children and women’s mental-health and substance-use programs with the PHSA, says that having the support of the Canucks has helped boost awareness of mental illness, and Mindcheck, significantly.

“The hockey crowd is a very diverse group of people, and it includes men, which is a big target audience,” Coniglio tells the Georgia Straight. “They’re not the easiest to reach around health issues in general, and mental health is no different. We wanted to reach both men and women of the youth and young-adult population.

“We’re talking about young adults aged 17 to 25, who are often hard to reach with mental-health messages. They might not be in university or college; they’re people who are out in community and away from some of the places where structured opportunities to give those messages exist.”

Mindcheck is clearly resonating with people. Coniglio says that there were more than 58,000 unique visitors from 98 countries between January 24 and March 16 of this year alone. Plus, 28,000 self-assessments have been completed.

The year ahead will see new features added to the site as well as the development of related mobile apps.

“Obviously, people are interested enough and concerned and curious enough about their mental health that they’re using the site,” Coniglio says. “The Canucks are keeping it on people’s radar screens and have really opened up the dialogue. It’s become a bit of an antistigma campaign.”

After heading the UN mission in Rwanda during the 1994 genocide in which machete-wielding forces killed at least 800,000 people in 100 days, Lt.-Gen. Roméo Dallaire blamed himself for everything that happened. He became suicidal and made headlines when he was discovered on a park bench in Ottawa after drinking himself into oblivion.

New programs are now being launched to help veterans overcome devastating but hidden wounds of war, conditions such as depression, anxiety, and insomnia, all of which struck Dallaire. Such initiatives mark a huge step forward in healing trauma and in the recognition of the mind-body connection, according to a local therapist.

A U.S. group called Bands for Freedom has just introduced its National Veteran Wellness Program, which will focus on treating physical and mental-health conditions. In Canada, meanwhile, the enhanced New Veterans Charter is being touted for its shift from disability management to a more modern, holistic model of wellness.

“One of the things people like Roméo Dallaire have done is bring trauma out of the closet,” says Catherine Fallis, a Vancouver movement therapist. “It’s so important that the military is now understanding those things.”

Underscoring people’s ability to overcome trauma is new research into the brain and neuroplasticity.

Fallis specializes in “somatic experiencing”, a body-awareness approach to trauma-healing developed by Boulder, Colorado, medical biophysicist and psychologist Peter Levine. The former NASA stress consultant’s methodology is based on what he calls an appreciation of how wild animals aren’t traumatized by routine threats to their lives whereas humans are readily overwhelmed.

“Fortunately, the very same instincts (and related survival-based brain systems) that are involved in the formation of trauma symptoms can be enlisted in the transformation and healing of trauma,” Levine writes on his website. “Therapeutically, this ‘instinct to heal’ and self-regulate is engaged through the awareness of body sensations that contradict those of paralysis and helplessness.”

Toronto MD, psychiatrist, psychoanalyst, and researcher Norman Doidge outlined the way people’s thoughts can alter the structure and function of their brains in his groundbreaking 2007 book, The Brain That Changes Itself: Stories of Personal Triumph From the Frontiers of Brain Science.

“Neuroplasticity not only gives hope to those with mental limitations, or what was thought to be incurable brain damage, but expands our understanding of the healthy brain and the resilience of human nature,” Doidge wrote. “We learn that our thoughts can switch our genes on and off, altering our brain anatomy.”

Fallis also subscribes to what’s known as the “polyvagal theory” of the autonomic nervous system formed by Chicago psychiatrist Stephen Porges. Proponents claim it will have huge implications for trauma therapies.

Porges maintains that everything from autism to panic attacks stems from the evolution of the human nervous system and that emotional disorders are biological in nature.

According to this theory, the autonomic nervous system has three, not two, branches: the sympathetic, parasympathetic, and social-engagement systems. Under stress, human beings first use the brain’s most sophisticated system, its relational tactics, as a survival strategy. If that fails, the fight-or-flight response kicks in. If that also fails, they end up in a state of immobility.

“The thing that I find very encouraging and inspiring about doing this work is that when people hear that they’re biologically programmed to go into freeze or shutdown when it becomes apparent that fight or flight aren’t going to work, they can forgive themselves for not fighting back or not doing enough or thinking ‘I should have done this or that’ in face of an accident or assault or anything like that,” Fallis says. “It’s not a failing of character if you can’t manage those kinds of things; it’s your biology.”

Trauma can result from a vast array of experiences, not just horrific events such as war, violence, or natural disasters, Levine contends. Rather, many seemingly ordinary situations can be traumatic.

“So-called minor automobile ‘whiplash’ accidents frequently lead to bewildering and debilitating physical, emotional, and psychological symptoms,” Levine writes. “Common invasive medical procedures and surgeries (particularly those performed on frightened children who are restrained while being anesthetized) can be profoundly traumatizing.”

The purpose of somatic experiencing is to help people find effective ways to address the lasting emotional effects of such events.

“The point is to expand people’s capacity to manage intense emotion,” Fallis says.

Jeanette Barrett is a Vancouver practitioner of self-regulation therapy (SRT), another form of trauma-healing centred on the mind-body connection. “I personally believe chronic conditions all have their roots in trauma, and that if we handle the trauma by default the chronic conditions by and large get resolved,” says Barrett in a phone interview.

Like other SRT practitioners, she maintains that stress and trauma can be physically discharged from the body. “That discharge is fairly physical in nature. It could be heat, tingling, twitching, yawning; that’s the stress information leaving the nervous system and leaving you free to reclaim your health or reclaim your life.

“The brain comes with its own operating system that allows us to self-correct,” she adds. “It’s quite extraordinary what it’s capable of doing.”

“I just went, ‘Wow, I love this,’” Jeffery says in a phone interview. “It’s a great sport. It gets me moving quickly; it’s exceptional exercise. It’s a welcoming group and a phenomenal community, and I love the fact I’m outside.

“It’s my sanity,” Jeffery adds. “I can forget about everything. I get on the field and I can’t think about things like getting older or else I’m going to get a ball in my face.”

Jeffery has hit on an undeniable truth about physical activity: whether it’s attending football practice (which, in Jeffery’s case with the B.C. Touch Football League, includes sprint drills and running patterns), riding your bike to work, going to the gym, or hiking trails, regular exercise does wonders for your mental health.

In fact, research increasingly backs up the link between movement and emotional well-being.

According to Boston University psychology professor Michael W. Otto and Jasper A. J. Smits, associate professor of psychology at Dallas’s Southern Methodist University, one reason exercise positively affects mental wellness is that it increases the production of serotonin. Low levels of this neurotransmitter have been linked to depression, they write in their recent book Exercise for Mood and Anxiety: Proven Strategies for Overcoming Depression and Enhancing Well-Being.

Then there is the theory that exercise “whips your body into better shape” to handle stressors, they contend. Exercise in itself is a stressor, forcing the body to adapt to the demands placed on it, and this kind of regular stress may help you be physiologically better at handling stress in general.

In their book, the two refer to several long-term, large-scale studies supporting the positive effects of exercise on mood.

A 2010 meta-analysis of 70 studies on the subject published in Annals of Behavioral Medicine, for instance, found that adults who reported sad or depressed moods—but not at levels that were considered psychiatric disorders—reported meaningful improvements in their mood as they started doing regular exercise.

A 2007 Psychological Medicine study of adolescents found that 16 percent of those who weren’t physically active developed an anxiety disorder over a four-year period compared to half that rate among those who exercised regularly.

Another study, from 2000 and published in Preventive Medicine, found that exercise is linked to less anger and “cynical distrust” as well as stronger feelings of social integration.

Perhaps the most convincing argument in favour of regular exercise for mood is also the simplest: unlike the goal of losing weight, the benefits of physical activity on a person’s mental state are almost immediate, Otto and Smits say. About 20 minutes into a workout, you start feeling better; that effect can last hours or even into the next day.

The authors don’t discount the role that medication and talk therapy can play in the treatment of conditions like depression and anxiety, and they emphasize that suicidal thoughts need immediate treatment. However, they argue that in many cases, exercise can function as the body’s own natural antidepressant.

Exercise is one component of the Canadian Mental Health Association B.C. branch’s Bounce Back: Reclaim Your Health program. Funded by the provincial Ministry of Health, the free program is geared to people with milder mental-health problems and helps them recognize and deal with signs of stress, low mood, and worry.

Some of the coping strategies are delivered through workbook materials and telephone coaching, with one being centred on using exercise to improve how you feel.

“Planned exercise has been shown to boost mood, reduce tension and anxiety, and improve self esteem,” Lynn Spence, CMHA B.C. division associate executive director, tells the Georgia Straight. “Additional benefits include fun, social contact, structure provided in the day, plus wider long-term physical health benefits.”

It can be hard to head out for a jog or an aerobics class when you’re feeling blue, so Spence advises setting achievable goals.

“People can start with a realistic plan, choosing exercise that they used to enjoy and scheduling the activity into their day, taking small steps towards more activity,” she says. “They might pick a physical activity that can be done in just five or 10 minutes.…They might choose to do the activity with someone else, increasing the likelihood of following through. Resulting benefits from exercise can facilitate motivation for action in other areas that are contributing factors to low mood.

“Our thinking, behaviour, relationships, life situation, and body all affect each other,” Spence adds. “A change in one can lead to change in others.”

Psychologists Otto and Smits admit that sometimes even they find it tough to get off the couch and exercise. In their clinical practice, they’ve heard every excuse when it comes to avoiding physical activity: feeling too busy, tired, depressed, or unmotivated. They offer dozens of practical strategies to put intentions into action, such as bringing an audio book to reward yourself after the fact.

Exercise, they maintain, is your chance to approach the world with “appropriate selfishness—doing what you need to do to feel better today”.

“Keep this in mind as you think about your next workout,” they write. “You are doing it to feel less stressed, less down, and more relaxed. You are doing it for the sense of energy it provides and for the sense of being in tune with your body.…The key is getting out there and making your exercise a regular part of your life.”

Injured drivers taken to B.C. hospitals over the next five years will help answer the question: Do those who are high on marijuana cause more crashes than sober drivers?

In the marijuana-impairment study – the first of its kind in Canada – blood will be collected from injured drivers without their permission. Since the data is collected anonymously and not used to pursue legal charges, researchers don’t have to seek approval from drivers to analyze their blood under the ethics-approved terms of the study.

Blood is drawn for treatment of any injuries and the excess amount is then analyzed. The sample is assigned a code that is not shared with police, and the resulting data is then linked to police accident reports to eventually show researchers if cannabis contributed to the accident.

A recent random sampling of B.C. drivers showed that 10 per cent were impaired by alcohol and 7.2 per cent by drugs, usually marijuana or cocaine. After alcohol, cannabis is the most widely used intoxicating substance in the world. In the random sampling, it accounted for about two-thirds of the drugs detected at the police roadside stops, followed by cocaine.

Concentrations of THC, the active ingredient in cannabis, will be measured in the new marijuana study.

It will be led by Dr. Jeffrey Brubacher, an emergency doctor at Vancouver General Hospital.

Many marijuana users think it’s less hazardous because cannabis tends to make people drive more slowly and less aggressively than, say, drivers who are drunk, according to studies.

At the same time, drivers high on marijuana have a harder time staying within lanes and their reflexes are slower, which means they are more likely to crash into obstacles that suddenly appear. On the other hand, “cannabis users tend to overestimate their impairment whereas people who used alcohol underestimate theirs,” Brubacher stated in an explanation of his study in the B.C. Medical Journal.

Brubacher said data on the first 100 injured drivers have already been collected for the study, which aims to include information on 3,000 crashinvolved drivers at five B.C. hospitals. THC levels in blood – which are measurable no matter how the cannabis is consumed (smoked, sprayed, drunk or eaten) – yield a blood THC concentration considered more accurate than THC metabolites in urine. Brubacher said urine metabolites remain active for days after cannabis exposure, even though impairment typically lasts less than four hours.

“Our primary objective is to determine whether injured drivers who used cannabis before a motor vehicle accident are more likely to have caused the crash than those who did not,” said Brubacher, adding that the number of crashes caused by impaired drivers will be compared to a control group of drivers who were found to be not culpable.

The ultimate goal of the $1-million study, funded by the federal Canadian Institutes of Health Research, is to help traffic-safety experts develop safer driving policies. It is possible, for example, that the study might show whether there should be a legal cutoff level for THC blood concentration, just as there is for alcohol. The study results should also help inform the debate around whether marijuana possession should be decriminalized.

When it comes to drug-impaired drivers, current practice is for police to do a roadside sobriety test if they have suspicions. If the driver fails the initial observational tests (walking a straight line, etc.) then the driver must accompany the officer to a police station for further examination by a specially trained drug recognition expert. Drivers may be ordered to submit blood, saliva or urine samples, or face a fine for refusing to comply.

While there have been some surveys showing that drivers impaired by cannabis were nearly twice as likely to crash, Brubacher and his co-investigators are using a similar “culpability” study design as was used in studies in Australia and France, linking data from injured drivers to police reports to show who caused the accident and their level of impairment.

Those studies had a few drawbacks, however, including a cumbersome process in which the drawing of blood was delayed about three hours from the time of the crash.

“We anticipate that our data will provide a more accurate reflection of true THC levels at the time of crash,” Brubacher said, noting that in a pilot project, the average time from crash to blood draw was 53 minutes.

RCMP Supt. Norm Gaumont said he’s pleased the study is being conducted because there is little research on the effects of drug-impaired driving compared to the evidence about the dangers of drunk driving. Gaumont, who heads traffic services in B.C., said there is urgency to get the type of data in the study because of a steady increase in the number of deaths caused by drug-impaired drivers. At last count, B.C. coroners showed there were 62 deaths (out of 374 in 2008) attributable to drugimpaired drivers.

“Drug impairment is becoming a bigger and bigger problem. We’ve done a good job educating people about drunk driving, but [offered] very little on drugs. So certainly this study will be a benefit,” Gaumont said. He added that B.C. lawenforcement authorities are monitoring studies in Europe and Australia, where police are experimenting with roadside saliva tests that can yield instant information about what drugs drivers have used, and their level of impairment.

By Jill Barker, For Postmedia News November 16, 2011

Stir the pot: Kneel before an exercise ball and place your forearms on the ball. Lift the knees off the floor and form a straight line with your body, positioning your elbows under the shoulders as you support your weight on your toes and forearms. Slowly rotate the ball in circles, keeping it under the shoulders.    Photograph by: Vincenzo D’Alto, The Gazette

Sit-ups, once the darling of the fitness community, have fallen out of favour in the past few years. Leading the charge is Stuart McGill, a professor of spine mechanics at the University of Waterloo, whom Maclean’s magazine referred to as “the man who wants to kill crunches.”

McGill’s beef with sit-ups, crunches, and any other similar exercise, is that bending forward is tough on the spine. And since everyday life demands a number of forward bends, like putting on shoes and emptying the dishwasher, why increase the strain on the back by adding sit-ups to the mix?

In place of crunches, McGill suggests performing exercises that work the core muscles without a forward bend. He claims exercises like the plank, the bird dog and “stir the pot” are better choices.

Not everyone agrees with McGill. Strength and conditioning specialists Bret Contreras and Brad Schoenfeld question McGill’s argument that curl-ups have a negative impact on spine health. In an article published in the August 2011 edition of the Strength and Conditioning Journal, Contreras and Schoenfeld contend that experiments such as those done by McGill and other researchers don’t replicate the real-life application of the exercise.

“The studies in question attempted to mimic loading patterns of occupational workers by subjecting spinal segments to thousands of continuous bending cycles, which is far beyond what is normally performed in the course of a dynamic exercise program,” said Contreras and Schoenfeld.

They go on to explain that the average ab routine consists of two to three sets of a limited number of crunches, punctuated by a rest between sets. This is nowhere near the procedure used in the cited studies measuring the consequences of repeated abdominal curls, which mechanically simulated 4,000, 6,000, 10,000 and 86,400 forward-bending cycles using pig spines.

“Thus, total bending cycles per session ultimately amount to a fraction of those used in the cited research protocols, and these cycles are performed intermittently rather than continuously,” said Contreras and Schoenfeld.

They also question whether experiments using the spine from a pig’s cadaver (standard practice in the field, as pig spines are close anatomically and biomechanically to humans) are an adequate reflection of the workings of the spine in a living, breathing human. The authors contend that healthy spines attached to a living human adapt positively when subjected to moderate exercise. Spines gleaned from cadavers do not.

So if the wear and tear of years of forward bends isn’t the culprit behind disc injury, what is? Contreras and Schoenfeld point to studies suggesting that heredity factors, such as the size and shape of the spinal structures, play a far more significant role in the degeneration of discs over time than do crunches.

But that’s not all they have to say. Not only do they think the scientific community has been too harsh on crunches, they propose that the exercise is actually good for your spine. They cite improved delivery of nutrients to the discs of the spine, enhanced flexibility of the spinal column and improved strength of the rectus abdominus (the long abdominal muscle that runs from the pubic bone to the sternum) as reason enough to add crunches to your workout routine.

In response, McGill isn’t ready to back down. He suggests that the argument about whether to crunch or not can get complicated, and it’s not as easy as labelling an exercise good or bad. The real question is whether the exercise is right for you, based on your personal goals and history of back health.

He also says he does plenty of experiments with humans and, through his clinical practice, has experience dealing with athletes, the sedentary and everyone else in between, so his conclusions are not just based on experiments with porcine spines.

And he still advocates against crunches. “Most back pain in young people 20 to 50 years of age is due to excessive forward flexion,” said McGill.

So where does that leave the average exerciser looking to improve core strength?

Well, you need to weigh the risks against the benefits before deciding to add crunches to your workout. If you have back pain or a job or activity that demands lots of forward bending, like a hockey player or a construction worker, then you should avoid crunches and do a challenging exercise, such as stir the pot, which, according to McGill, does a better job of challenging the core without the stress of a crunch.

However, if you are free of back pain, healthy and active, adding crunches to your ab workout probably won’t have dire consequences. But you should limit the number of crunches to a moderate number, performed no more than a couple of times a week with at least 48 hours of rest between sessions.

One thing McGill, Contreras and Schoenfeld all agree on is that hundreds of crunches a day have few benefits and lots of risk. So get used to the plank, stir the pot and the bird dog — they’re your new best friends.