Research has known for a long time that the mind-body connection is powerful: What you think and feel can result in physical sensations in the body, including pain. We are only now beginning to understand how emotional health affects our long-term physical health and longevity. Taking care of your mental health is a form of self-care. Here are some things to know and do.

Anxiety can cause physical pain

“Most people experience the symptoms of anxiety at some point in their lives,” said Crystal D. Narcisse, M.D., internal medicine/pediatrics physician with Norton Community Medical Associates. “But if you have these feelings for a long period of time, or your daily life is affected, you may have a generalized anxiety condition.”

Symptoms of anxiety in women include:

• Feeling nervous, restless or tense
• Having a sense of impending danger, panic or doom
• Having an increased heart rate
• Breathing rapidly (hyperventilation)
• Sweating
• Shaking
• Feeling weak or tired
• Trouble concentrating or thinking about anything other than the present worry
• Having trouble sleeping
• Experiencing gastrointestinal (GI) issues
• Having the urge to avoid things that trigger anxiety

You probably know about the fight-or-flight responses – when you are confronted with danger (whether real or perceived) your body responds in one of these ways. Flight means you run from the danger. Fight means you go toward the source of danger and confront it. When you are in one of these modes, your body releases hormones: adrenaline (uh-DREN’-uh-lin) and cortisol (COR’-tiz-all). These hormones help us exert a lot of energy quickly.

“Cortisol and adrenaline have an important part to play in our bodies, but if you are constantly in a state of fight or flight, your system is constantly full of these hormones,” Dr. Narcisse said. “You never get to a rested state so you can recover from high hormone levels.”

Prolonged high levels of stress hormones can cause:

• Weight gain, especially in your face and abdomen
• Muscle weakness and soreness
• High blood sugar, which often turns into Type 2 diabetes
• High blood pressure (hypertension)
• Digestive issues such as gas, bloating or diarrhea
• Stomach pains or cramps
• Headaches
• Insomnia

High stress hormones also can weaken your immune system, making it harder to fight off even small viruses.

Talking to your primary care provider about mental health

Women, it turns out, are more likely to seek out help for mental health conditions than men.

“Your annual check up with a health care provider is a good time to also talk about mental health,” Dr. Narcisse said. “Many times, we are the first ones to help diagnose a mental health issue, such as generalized anxiety disorder.” 

During a typical check up, your doctor will take physical measurements, such as height, weight and blood pressure. They also will ask questions about changes in your health history and medications. Many people can feel embarrassed about talking with their doctors about sensitive subjects, such as mental health.

“We understand that it can feel awkward to talk to us about these issues,” Dr. Narcisse said. “But we are here to help you.”

A mental health screening may include questions about:

• Your family history with mental health, since depression and anxiety can run in families
• Your sleep, exercise and dietary habits
• How you cope with stress
• Your general health history – pain can cause depression, and vice versa
• How often and how severe your symptoms are

Depending on your answers to these questions and others like them, your doctor may have some recommendations for things you can try at home, such as meditation or yoga. Or they may prescribe medication. You may be referred to a specialist who can work with your primary care team to address your mental health needs.

“If you are prescribed medication, it is very important to follow the doctor’s orders. Never stop taking a medicine unless you are told to,” said Dr. Narcisse. “Be sure to follow up with the prescriber.”

When to see a doctor

“You should see a doctor sooner rather than later if you have symptoms of anxiety or depression,” Dr. Narcisse said. “It’s also very important that you are honest about your health, lifestyle habits and symptoms, so that we can help you start to feel better as soon as possible.”

If you are needing more specialized care, Norton Community Medical Associates patients may be referred to a Norton Behavioral Medicine provider. Because your mental and physical health can be deeply connected, our team of primary care and behavioral health providers works together with you and your support network to deliver care that addresses mental health, substance abuse and other medical needs. Your mental health is every bit as important as your physical health, and the team at Norton Healthcare and Norton Behavioral Medicine can work together to give you the care you need.

If you are in crisis or a loved one is, reach the National Suicide Prevention Lifeline by calling or texting 988. You also can contact the lifeline through its website, 988lifeline.org.

The Trevor Project has a crisis line for the LGBTQ+ community: (866) 488-7386 or text “START” to 678678. You also can reach help through The Trevor Project’s website.

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Pain and other physical symptoms of depression can include:

• Chronic joint pain
• Pain in limbs and/or back
• Stomach or other gastrointestinal concerns
• Fatigue
• Sleep difficulty
• Changes in psychomotor activity (non-goal related behavior such as pacing, toe tapping or rapid talking)
• Appetite changes

“Depression can cause pain and pain can cause depression. The connection between pain and depression is rooted in biology,” said Crystal D. Narcisse, M.D., an internal medicine specialist and pediatrician with Norton Community Medical Associates – Hurstbourne primary care. “Chemical messengers in the brain, serotonin and norepinephrine, affect both pain and mood. Antidepressants that influence these neurotransmitters can effectively treat both depression and any associated pain.”

RELATED: Mental health is as important as physical health. If you need mental health help, here are some things you should know.

Also, cultural norms that associate emotions with women more than men, can make it more likely that men will talk about the physical symptoms of depression. Depression in men is more likely to lead to external symptoms such as violence, anger and substance abuse.

Your primary care provider can prescribe antidepressants and other mental health medication and may refer you to a psychiatrist or therapist.

Possible treatments that can help with pain as well as depression include:

• Antidepressants that influence the neurotransmitters shared by depression and pain.
• Talk therapy or counseling can help both conditions when they are intertwined.
• Techniques for reducing stress such as exercise, meditation, journaling , getting adequate sleep and developing coping skills.

For some men, asking for help can be difficult. Starting with your primary care provider rather than a mental health specialist may be easier. Depression is unlikely to go away on its own and may get worse. Treatment, however, can improve symptoms and make your life better as well as the lives of those around you.

Asking for help when you need it is a sign of strength.

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How mental health affects Black communities

“We hear often that Black Americans view mental health struggles as a personal weakness,” said Jonathon White, LCSW, a social worker with Norton Behavioral Medicine. “Or they don’t believe mental health struggles even exist.”

The statistics are stark:

• African Americans are 10% more likely to experience serious psychological distress.
• Black adult blacks living below the poverty line report severe psychological distress two to three times more often than those living above it.
• Black adults are more likely to have feelings of sadness, hopelessness and worthlessness than white adults.
• Lack of access to behavioral health resources such as health care, education and economic resources, may contribute to African Americans’ worse mental health outcomes.
• Black teens are more likely to attempt suicide than white teenagers, and African Americans of all ages are more likely to be victims of violent crime; meaning they have higher incidence of post-traumatic stress disorder (PTSD).

What causes disparities in mental health care?

“There are many factors that get in the way of care for African Americans,” Jonathon said. “Some are deep-seated systemic issues like cultural bias or fear of the medical establishment. It’s important that providers understand these barriers and work to overcome them.”

RELATED: Mental health is as important as physical health. If you need mental health help, here are some things you should know.

Barriers to behavioral health care for Black individuals include:

• Economics. According to the U.S. Census Bureau in 2012, 19% of African Americans did not have health insurance.
• Physical access. Black communities are often far from hospitals or clinics that provide mental health services.
• Lack of clinical trials. Barriers such as lack of awareness, economic factors, communication issues and mistrust often lead to underreported racial demographic data.
• Mistrust. A history of racism in medical settings can result in a serious lack of trust in medical professionals.
• Lack of providers who are Black. According to the American Psychiatric Association, only 3.7% of its members are African American.

What can be done about access for minorities to health care services?

“From a patient standpoint, you should visit a primary care provider,” Jonathon said. “Your provider will help screen your symptoms and take the first step in creating a plan to ensure you have the best quality of life.” 

Norton Behavioral Medicine offers outpatient mental health care in Kentucky and Indiana that is integrated with the ongoing care provided by your Norton Healthcare primary care provider or specialist. Working with you and your primary provider, Norton Behavioral Medicine therapists, psychologists, psychiatrists, addiction medicine specialists and licensed clinical social workers are on your care team. Talk to your Norton Healthcare primary care provider about this service.

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PTSD vs. CPTSD

“Trauma is not rare,” said Jonathon White, LCSW, a social worker with Norton Behavioral Health. “About 60% percent of men and 50% of women will experience some form of trauma in their lifetime.”

Traumatic events include war, domestic violence, death and more.

“PTSD can happen to anyone, at any time. It’s not a sign of weakness,” Jonathon said. “Many times, developing this condition isn’t in your control.”

A type of trauma that is often unaddressed is race-based trauma. “It’s a culturally sensitive topic, so therapists may avoid bringing race into a therapy session out of racial bias or limited cultural insight,” said Jonathon. He recommends The Unapologetic Guide to Black Mental Health by Dr. Rheeda Walker as a resource for helping navigate mental health systems.

RELATED: Mental health is as important as physical health. If you need mental health help, here are some things you should know.

Symptoms fall into four categories. Not everyone experiences these in the same way or to the same degree.

• Reexperiencing the event: This includes memories of the event that bring on the same feelings as the event and can feel very real.
  “Reliving the event could look like having nightmares or flashbacks,” Jonathon said. “You might have triggers for this such as hearing fireworks or seeing a news report on a similar subject.”
• Avoiding anything that reminds you of the event: This includes staying away from people, places and situations that remind you of the incident. You might avoid talking about or thinking of the event.
• Changes in negative thoughts and feelings: You might be more negative after the trauma. “This includes a wide range of symptoms,” Jonathon said. “You might repress memories of the event, or stop enjoying things you used to enjoy.”
• Feeling anxious: This could be hypervigilance, jitters or sudden anger. You might have a hard time sleeping or find it difficult to concentrate.

“Complex PTSD is pretty much just what it sounds like — a more complex variation on regular PTSD,” Jonathon said. “The symptoms might be more intense, more frequent or happen in conjunction with many other symptoms.”

CPTSD includes the symptoms above and:

• Difficulty controlling emotions
• Feeling angry, frustrated, hopeless, empty or distrustful much of the time
• Isolating yourself from friends, family and responsibilities
• Dissociative symptoms, which make you feel like you are detached from your body or that the world is not real

“You aren’t alone,” Jonathon said. “It’s not a sign of weakness to ask for help.”

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“As caregivers, we want to know what is normal and if there’s anything we can do,” said Rachel N. Hart, D.O., a geriatric medicine specialist with Norton Neuroscience Institute Memory Center.

Here are the causes of changing behavior with dementia, strategies for managing symptoms without medication and considerations for medication if that is deemed necessary.

What causes behavioral changes in dementia patients?

“About 97% of people at some point may experience neuropsychiatric symptoms,” Dr. Hart said. Neuropsychiatric symptoms (NPS) describe a set of behavioral or psychological symptoms. These symptoms can range from delusional to physical (pacing or restless wandering) to verbal (incoherent speech or negativism). It can vary in level of aggression, and can include yelling, hitting or biting.

“Every person is different, and the way the disease presents itself in these symptoms depends on so many factors,” Dr. Hart said.

Behavior changes are affected by the stage of dementia. Early stage dementia can appear with depression or anxiety. In moderate stage, delusions, hallucinations, or paranoia are more common. The type of dementia also plays a role. NPS appear differently in patients with Alzheimer’s disease, Lewy body dementia or frontotemporal dementia.

How can caretakers handle behavioral changes?

Here are five ways to help loved ones if you are a caregiver:

1. Clear and simple communication: Use short sentences and simple words. Long, complicated sentences are confusing and frustrating for someone who is losing their language capabilities.
2. Approach with care: Give the person time to recognize who is coming toward them. Walk slowly and speak softly.
3. Keep questions simple: Avoid open-ended questions and narrow down choices: A question that is better than asking, “What do you want to wear today?” would be: “Do you want to wear the blue dress or the green dress?”
4. Practice patience: Try not to point out mistakes or lose your temper. This can worsen anxiety and agitation in individuals with dementia.
5. Maintain a routine: Doing the same things at the same time is comforting and can help decrease anxiety.

“Most often it comes down to impaired communication,” Dr. Hart said. “We all have needs and desires we want to be addressed. We want companionship and safety. Individuals with dementia are gradually losing the ability to have those needs met and those desires satisfied.”

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What interferes with decision-making?

There are many conditions that affect decision-making ability.

“Neurodegenerative diseases such as dementia or Alzheimer’s disease, traumatic brain injury, psychiatric illnesses such as schizophrenia, bipolar disorder, and major depression can compromise memory and impair capacity to make decisions,” said Rachel N. Hart, D.O., geriatric medicine and memory care physician with Norton Neuroscience Institute Memory Center. “Maybe the most difficult part of the process is just that: It’s a process, and it doesn’t just happen overnight. The individual might have some sense of their own decline, or they may brush it off as a little forgetfulness.”

How do I know my loved one is having trouble making decisions?

“Sometimes financial capacity is the first clue someone’s decision-making capability is declining,” Dr. Hart said. “Not paying bills such as a mortgage or an electric bill can have serious consequences now and down the line.”

People with decreased mental capacity often become the targets of financial scams. If your loved one is not making good choices for themselves with regard to finances, health and basic needs, that is a sign they may be in cognitive decline.

“If someone is choosing not to address a serious health issue, we have to do our best to protect them from consequences of bad decisions,” Dr. Hart said.

When should I seek professional help?

If you see any troubling behaviors or just have a feeling that something is off with your loved one’s behavior, ask a doctor to perform or make a referral for a cognitive assessment.

“There are many ways we can help someone with dementia or a memory disorder,” Dr. Hart said. “Lifestyle adjustments, geriatric physical rehabilitation, house calls and in-home care, to name a few.”

You or your loved one may want to consider creating or updating the following:

• Living will – A living will is a document that describes the medical treatments someone would and would not want to be used to keep them alive. It includes preferences for other medical decisions, such as pain management or organ donation.
• Power of attorney – A medical or health care power of attorney is a type of advance directive in which a person is named to make decisions for you when you are unable to do so. In some states this directive also may be called a durable power of attorney for health care or a health care proxy.
• Do not resuscitate  – You don’t need to have an advance directive or living will to have do not resuscitate (DNR) and do not intubate (DNI) orders. To establish DNR or DNI orders, tell your provider about your preferences. The provider will write the orders and put them in your medical record.
• Medical order for scope of treatment (MOST) – This outlines someone’s wishes for health care in an emergency, including directions about life-sustaining measures, intubation breathing machines, antibiotic use and feeding tubes.

There are many local resources for patients and their caregivers, including classes, information sessions and more.

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Should I have surgery for epilepsy?

“Medication-resistant epilepsy” (known medically as refractory epilepsy) is a condition where seizures do not stop with medicine. Uncontrolled seizures can result in health risks, including physical harm — think drowning — during a seizure; sudden unexpected death in epilepsy (SUDEP); depression and anxiety; or worsening memory and thinking skills.

Your doctors will run tests to see if you are a candidate for epilepsy surgery. Tests include electroencephalogram (EEG), MRI, and brain-mapping tests like functional MRI and a Wada test. Epilepsy neurologists with Norton Neuroscience Institute (Ambica M. Tumkur, M.D.; Rebekah J. Woods, D.O.) then collaborate with epilepsy neurosurgeons (Abigail J. Rao, M.D.; David A. Sun, M.D., Ph.D.). 

“We find surgery is highly effective if the seizures originate in one place in the brain,” Dr. Rao said.

Types of surgery for epilepsy

Norton Neuroscience Institute neurosurgeons use ROSA, a robotic-assisted surgery tool, to map the safest route through the brain to identify the source of epilepsy disorders. The ROSA system generates a 3D map of your brain, so surgeons can see structures at any angle and any depth. With the imaging in hand, surgeons use ROSA’s robotic arm to thread tiny tools through holes the width of spaghetti noodles, to the source of your seizures. This surgery, through small incisions, avoids removing part of the skull.

Other epilepsy surgeries include:

• Resective surgery: The surgeon removes the portion of the brain where seizures originate. This can be the site of a tumor, brain injury or malformation.
• Laser interstitial thermal therapy (LITT): Using a laser to focus on and destroy a small portion of brain tissue, this surgery uses a minimal incision while MRI heat maps guide the laser the surgeon uses.
• Deep brain stimulation: A small device is inserted permanently into the brain to deliver electrical signals that disrupt seizure-inducing impulses.
• Responsive neurostimulation: A closed-loop device implant that monitors and responds to brain waves.

“Our multidisciplinary team considers which option is best for the individual patient, allowing us to offer excellent surgical outcomes and leading-edge care,” Dr. Sun said.

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“We were seeing a rise in the need for mental health care even before the lockdown in 2020,” said Nicole Ryan, DNP, APRN, a nurse practitioner with Norton Behavioral Medicine. “Post-COVID-19 stress disorder has emerged as a real issue for people.”

Here are some things to try and ideas to consider.

What to do if you feel depressed or anxious

“There are lots of things you can do on your own at home that can help boost your mental health,” Nicole said.

Here’s a short (not exhaustive) list of things you can do to help yourself feel better:

• General preventive wellness: See your primary care provider and any specialists (dentist, OB/GYN, etc.) for yearly checkups.
• Good sleep: Chronic lack of sleep can contribute to depression and anxiety, so be sure to get a solid eight hours a night.
• Basic hygiene: If you are not bathing regularly, doing laundry so you have clean clothing or brushing your teeth, that could be a signal of depression.
• Meditation: This is an age-old beneficial coping skill that can be done almost anywhere, anytime. There are also smartphone apps, books and free resources online for meditation.
• Journaling: Writing things down can get the thoughts out of our heads so they don’t interfere with our lives.
• Nutrition: Eating a healthy balanced diet helps our mood.

Community and spirituality

Recovery from the COVID-19 pandemic and the last two years of uncertainty and upheaval extends beyond our physical bodies and well into the emotional and spiritual realms, too.

“Spiritual care works in harmony with physical care to help us feel stable, balanced, and happy,” said the Rev. Amy C. Helwig, M.Div., MAMFT, a chaplain with Norton Healthcare.

The past two years of quarantines and isolation have kept people from participating in so many of the activities they had been doing, including religious services, volunteering and social gatherings.

“This takes its toll,” Amy said.

Chaplains like Amy can serve as spiritual counselors, but they are also bridges to other resources such as individual coaching, work-life balance, and financial well-being.

Getting help with mental health

“There is still a lot of stigma surrounding mental health,” Nicole said. “But one of the benefits of the last two years has been the expansion of access to mental health resources.”

Many mental health counselors are available via online/video chat or phone call. Many employers offer an employee assistance program (EAP), which provide free or reduced-cost mental health services.

“Just talking to someone helps,” said Nicole. “Family, a friend, your primary care doctor – reaching out in whatever way feels comfortable will be beneficial.”

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Although researchers found anxiety-related searches soon returned to previous levels, emergency rooms and immediate care clinics have continued to see high levels of patients experiencing anxiety symptoms, well into the ongoing COVID-19 pandemic.

Am I having a panic attack?

Panic is a natural physical response to fear or threatening situations. Our prehistoric ancestors had to be on alert for predators or other dangers, and the response is still around in the modern human brain. A panic attack is an exaggerated reaction to a fear, either real or perceived. Symptoms of a panic attack or anxiety attack vary from person to person and can include:

• Racing heart
• Feelings of terror, losing control or that you are going to die
• Dizziness, nausea or feeling faint
• Pain in chest, stomach or abdomen
• Shaking, sweating or trembling

Is it my heart?

No matter what your health status is, you should go to the emergency department immediately if you have sudden, severe chest pain. You can be tested for specific enzymes in your blood that would indicate you had or did not have a heart attack. Heart attack symptoms include:

• Chest pain that radiates down the arms, into the neck or jaw, or into the back and shoulders
• Nausea and vomiting
• Shortness of breath or pressure in the chest

It’s important to look at all the symptoms together, as well as your health history, to determine the difference between a heart attack and a panic attack.

How does anxiety affect your heart?

The Centers for Disease Control and Prevention suggests that there is a connection between mental health and physical wellness. Anxiety can trigger increased heart rate, higher blood pressure and an increase in the stress hormone cortisol. Over time, these effects can lead to calcium buildup in the arteries, cardiac events (such as heart attack) and metabolic disease. People with anxiety also may take up behaviors such as smoking, or they might decrease their activity levels. These behaviors can contribute to heart disease.

When in doubt …

If you regularly experience panic attacks and are at risk for heart disease, talk to your doctor about what symptoms should trigger an immediate trip to the emergency department.

If you’ve never had a panic attack and you’re not sure if that is what is happening, it’s better to be evaluated immediately — don’t explain away symptoms. Call 911 to be transported to the hospital via ambulance. That way, EMTs can monitor you and provide important information to your emergency doctors. Every minute matters with a heart attack — time saved is heart muscle saved.

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A cancer diagnosis is life-altering, and living with cancer can cause feelings of fear, sadness, nervousness and uncertainty, and a sense of being overwhelmed.

At Norton Cancer Institute, the health care team understands that patients need both leading-edge medical care and support for their mental and emotional health needs. The complexities of treatment can contribute to patients’ further uncertainty regarding how well they may tolerate treatment and what their prognosis may be. Coping with this news can seem daunting.

We understand a significant number of cancer patients will experience difficulty with adjustment, difficulty with anxiety and even feelings of depression.

To meet the emotional and psychological health needs of patients, Norton Cancer Institute Comprehensive Support Care includes a multidisciplinary team of specialists, including psychiatric advanced practice providers, licensed clinical social workers, music and art expressive therapists, nutritionists, massage therapists, and nurse navigators.

Related: If you’ve been diagnosed with cancer, here are questions to ask

Cancer is an illness that impacts each individual differently. There is no one-size-fits-all approach to the compassion and care. Just as we deliver individualized medicine, we deliver individualized care to ensure we meet the needs of the whole person. We know that cancer can be all-encompassing.

As patients begin treatment at Norton Cancer Institute, all are screened to see who might benefit from specialized mental health services. Norton Cancer Institute Behavioral Oncology Program providers work collaboratively with the medical team to determine the needs of each patient and their caregivers. The program offers individual and group therapy and brief caregiving interventions. When appropriate, medications may be prescribed to treat a variety of mental health issues and enhance quality of life.

RELATED: Mental health is as important as physical health. If you need mental health help, here are some things you should know.

Our primary goal is to ensure that individuals going through a cancer journey have the resources available to them to meet the demands of the illness with as much grace and dignity as possible. We want to help patients adapt to a new normal, leverage their personal strengths and enhance their ability to deal with whatever challenges the illness may bring.

We know that each individual brings different perspectives, life experiences and resources, and varying capacities to cope with a cancer journey. We want to ease the burden that cancer can bring by connecting individuals to resources to enhance the sources and types of psychological support available. As psychosocial oncology care providers, we are here to help manage the human side of cancer.

Elizabeth M. Archer-Nanda, DNP, APRN, is an advanced practice psychiatric provider and leads the Behavioral Oncology Program within Norton Cancer Institute’s Comprehensive Support Care.

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