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Self-Care & Mental Wellness: Dr. Susan B. Trachman On The Top Five Selfcare Practices That Improve Mental Wellness

An Interview With Maria Angelova

Let’s face it. It seems that everyone is under a great deal of stress these days. This takes a toll on our mental wellness. What are some of the best self-care practices that we can use to help improve our mental wellness and mental well-being? In this interview series, we are talking to medical doctors, mental health professionals, health and wellness professionals, and experts about self-care or mental health who can share insights from their experience about How Each Of Us Can Use Self Care To Improve Our Mental Wellness. As a part of this series, I had the distinct pleasure of interviewing Susan B. Trachman.

Susan B. Trachman, MD is a practicing psychiatrist with over 30 years of experience who is passionate about exploring medically unexplained illnesses through the lens of psychiatry. In addition to private practice, she is an ​​Assistant Clinical Professor of Psychiatry at Virginia Commonwealth University and Clinical Associate Professor of Psychiatry at George Washington University, where she teaches medical students, residents and post-residency fellows in psychiatry.

Thank you so much for doing this interview with us. It is a great honor. Our readers would love to learn more about you and your personal background. Can you please share your personal story? What has brought you to this point in your life?

Thank you so much for this opportunity. As a child, I always wanted to figure out how things worked. Unfortunately for my mother, I disassembled a kitchen clock to try and figure out time….didn’t work out too well! Luckily, I didn’t break into the TV screen to see if I could be a guest on the show that was playing.

Initially, I thought I would be a veterinarian, because my first friend literally was my dog. My father brought Bruno home when I was only ten days old. He was my constant guardian and companion.

In college, I suffered through premed classes and decided it wasn’t for me, so I chose a different path. I switched to psychology and my need to figure things out shifted to the role of the brain in influencing mood and behavior. Once in medical school, I found psychiatry, particularly the subspecialty of psychiatry that combines medicine, mood, and behavior to be the most interesting, and decided to pursue a residency in psychiatry. During my residency, I had the opportunity to learn from excellent mentors and at their urging, applied for a fellowship in psychosomatic medicine. That is the subspecialty within psychiatry that specializes in the mind-body connection or more specifically, the biopsychosocial model of illness. This model conceptualizes medical illness as the product of multiple factors: psychological factors, environmental factors, and biologic/genetic factors.

What is your “WHY” behind what you do? What fuels you?

I find human behavior endlessly fascinating. Although we have come a long way toward understanding the brain and how it affects everything in our daily lives, there is always more being unearthed. I learn something new every week, often through my interaction with my patients. As psychiatrists, we must adapt and be flexible. Each patient is different, as are their circumstances. We don’t have fancy equipment, so we must rely upon our knowledge base and experience, but also on what we see and sense as we sit with our patients. Learning to rely on your senses; sight, sound, and smell can provide a wealth of information about what is going on with another individual. That should be true of all branches of medicine, but unlike my primary care friends, I have the luxury of time to spend with people during their appointments and do not have to arrive at a diagnosis and treatment plan within a fifteen-to-twenty-minute period. COVID was a challenge for all of us, but particularly for those with mood and anxiety disorders. I never provided telemedicine as an option until the pandemic forced many of us to do so. Learning how to provide adequate care through a screen was a new frontier, but one I eventually assimilated into my practice.

Sometimes our mistakes can be our greatest teachers. Can you share a story about a mistake or failure which you now appreciate has taught you a valuable lesson?

When I entered medical school, I was sure I would become an OB-GYN. The mistakes I learned and the experience I had in my OB-GYN third-year clerkship were a rude awakening, but also taught me a valuable lesson which I share with medical students, residents, and even patients.

One of the jobs of a third-year medical student is to hold retractors and cut sutures during surgery. From day one of my OB-GYN clerkship, a second-year resident took a real dislike to me. At our first surgery together, he turned to me and said, “cut.” Holding scissors, I cut the sutures. “Too long,” he said. Taking that into consideration during our next procedure, when he said, “cut,” I cut the sutures a bit longer. “Too long!” he replied. This went on for four weeks in addition to his finding fault with just about anything I attempted. By the end of that time, I decided this specialty was not for me, my experience had been demoralizing. On the final night when I was the on-call student, I was called into an emergency surgery with my hated resident and a very lovely private attending physician. It was the middle of the night, I was tired, frustrated, and fed up. When the resident said, “cut”, this time I answered, “too long, or too short?” The attending laughed so hard behind his surgical mask, I thought he would fall into the poor unconscious patient’s abdominal cavity! The resident never bothered me again.

So, what did I learn from these mistakes? Sometimes, no matter what you do, right or wrong, there are people who will never be happy with your performance, it is a valuable life lesson.

You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?

Don’t assume you know the answer when you don’t: I would like to think I’m pretty good at what I do, but I can be fooled. Sometimes, it is tempting to jump to a conclusion based on limited information. I teach this to medical students and residents. I used to give practice exams or “mock boards” to the psychiatry residents getting ready to sit for the psychiatry boards. We were one of the only specialties in medicine that required our practitioners to take written and oral board exams. The oral exams were notorious for failing even qualified candidates. Candidates were faced with an unknown real live patient to interview in 30 minutes while three board examiners sat in the room with them watching their every move. Even qualified individuals saw this as a terrifying experience and could “choke.” After the interview, the candidate would have a few minutes to process the information and arrive at a possible diagnosis and treatment plan while the examiners would ask whatever questions that they chose to. If the candidate “knew” the answer but did not even consider alternatives — automatic fail.

When I took the oral boards, I was seven months pregnant with my daughter. I knew my location was at a veteran’s hospital, so I studied up on diagnoses like post-traumatic stress disorder, anxiety disorders, and substance abuse the night before. The interview did not go particularly well. The patient was not that forthcoming. Time was running out. I had no idea what he suffered from. Five minutes before they called “time,” he spewed out information I had not expected — he assaulted someone with a hammer and ended up in jail: TIME!

Now I was in trouble, my original thoughts about PTSD and substance abuse did not fit. This guy had a serious personality disorder I did not review the night before the test. When the examiners started their questions, I remembered — don’t assume you know the diagnosis, discuss everything it might possibly be and maybe they will have mercy on you and your enormous belly. Fortunately, they did.

Treat all professionals as your equals or more: As physicians, some of us believe by virtue of our degree we are entitled to more respect than someone else — not true!

When I was an intern in medicine, one of the hardest services I worked on was oncology. The patients are very sick, there are a lot of them, and you better be a team player. The nurses on that service were my best friends — they had much more experience than me and if I pitched in and helped them with their work, they would have my back. When I was on all-night call, I did all my own blood draws, placed intravenous catheters, and asked the nurses for advice when I was unsure of something. I was one of the only interns who was given a nice bed to sleep in when we weren’t terribly busy. I think this philosophy has helped me in my practice. When patients feel as though they are being treated with respect, they appreciate it and are more likely to be a collaborator in their own care, comply with treatment recommendations, and get better. When patients feel they are unheard, or their concerns are being minimized by their practitioner, they have worse outcomes. Medical students and residents do not learn effectively when they are treated poorly. I think I am a good teacher because I try and provide a non-threatening environment for them to learn, and offer constructive rather than demoralizing feedback.

Be flexible: Things will not always go as planned. Being rigid is a recipe for disaster.

One of my teaching roles is running the psychiatry consultation team several times per year in a major teaching hospital. We get called by other medical teams to evaluate patients that have complicated psychiatric histories, are difficult to manage, or are acting in a manner that is not easily understood by the treatment team. Yes, we have strong opinions about how some of these patients are being managed. But I must remind my team that we are consultants and must negotiate with the managing team on how to best serve their patient. In order words, we must be flexible and work within their guidelines not based solely on what we think should be done. Sometimes, this is challenging.

What are some of the most interesting or exciting new projects you are working on now? How do you think that will help people?

Thank you for asking this question. I am writing a book, tentatively entitled, It’s Not Just In Your Head. It explores medically unexplained symptoms as the product of the connection between your brain and the rest of your body. Ten of the most common problems that lead adult patients to seek help from their primary care physician include chest pain, fatigue, dizziness, headache, swelling, back pain, shortness of breath, insomnia, abdominal pain, and numbness. These account for almost forty percent of primary care visits, yet a “biological” cause is found only about a quarter of the time. In this scenario, doctors may express frustration at the lack of diagnosis, but more importantly, his or her exasperated response can make patients feel disrespected, uncared for, and even hopeless. My goal in writing about this is to help the millions of people worldwide who suffer from one or more of these illnesses to feel heard and understand that their illness is not in fact medically unexplained — it is explainable if their practitioner knows where to look. In preparation for the eventual book launch, I had the opportunity to participate in several podcasts related to these topics, create a blog on Psychology Today entitled It’s Not Just in Your Head, and be interviewed by journalists like yourself. All of this is very exciting!

OK, thank you for all of that. Let’s now shift to the main focus of our interview, about the interface between self-care and mental health. From where you stand personally or professionally, why are you so passionate about mental well-being?

Personally, and professionally, I believe to make an arbitrary distinction between physical and mental health makes absolutely no sense. If I cut your head off, could you function? Of course not! Mental health equals overall health. We know that many medical illnesses are either caused or mediated by what is going on in your brain. For example, untreated depression is an independent risk factor for the development of cardiovascular disease. Experiencing stress is positively correlated with worsening irritable bowel disease. Anxiety which occurs in approximately 30% of the U.S. population is only diagnosed in one third of cases and untreated, can worsen your immune function.

Based on your research or experience, how exactly does self-care impact our mental wellness?

The concept of self-care can be different from person to person, but on a fundamental level, practicing self-care means taking care of yourself to maintain your overall health.

Self-care techniques and general lifestyle changes can help manage the symptoms of many mental health problems. They may also help prevent some problems from developing or getting worse. Self-care is vital for building resilience toward life stressors in life that are inevitable. Many of these techniques revolve around basic concepts that can be easily neglected.

In 1946, the first publication devoted to self-care was created. The term self-care was added to the Medical Subject Headings of the National Library of Medicine in 1981 and was defined as caring for self when ill, or positive actions and adopting behaviors to prevent illness.

In 2019, the Theory of Self-Care of Chronic Illness was refined to clarify how symptoms relate to the self-care process. This would apply to both physical and mental illness. Investigators revealed the complexity of self-care, and illustrated through their research a wide variety of factors influence the decisions that individuals make about engaging in self-care. What is clear, however, is the positive correlation between self-care behaviors and positive health outcomes. For example, individuals with diabetes fare much better if they follow a diabetic diet and engage in even moderate exercise. Those with cardiovascular disease have better outcomes if they practice behaviors that lower their blood pressure. These self-care behaviors include a sodium restricted diet, exercise, and smoking cessation.

In my practice, many of my patients suffer from health issues along with mood and/or anxiety disorders. I encourage healthy eating, engaging in regular exercise, limiting alcohol and/or other recreational substances, and very importantly maintaining a regular sleep routine. Even following one of these recommendations can positively improve mental health outcomes. I recently wrote an article entitled, Exercise Can Save Your Life. The research I reviewed for this article includes studies that cite the following benefits of regular aerobic exercise on mental health:

  • Psychosocial and Cognitive Factors: Exercise can increase your sense of self-worth, self-confidence, sleep quality, and life satisfaction. Some studies documented that during exercise interventions, you may seek social support which reduces loneliness. Based on psychological and social benefits, group exercise may be more effective than individual exercise.
  • Anti-Inflammatory Factors: Inflammation is involved in the development of depression. Stress can cause your brain to release chemicals that lead to the experience of depression and/or anxiety. In a 12-week study of depressed elderly patients, aquatic exercise decreased depression and anxiety as well as inflammation.
  • Brain Growth: The anti-depressant effects of exercise are associated with neurogenesis — the process by which your brain increases the amount of brain cells. In addition, exercise is positively associated with increased neuroplasticity — the ability of the brain to form new connections and pathways and change how its circuits are wired.
  • Release of natural chemicals that make you feel good: Endorphins which are natural cannabis-like brain chemicals are increased during vigorous exercise. This likely explains the well-known, “runners high.”
  • Decrease in stress hormones: Cortisol is one of your body’s stress hormones, released as part of the fight-or-flight reflex. Too much cortisol for too long can have serious, negative effects. Exercise is perceived by the body as a form of stress and initially stimulates the release of cortisol. However, the more your fitness improves, the better your body becomes at dealing with physical stress. This means less cortisol will be released during exercise and more importantly, in response to emotional or psychological stressors.
  • Distraction: When you engage in strenuous exercise, it takes your mind off the things that are troubling you. You can take a break from a cycle of negative thoughts that feed depression and anxiety.

Here is our primary question. Can you please share your “Top Five Selfcare Practices That Each Of Us Can Use To Improve Our Mental Wellness”?

Thank you for this question. There are certainly more than five selfcare practices that improve your mental health. However, if I had to choose my top five, they would be:

  • Sleep: Sleep deprivation studies show even healthy people can experience increased anxiety and distress levels following poor sleep. Those with mental health disorders are even more likely to experience chronic sleep problems and, in turn, these sleep problems are likely to exacerbate psychiatric symptoms and even increase the risk for suicide. Psychiatric disorders are brain disorders. Sleep is what your brain requires to recharge on a nightly basis. If you deprive your brain of the ability to recharge, it is akin to having the battery in your car drain. Eventually, the car will not turn on. The National Sleep Foundation recommends most adults get between 7 and 9 hours of sleep each night and adults over 65 years of age get between 7 and 8 hours. The rapid growth and development of youth mean children need additional hours of sleep, with specific recommendations varying by age. Babies might need up to 17 hours per night, while the range for teens is 8 to 10 hours. Quality sleep is continuous. Sleeping straight through the night with minimal disruption is more restorative than having your night’s sleep interrupted frequently or for long periods of time. Disrupted sleep interferes with the natural process of cycling through all four stages of sleep and may keep you from getting a healthy amount of deep sleep and REM sleep. Getting a healthy amount of sleep is a key part of a good sleep pattern.
  • Healthy Diet: Did you know your diet can affect your mood? One of the main roles of the gut is to process and digest nutrients. What you eat, directly influences the makeup of bacteria in your gut-known as the microbiome, which in turn impacts your health. A healthy gut helps prevent chronic diseases like heart disease and cancer and can reduce inflammation. A healthy gut keeps your brain healthy, and helps you maintain a healthy weight. Processed food like bacon (which tastes really good) lacks diversity and fiber and is often filled with additives such as sugars, salt, and/or artificial sweeteners which contribute to poor gut health. This is not to say you can never have bacon, just try, and eat it in moderation. Garlic isn’t only good for keeping vampires at bay. It acts like preventative medicine and may reduce your risk of heart disease. It is an anti-inflammatory food and contains two healthy fibers. Dark chocolate is a rich source of antioxidants and minerals, and it generally contains less sugar than milk chocolate. Some research suggests dark chocolate may help lower the risk of heart disease, reduce inflammation and insulin resistance, as well as improve brain function.
  • Maintain an exercise routine: As mentioned previously, regular exercise has a significant positive impact on overall health. A study published in the British Journal of Sports Medicine found exercise was equivalent to antidepressants in effectively treating mild to moderate depression. Interestingly, adding an antidepressant to an exercise regimen did not increase the effectiveness of the medication. In the population studied, exercise used alone as treatment worked just as well as medication.
  • Maintain Social Contacts: During COVID, with the world shut down it became easy to feel isolated and alone. I am a doctor who practices what I preach. During the pandemic, while maintaining good health practices, I maintained close contact with my female doctor friend group through small socially distanced dinner parties outside of my home. We all looked forward to these events — not just to share concerns about how our patients were faring, but to help each other cope with the stress of practicing during unknown times and helping to raise each other’s spirits. Similarly, my college friends and I initiated a twice-monthly virtual friends’ chat. We laughed and shared our own experiences in isolation but also recommended good books, recipes, and Netflix suggestions. Emma Seppala of the Stanford Center for Compassion and Altruism Research and Education, and author of the 2016 book “The Happiness Track,” wrote, “People who feel more connected to others have lower levels of anxiety and depression. Moreover, studies show they also have higher self-esteem, greater empathy for others, are more trusting and cooperative and, consequently, others are more open to trusting and cooperating with them.
  • Meditate: Research over the past two decades broadly supports the claim that mindfulness meditation — practiced widely for the reduction of stress and promotion of health — exerts beneficial effects on physical and mental health, and cognitive performance. A 2011 study from the Harvard Medical School examined the effects of mindfulness meditation on the brain and found a connection between mindfulness and processing new information. According to researchers at Stanford University, mindfulness meditation can especially help those with social anxiety. In a 2009 study published in the Journal of Cognitive Psychotherapy, 14 participants with social anxiety disorder participated in two months of meditation training and reported decreased anxiety and improved self-esteem after completing the program. Research has also supported the benefits of mindfulness-based stress reduction (MBSR) — a therapy program that incorporates mindfulness meditation. Studies have found that MBSR can help those with anxiety calm their minds and reduce symptoms of depression, including trouble sleeping, loss of appetite, and low mood. I often hear, “I don’t have time for this!” to which I reply, “You don’t have to take a twelve-week program on MBSR. There are free apps such as Headspace and Calm that are 10 minutes per episode and can be downloaded to your phone.

Can you please share a few of the main roadblocks that prevent people from making better self-care choices? What would you suggest can be done to overcome those roadblocks?

As humans, we tend to resist change. The prospect of change may lead to emotional anxiety caused by the prospect of a transformation or change that is taking place. It may be the result of fearing the unknown — “what if I try to change but find the effort was not worth it?” Or “what if I try but can’t do it?” This may be a fear of failure. We also tend to be attached to our habits, both positive and negative. The loss of autonomy or control is another reason we resist change. Generally, individuals do not like to be told what to do or lack the motivation to alter the status quo.

To overcome resistance to change, one must be patient. Things will not change all at once. It is helpful to break things down into more acceptable options. So maybe the first step is to try and improve sleep patterns. Do not attempt to change sleep, diet, social engagement, and meditation all at once. Do not expect to be successful at every attempt. Just trying is better than not doing anything at all. Perfection is a fantasy; progress is reasonable.

In one sentence, what would you say to someone who doesn’t prioritize their mental well-being?

I think I would first ask, “what do you prioritize?” and try and link mental well-being to their answer.

“Life Lesson Quote”? Why does this quote resonate with you so much?

That’s a tough one because I have heard so many. I guess I like “treat others the way you would hope to be treated?” We’re all in this together and it never hurts to be nice.

We are very blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world or in the US whom you would love to have a private breakfast or lunch with, and why? They might just see this, especially if we both tag them :-)

When I was growing up, Billie Jean King was one of my idols. I played for my tennis team in high school and continued to watch her role in the sport. As I became an adult, my admiration for her expanded — not only is she an excellent athlete but a humanist, feminist, and role model for all those who strive to openly be their true selves. She opened the door for many women and was at the forefront of gaining equal pay for women in the sport. She continues to be one of my idols and I would be thrilled if she read this and wanted to share breakfast with a fangirl!

This was very inspiring. Thank you so much for the time you spent on this. We wish you only continued success.

About The Interviewer: Maria Angelova, MBA is a disruptor, author, motivational speaker, body-mind expert, Pilates teacher and founder and CEO of Rebellious Intl. As a disruptor, Maria is on a mission to change the face of the wellness industry by shifting the self-care mindset for consumers and providers alike. As a mind-body coach, Maria’s superpower is alignment which helps clients create a strong body and a calm mind so they can live a life of freedom, happiness and fulfillment. Prior to founding Rebellious Intl, Maria was a Finance Director and a professional with 17+ years of progressive corporate experience in the Telecommunications, Finance, and Insurance industries. Born in Bulgaria, Maria moved to the United States in 1992. She graduated summa cum laude from both Georgia State University (MBA, Finance) and the University of Georgia (BBA, Finance). Maria’s favorite job is being a mom. Maria enjoys learning, coaching, creating authentic connections, working out, Latin dancing, traveling, and spending time with her tribe. To contact Maria, email her at angelova@rebellious-intl.com. To schedule a free consultation, click here.

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Maria Angelova, CEO of Rebellious Intl.

Maria Angelova, MBA is a disruptor, author, motivational speaker, body-mind expert, Pilates teacher and founder and CEO of Rebellious Intl.