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Health is more than just diet and nutrition and how you look in the mirror. In order to live your best life, taking care of your mental health is crucial. Your mental state allows you to feel good about yourself, be confident to live the life you want to, and have positive, enriching relationships.

Kevin Curtis is a licensed clinical social worker with University Neuropsychiatric Institute. He suggests asking yourself three questions to assess the state of your mental health:

• Are you having thoughts that are useful to you?
• Are you having thoughts that impact your ability to function?
• Is your emotional state supporting or hindering achieving your goals?

Kevin is joined on this episode by his friend Ben. Ben works at the University of Utah and considers himself a regular guy who has been working with professionals to improve his mental health over the past decade.

Ben admits that he's not the paragon of mental health, but feels tons better than he was 10 years ago. He's learned a few tools and techniques that have helped improve his mental health over the past 10 years. He shares the three tools he feels were the most helpful for him.

1. Box Breathing/Tactical Breathing
   The way you feel during an emotion is ultimately a physical response. The increase in heart rate when anxious. The flush of blood to the face when angry. These physical changes can start a feedback loop with your emotional state that can lead to an overwhelming response.

   To help keep your mind calm when feeling stressed, Ben focuses on his breathing. He will breathe in for a count of four. Hold that breath for a count of four. Breath out for a count of four. Pause for a count of four. Repeat as necessary. This is called "box breathing."

   This breathing technique allows you to shift your mind to a physical response rather than an emotional one. It changes the way your body feels, and in turn is able to help make the emotion feel less overwhelming.

   Tactical breathing uses the same four-second breathing technique but removes the pauses between breaths. This alternative will provide the same benefit, but is best used in a situation when you need to be able to breathe regularly.

2. Check fo BLAST(H) Conditions
   We've all had a friend, partner, or child in our lives that make poor decisions or are particularly irritable because something more physical is going on. It's sometimes easy to see exactly why another person is stressed, but hard to recognize it in yourself. As such, Ben's second technique takes a personal inventory of the following if you are feeling overwhelmed:

   B: Bored
   L: Lonely
   A: Angry
   S: Stressed
   T: Tired
   H: Hungry

   If these "BLAST" conditions are present, recognize they may be having an impact on your emotional state.

   A good step to improve your mental health is to adopt strategies and daily habits that will keep you out of these conditions as often as possible.

3. The Reach Out
   While professional help can be an integral part of your mental health strategy, it's also important to build a network of support and "emotional scaffolding" with people in your life and network.

   "The Reach Out" is a technique that aims to build and strengthen your connection with others. If you are feeling down, or upset about a situation, reach out to two people you trust. These people can be friends, family, coworkers. Take the opportunity to tell them what is going on in your life and how you feel about it. Explain that you are not seeking solutions to your problems, but rather you are merely reaching out to let them know what you are experiencing.

   By expressing vulnerability without setting an expectation, you are inviting these people to join a network of support without placing pressure on them. Additionally, by reaching out and getting personal, you are inviting the possibility of sharing a meaningful interaction that can deepen the bonds you have together.

In times of stress, be sure to take care of your mental health. These tips may help maintain and improve your day to day mental resiliency. However, if you are experiencing overwhelming feelings of depression or contemplating self-harm or suicide, reach out to a professional.

For people in Utah consider the Crisis Intervention Services at University of Utah Health. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

You wake up at 2:00 in the morning. You can't take a deep breath and your chest hurts and your heart is pounding. Is this coronavirus, or is it a panic attack?

These are anxious times. Economic insecurity, worries about friends, and the 24-hour news cycle of death and disaster elevates everybody's stress hormones. Increased anxiety sets off the alarms of your sympathetic nervous system, your fight or flight system. Your heart rate increases. Your muscles tighten. You start to breathe faster. These can be symptoms that anxiety can cause all day long or just for a short period of time, and this is anxiety or a state of anxiety. These can be symptoms that anxiety can cause all day long.

However, sometimes for no good reason, the body is suddenly flooded with the stress hormone called norepinephrine, and these symptoms are amplified. This is called a panic attack. You can't catch your breath. You can't seem to take a deep breath. Your heart is pounding out of your chest, and you may have chest pain or feel that there's a heavy weight on your chest. You're pretty sure you're going to die.

These symptoms were often confused with the symptoms of a heart attack. Panic attacks come on suddenly and heart attacks come on suddenly, so it's not uncommon for emergency rooms to see younger people who come in with symptoms of a heart attack who leave with the diagnosis of a panic attack. Of course, the long-term consequences of a panic attack are different than a heart attack, and the management is different.

Now, however, in the days of the COVID-19 epidemic, we're hearing the symptoms of infection that include rapid breathing, feeling that you can't take a deep breath, heart pounding, and pain or pressure in your chest. So how can you tell the difference? Of course, if you're in the emergency room, we have the tests and equipment that can help us to quickly sort this out.

The first is to take a history. Have you had a fever? A fever is common with COVID-19 and rarely seen with panic attacks. People with panic attacks can get sweaty as can people with fever when it breaks, but the body temperature doesn't spike usually with a panic attack.

Have you had a cough? Cough is common for COVID-19 but not in panic attacks. Have you had muscle aches and pains over the past several days? That's common for COVID-19 and not so much for panic attacks. Did all this come on all of a sudden? Which is rare for COVID-19 that usually builds up over a day or so. Panic attacks come on all of a sudden and usually only lasts less than 30 minutes at their worst.

Then in the ER, we have this little amazing device that we can put on your finger to measure your oxygenation. If that's normal, then your difficulty breathing isn't likely to be COVID-19. We can also get a chest x-ray, which would be normal in a panic attack, but not in the case of severe shortness of breath from COVID-19. Of course, we can get a cardiogram to help rule out a heart attack, and we can take your temperature. Actually, that was done in triage before you even got into the emergency room, as was the pulse ox, that cute little thing on your finger.

But you aren't in the ER. You're at home in bed in the dark thinking you're going to die, or maybe it's in the middle of the day or maybe you're driving. If you're driving, pull over immediately. If you're in bed, get up and sit upright in a comfortable chair. If you're not alone, get someone to help and be with you and tell them how you're feeling. Take some slow, deep breaths all the way in for a count of four, hold for four, all the way out for a count of four, hold for four. If you can't do it for the four count, do it for three or speed up to four. Do that 10 times and count them.

Then ask yourself the questions: Do you have a fever? Have you had a fever? You can take your temperature if you have a thermometer at home, and it really helps to have a thermometer at home. If you're too stressed to find the thermometer, maybe someone could help you. No fever? This is good, 10 more breaths. Do you have a cough? Have you had a cough in the last couple of days? If not, that's a good sign, 10 more breaths. Did this come on all of a sudden, or have you had weakness and muscle fatigues and fatigue for several days? No? That's a good sign, 10 more breaths.

How are you doing? Check in with yourself from toes up. How are the bottom of your feet on the floor feeling? How are your toes feeling? How are your knees feeling? How's your butt feeling in that chair? Take time to check out each part of your body. It will give your anxious brain some work to do. Mostly okay? That's good.

So if you're feeling better and you've answered to yourself no to all these questions, you're probably having a panic attack. If you answered yes to fever and cough and the symptoms are getting worse over the past couple of days, call your clinician or the ER and they can send you where you should be seen. If there's any other way, please do not drive yourself. If you can't get someone to drive you and you cannot breathe slowly and you're still have pain or pressure in your chest, call 911 and the EMTs will come to help.

These are difficult times. Gloom and doom is part of everyday news cycle. Please, turn off the news for a while every day. Get out and walk about in a physically distanced way. The phrase "socially distance" isn't the right one. Physically distance is right thing. Exercise is one of the best things for long-term therapies for anxiety. Reach out for friends on the phone. Stay connected. Call us if you need us and thanks for joining us on The Scope.

Announcer: Is it bad enough to go to the emergency room? Or isn't it? You're listening to ER or Not on The Scope.

Interviewer: It's time for another edition of ER or Not, it's a game where you get to play along and determine whether a condition that we've talk about here warrants a trip to the ER or not? Today, we're with Dr. Troy Madsen as always. He's an emergency room physician at University of Utah Health Care. All right the scenario today is difficulty breathing. What do you think? ER or not?

Dr. Madsen: So difficulty breathing. So when we talk about issues that we had seen in the ER, my thought process is ABC. First thing is airway, and the second thing is breathing. So if you're having difficulty breathing, for me that is absolutely reason to go to the ER, and when I hear someone that's having difficulty breathing I think of a number of things.

Maybe they have asthma, maybe they've had an allergic reaction that's closing off their airway and making their lungs tight. Maybe they have a blood clot in their lungs, maybe they have heart failure, maybe they have a heart attack. All these things are serious things, these are not things you're going to be taking lightly. You're not going to call your doctor and say, "Hey, I'm having difficulty breathing can I get an appointment in a week?"

If this is something that's come on suddenly, you're having trouble getting deep breaths in, you feel shorter breath, your lungs feel tight, your throat feels tight, those are absolutely reasons not only to go to the ER but you may even consider calling 911.

Interviewer: Wow. So any difficulty breathing is probably something you need to take seriously?

Dr. Madsen: It is something you need to take seriously.

Interviewer: I know. I'm trying to make that very all inclusive.

Dr. Madsen: Yeah.

Interviewer: I mean is it?

Dr. Madsen: I don't want to tell you to call 911 right off the bat. Maybe you have a history of asthma and you're familiar with this and you've been exercising, and it's cold outside and your lungs feel a little bit tight and you know you've had experienced with it. You know if you use your inhaler, your lungs are going to open up, you're going to feel fine. I mean that's one kind of example there.

But here I think we're talking more about the person who typically is not used to having this throat tightness or lung tightness and suddenly they feel their lungs are tight, their throat is tight, they can't get a deep breath, that's the reason to get to the ER. Again, depending how severe it is, even call 911 or have a family member call 911 to go by ambulance.

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Debra: If you've been to the dentist you may have heard of laughing gas. Did you also know that it's used for labor pains? Today we'll be talking about nitrous oxide on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Debra: I'm Debra Penney and I'm talking today with Michelle Collins, PhD. She's also a certified nurse midwife and the director at Vanderbilt University of the Nurse-Midwifery Program. First of all Michelle, what is nitrous oxide?

Michelle: A lot of people think of nitrous oxide as laughing gas because that's what they know it from the dentist. It is similar to what they use at the dentist, but it's a different concentration. A lower concentration when we use it in labor.

Debra: And tell me, how is it given to women in labor?

Michelle: They inhale it either through a mask or a mouthpiece. The mask goes over their mouth and nose, where the mouthpiece they purse their lips around.

Debra: And can she be up and mobile while she's taking this gas or does she have to be in bed? How does that work?

Michelle: It does allow for a woman to maintain her mobility. So she can be on her birth ball, on her hands and knees on her bed, doing slow dance with her partner, in the rocking chair, any position really.

Debra: What kind of affect does it have on her and does it have any side effects?

Michelle: Probably the largest side effect is about 10% of women will feel nauseous or need to vomit. But that's only 1 out of 10 women. That's probably the most prevalent. Some women get a little bit dizzy when they use it as well.

Debra: What about the baby? How much of this gets to the baby?

Michelle: So there has not been a great deal of research done on nitrous oxide, although we have a large body of what we call anecdotal evidence, meaning it's been used for almost a century in other countries. So we have lots of babies born over lots of years in lots of countries to look at and we've not seen it affect the baby at all after birth. In other words, we don't see sleepy babies or drug affected babies from mom using the Nitrous.

Debra: Well it sounds like a pretty good thing then. If it's that good why aren't we using more of it here in the US? I understand there are only about 100 hospitals that have it available to laboring women.

Michelle: It was actually used in the '50s, and then with the advent of the epidural anesthetic it kind of went out of favor as epidurals rose in popularity. Now in other countries the epidural rate is not what it is, not as high as it is in the United States, so they continue to use nitrous oxide widely. For instance some countries, like Great Britain, 60% of all women in labor use it. Some countries like Norway 80% of women use it in labor.

Debra: So does this nitrous oxide work for every woman?

Michelle: Not every woman is going to take the nitrous oxide just like not every woman likes an epidural or not every woman likes a narcotic. Some women will try it and not like it at all, feel it's not helpful, and move on to something else.

Debra: When hospitals use it, do they have some kind of guideline in place for how it's given, or who gives it?

Michelle: In most places in the US the midwife or obstetrician or family practitioner, or whoever is taking care of the mother, gives an order to the nurse, and the nurse initiates the nitrous oxide. In some hospitals only an anesthesia person initiates it. So it's dependent on the hospital. In birth centers there are only midwives and nurses so they would be the ones doing it at a birth center.

Debra: So it sounds like a pretty good option. What other kinds of affects, other than taking the pain away, does it have any other affects on the mom?

Michelle: It is really good for anxiolytic properties. What that means is it decreases one's anxiety. So for some women it's not the pain of labor that is intolerable, but the anxiety. They're so afraid of the birth process. So it can decrease their anxiety and help their labor along.

Debra: So apart from labor pain, say she's waiting for an epidural that's really her drug of choice, can she still use this nitrous oxide while she's waiting?

Michelle: Yes, that's a good use of it, is for the woman to inhale it while we're having her epidural placed. Helps with the pain, helps with her anxiety and generally gets her through that transition period until the epidural is working well.

Debra: Have you ever seen it abused in the hospital? Or heard of stories with it abused?

Michelle: That's a common misconception and it doesn't appear in the literature as any problem in the European hospitals and we've been using it at Vanderbilt for four years and have not had one instance of that happening.

Debra: So what if a woman tries it and finds out she doesn't really like it?

Michelle: If she inhales a few breaths, part of the advantage of using nitrous oxide is it's a very quick onset. Within about 30 seconds she'll feel an affect, and it also has a rapid offset. Meaning if she doesn't like it, she stops breathing it, takes a couple breaths, and the effect is gone. And that is really one of the advantages of using nitrous oxide.

Debra: What are some of the other advantages?

Michelle: Besides not affecting the baby at all, that we have seen in use, women can also control it themselves, so it's not strapped to their face where somebody else is controlling it. They are empowered to breathe it when they want and not breathe it when they don't want. This makes it a really attractive advantage, and hopefully it will be widely available to women in the US soon.

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Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: We thought we take a moment here on The Scope Health Sciences Radio to do a mindfulness exercise. We're with Dr. Paul Thielking. He's at Huntsman Cancer Institute's Wellness Survivorship Center. He teaches an eight week mind and body skills group for cancer patients and a lot of it is being mindful to reduce stress and to sometimes reduce pain and I thought we'd do a quick exercise to see how this works. So, teach me this simple exercise. What's this one called?

Dr. Thielking: So, we'll just call this a breath meditation. Focusing on the breath as a very basic kind of starting point for a lot of mindfulness practices.

Interviewer: Okay. And what benefit should I experience when we're done doing this?

Dr. Thielking: Well, I'm hoping that by the time we're done with this very short exercise, you might feel a little more relaxed, like we do right now. Unless you're super relaxed already.

Interviewer: All right.

Dr. Thielking: And maybe you'll just feel a little more present with whatever is happening in the moment.

Interviewer: All right. I'm going to see if that happens. I'm curious about this.

Dr. Thielking: Sometimes it's better to actually do this as an experiential exercise than for me to talk about it.

Interviewer: Okay.

Dr. Thielking: So this is a great way to start.

Interviewer: Okay. So I invite our listeners right now, it's just going to take a couple of minutes.

Dr. Thielking: Let's say two to three minutes.

Interviewer: Okay. So we're just going to take a couple of minutes. So push your keyboard and mouse away and do this with us.

Dr. Thielking: And I'm rushing through this a little bit. So just to start with, make sure you're in a comfortable position. To start with, just focus on your body. Just notice if there's any areas that feel tense, if you're carrying any stress or tension in your body, your back, or your shoulders, any place else. And just quickly check in emotionally with how you're feeling right now. And then just notice what's going on with your thoughts, whether your mind is active or quiet. A

And anything is okay, whatever is going on right here right now in your experience is fine. We're not trying to change or manipulate it. It's just kind of taking an inventory. And then just notice your breath and for the next few breath cycles just focus on breathing in a little more deeply and a little more fully with each in breath. And then having a relaxed, slow exhalation. We do that two more times deepening and slowing your breath.

And then after your next exhalation, I'd like you to keep your mind focused on your breath but simply following it. You're not trying to change it. You're simply following your natural breathing, your in breath and your out breath. And if you find your mind getting distracted or yourself thinking about other things, you just gently bring your focus back to your breath. And sometimes it can actually help to count your breaths like counting up to four and then starting over again.

So in a real mindfulness kind of session, we might go on like this for another 10 or 15 minutes where we're just keeping our focus on our breath and bringing our mind back to our breath whenever we find ourselves distracted in a very open non-judgmental sort of way. Usually when people start with something like this, they might find their mind wandering before they can get to the second breath, that's normal. With practice though, it actually gets easier and we might even realize how often we're caught up in our minds, we're worrying about things when we weren't aware of it before. So this is a very short introduction in the interest of time but this is a basic mindfulness exercise that again, you might sit down and do for like 10 minutes as a starting point.

Interviewer: You were so right. I found my mind thinking about all the million different things that it's always thinking about. And then eventually there was a brief, brief little moment where it was completely blank and free. And you know how cool that felt? It felt really cool.

Dr. Thielking: If you allow your mind to relax like that, your body kind of follows and is able to relax too. That's the intention of this kind of exercise for people that are going through stress.

Interviewer: So I find myself kind of smiling too. Is that a normal response?

Dr. Thielking: Yeah. I think the things that people find as they feel more relaxed physically. Emotionally they might just feel a little more light, a little more at ease with whatever is going on. The mind naturally tends to settle after a little while. Maybe a minute or two is not quite long enough to notice some of these effects but the basic exercise of just coming back to the breath, people can just do on their own for as long as they want.

Interviewer: How about before you go to bed at night? Maybe schedule an extra 15 minute and just lay there and do this exercise?

Dr. Thielking: Yeah. It's great. Like you're pointing out you've got a million other things going on in your mind right now because you're in the middle of a busy day. The morning, first thing in the morning after getting out of bed or the evening before going to bed tend to be the easiest times for people to find a quiet place to set aside and do this sort of exercise. Some people are morning people, some people are evening people.

What I would suggest if you're interested in trying this is that you try to set aside 10 or 15 minutes everyday at the same time each day. It could be in the morning, it could be in the evening, it could be in the middle of the day if that works for you. And that you just try it for a week or two and you just have an open mind and notice whether it makes a difference or not.

Interviewer: Yeah. Having the open mind is kind of hard I think because if somebody was to come by as I'm sitting here breathing deeply, I'd feel a little silly about that maybe.

Dr. Thielking: Yeah. You might feel that way because you're doing it in kind of a public place right now.

Interviewer: Yeah, sure. Fair enough.

Dr. Thielking: But if you can find a quiet place alone in your own home, then you don't have to worry about what other people think.

Interviewer: Yeah.

Dr. Thielking: I mean sometimes I've done this, like sitting on a bus, sitting there with my eyes closed on a bus. You can find places like out in public too where it's not that noticeable. You're not calling attention to yourself.

Interviewer: So try it for a couple of weeks, keep an open mind. I can tell you I already feel a little bit more relaxed. I mean I think of all the stimulus we get on a daily basis. I've got my email open, I've got my phone, I've got messages coming through there. I'm thinking about my next thing and that little two minute period actually was kind of nice and I do feel a little refreshed.

Dr. Thielking: Yeah. It's kind of stepping away from all the stress in our lives even if it's just for 5 or 10 minutes. And if you do that on a regular basis you can actually make a difference and you can get back in your life with a clear, refreshed state of mind.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: July 16, 2019
originally published: April 29, 2015