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A Chinese Medicine Approach to Healing From “COVID Stress Syndrome”
Elizabeth Girard, MS, L.Ac.

Chinese Medicine Helps Stress and Anxiety

Abstract

For the last year, most of us have been mainly isolated at home during the pandemic. Due to the isolation and new worries of COVID19, it has brought about an even bigger mental health crisis. A group of symptoms that researchers are now calling “COVID Stress Syndrome” which includes a strong fear related to medical complications surrounding COVID 19 as well as the socio-economic impact it will have. A prior history of anxiety, depression and or other mental illness increases your risk of COVID Stress Syndrome (Brenner, 2020). Long-term stress and anxiety can cause an imbalance in our autonomic nervous system and negatively impact our long-term health. Heart rate variability (HRV) is a measurement of how well our body adapts to stress and a predictor of our overall health. A low HRV has been associated with an increase in heart disease and death. In this article, I will discuss three clinically proven and researched techniques to help to regulate your autonomic nervous system and increase your HRV. The techniques discussed are diaphragmatic breathing, acupuncture, and gratitude journaling. All three modalities are examples of strategies for managing and building mental stability during COVID 19. It is important to discuss any prolonged increase in anxiety or stress with your healthcare practitioner.

Keywords: COVID Stress Syndrome, Autonomic Nervous System, Heart Rate Variability, Diaphragmatic breathing, Acupuncture, Gratitude Journaling

        If you are like me, you have spent the last 11 months of “COVID times” on an emotional journey. One minute feeling hopeful to the next waking up in a panic over a thousand different things. According to the KFF health tracking poll taken in Dec. 2020 half of adults (51%) say worry or stress related to the pandemic has had a negative impact on their mental health, including one in four who say it has had a major impact (Luna Lopes, 2020). So how do we get off this emotional rollercoaster? Will these worries and concerns just suddenly disappear with the vaccine? Will we wake up tomorrow ready to just reenter back into the world like COVID 19 never existed? For the most part eventually, the answer will be yes. I believe we will adapt and evolve as a society and our economy will most likely recover over the next couple of years. But the chronic stress and anxiety must be addressed. According to the Anxiety and Depression Association of America, prior to the pandemic anxiety disorders were the most common mental illness in the U.S., affecting an estimated 40 million adults (18.1%) every year (2020). In an already overburdened mental healthcare system, how can we help support the healing and recovery from the emotional trauma of COVID19?

             As an acupuncturist and Chinese medicine practitioner, my approach to healing is to look at the “dis-ease” and find the root cause. What is imbalanced and needs to be corrected in order create homeostasis in a patient’s body? How does the increase in stress and anxiety affect our body? One way in which we know stress affects our body is through our Autonomic Nervous System (ANS) which controls our breathing and heart rate. Our autonomic nervous system processes outside stimuli from our environment and either activates our parasympathetic nervous system which allows us to relax or our sympathetic nervous system which alerts or excites us. Research has shown that an increase in stress creates a state of heightened sympathetic response in people. Meaning that someone with high stress lives in a normal state of an adrenaline rush. (Evidence Based Acupuncture, 2020). I often call patients in this state “wired” and “tired”. You experience heightened alertness and awareness which can be helpful at times but your exhausted from being anxious most of the day and still cannot rest or sleep.

        One way to objectively measure how well your body responds to stress is by checking your HRV. Your heart rate variability (HRV) is the variation in time between the beats of your heart. Your heart rate variability (HRV) is one way to measure if your body is more sympathetic dominant and can measure how adaptative your body is to stress. It measures your body’s health and resiliency. A high HRV means the person is healthy and can adapt and recover well to stress. A low HRV is often an indicator for poor health. Low HRV has been shown to cause an increase in inflammation and heart disease. One study looked at over 14,000 men and women and found that a lower HRV is associated with an increase in heart disease and death from several different causes (Dekker et al., 2000).

             Now that we have determined an underlying cause, we can now use that knowledge to start working on creating a more balanced system. There are several techniques that have been researched and shown to help regulate your autonomic nervous system and increase your HRV (heart rate variability). The three main techniques we use in our office is diaphragmatic breathing, Chinese medicine including acupuncture, and gratitude journaling.

            The first technique used and the simplest way to help regulate your autonomic nervous system is practicing deep slow breathing. Diaphragmatic breathing or “deep breathing” uses both your sympathetic and parasympathetic nervous system. Your sympathetic nervous system opens the lungs while the parasympathetic is responsible for closing them. According to John Hopkins Hospital, diaphragmatic breathing increases oxygen levels while decreasing carbon dioxide in our bodies. It also activates your vagus nerve (tenth cranial nerve) which helps slow our heart rate and regulate fluctuations in blood pressure. The vagus nerve is thought to control your parasympathetic NS (or relaxation response) and lower stress response (sympathetic nervous system reactions) (2021).  

          Slow breathing is defined as 4-10 breaths per minute (BPM). On average a typical patients breath rate is 10-20 BPM. We often use the “4-7-8 technique” which is just simply inhaling through the nose for 4 seconds, holding in for 7 seconds, and then slowly exhaling through the mouth for 8 seconds. Using this technique 4-5 times in a row. When you are inhaling make sure to extend your abdomen out and drop your diaphragm down. On exhale gently contract your abdomen in. Another name for diaphragmatic breathing is “belly breathing”.  

            Diaphragmatic breathing can help in managing symptoms of chronic pain, irritable bowel syndrome, depression, and anxiety. It can also assist in lowering blood pressure, lowering heart rate, decreasing cortisol levels (our bodies stress hormone), and improves your core muscle stability (John Hopkins Children’s Hospital, 2021).

            The next technique used is traditional Chinese medicine (TCM). TCM uses a holistic approach to treating anxiety which includes acupuncture, Chinese herbs, nutrition, and lifestyle suggestions. The key to treating any dis-ease in the body is to create your optimal health. Proper diet, regular exercise, and healthy sleep habits are the basics to treating any health condition. Acupuncture has been proven by several research studies to effectively help reduce stress and anxiety. A systematic review with meta-analysis of 14 different studies was published in 2014 which showed that acupuncture effectively helped modulate the automatic nervous system and increased HRV (Chung, 2014). Studies have shown that acupuncture can suppress the excitatory activity in the sympathetic nervous system and promote parasympathetic dominance. Our parasympathetic nervous system is important because it is thought to conserve and have restorative functions on our body. Acupuncture has also been associated with causing our bodies to increase the release of our “feel-good chemicals” called endorphins (Evidence based acupuncture, 2020). Endorphins are our bodies' natural opioids that help to alleviate pain and create a sense of euphoria.

          Several Acupuncture points have shown to be effective at reducing stress and anxiety. Acupuncture point Pericardium 6 (PC6) and Large intestine 4 (LI4) are two of the most common acupuncture points that have been shown to have positive effects on our autonomic nervous system and increasing a patient's HRV. Pericardium 6 is located bilaterally on the inner forearm approximately 3 inches below the wrist crease between the two tendons. This point is often used to help with nausea and cardiac issues such as palpitations. In 2017, 200 participants were divided into treatment groups to measure the effects on needling PC6. The study showed PC6 having positive effects on cardiac regulation in subjects exposed to fear-invoking stimulation (Huang et al., 2017). Large intestine 4 is located on the hand in the web between the thumb and index finger. This point can be helpful for headaches, face, and neck pain. Studies have shown LI4 to have a strong relaxation and analgesic function. Both acupuncture points are commonly used as acupressure points that can be done on yourself. Using firm pressure, press on each acupuncture point, one at a time for about 5 seconds, and then release. Repeat this process 4-5 times alternating between both sides.

          The last technique I commonly use is a practice I like to call “finding joy in your life”. There are several ways to achieve this, but the most common and easiest way is to commit to some form of gratitude journaling. Several recent pilot studies have concluded that gratitude journaling not only has a positive effect on HRV but also decreasing inflammation markers in the blood. These results suggest gratitude journaling can be a powerful tool to affect our moods, pain levels, and other chronic health conditions. Small studies using fMRI have even been able to detect changes in the brain after participants had practiced gratitude journaling in as little as 3 weeks (Karns, C. M., Moore, W. E., 3rd, & Mayr, U., 2017).

        The easiest technique is to write down at least 3 things you are grateful for either in the morning when you wake up or in the evening before you go to bed. Try to create a habit out of it and do it for 21 days straight.

          It is still too soon to know the long-term effects of COVID Stress Syndrome but according to the ADAA, only about 39% of people suffering from anxiety seek out help (2020). If you or someone you know is suffering from anxiety or are currently experiencing a higher-than-normal level of stress right, reach out for support. Talk to a friend or a family member but more importantly let a health care professional know how you are feeling. They will be able to assess if you may need more medical interventions and offer guidance on your next steps. I offer these techniques because for most people these are safe to use no matter where you are in your healing journey. They do not negatively affect medication use and can be used in conjunction with all other healing modalities such a cognitive behavioral therapy. These are safe, effective techniques that can be used to support us on the road to recovery and help build resiliency after COVID 19.  

References

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Brenner, G. (2020, July 11). COVID stress Syndrome: What it is and why it matters. Retrieved February 13, 2021, from https://www.psychologytoday.com/us/blog/experimentations/202007/covid-stress-syndrome-what-it-is-and-why-it-matters

Chung, J. W., Yan, V. C., & Zhang, H. (2014). Effect of acupuncture on heart rate variability: a systematic review. Evidence-based complementary and alternative medicine : eCAM, 2014, 819871. https://doi.org/10.1155/2014/819871

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Diaphragmatic breathing. (n.d.). Retrieved February 12, 2021, from https://www.hopkinsallchildrens.org/Services/Anesthesiology/Pain-Management/Complementary-Pain-Therapies/Diaphragmatic-Breathing

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Karns, C. M., Moore, W. E., 3rd, & Mayr, U. (2017). The Cultivation of Pure Altruism via Gratitude: A Functional MRI Study of Change with Gratitude Practice. Frontiers in human neuroscience, 11, 599. https://doi.org/10.3389/fnhum.2017.00599

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Post-covid stress disorder: Another emerging consequence of the global pandemic. (2021, January 08). Retrieved February 13, 2021, from https://www.psychiatrictimes.com/view/post-covid-stress-disorder-emerging-consequence-global-pandemic

Russo, M., Santarelli, D., & O'Rourke, D. (2017, December). The physiological effects of slow breathing in the healthy human. Retrieved January 19, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709795/

Uchida, C., Waki, H., Minakawa, Y., Tamai, H., Miyazaki, S., Hisajima, T., & Imai, K. (2019). Effects of Acupuncture Sensations on Transient Heart Rate Reduction and Autonomic Nervous System Function During Acupuncture Stimulation. Medical acupuncture, 31(3), 176–184. https://doi.org/10.1089/acu.2019.1350

Bibliography

Elizabeth Girard is a licensed acupuncturist and Chinese herbalist at Whole Body Healing, Acupuncture and Wellness, located in Northampton, Massachusetts. She received her Master of Science degree in Acupuncture and Chinese Medicine from one of the country’s top acupuncture schools, Pacific College of Oriental Medicine in 2008. She received a bachelor’s degree in Psychology from the University of Massachusetts in 2004. She is a licensed Acupuncturist and Herbalist in the state of Massachusetts as well as a board-certified by the National Certification Commission for Acupuncture and Oriental Medicine.

Elizabeth specializes in helping patients manage their own stress and anxiety naturally using a holistic approach of Traditional Chinese Medicine. She supports her patients to facilitate healing, building resiliency, and helping them find their inner joy.

 

 

Elizabeth Girard, MS, L.Ac.
Lyndsey Walsh, M.Ac., MS., L.Ac.
Kelly O'Connor, DAOM, L.Ac.

30 N. King St.
Northampton, MA. 01060
(413)345-0800
egwholebodyhealing@gmail.com
(Located within Northampton Naturopathic)

Whole Body Healing is Western Massachusetts leading Acupuncture and Chinese Medicine Clinic serving Northampton, Springfield and the Pioneer Valley.