Karen Faisandier works as a clinical psychologist in Wellington CBD at the Integrative Practice where she incorporates Acceptance Commitment Therapy (ACT), integrative medicine and ancestral knowledge.
I asked Karen why she chose to work in this field and she told me that she became interested in psychological theories while learning about childhood development as part of a nanny course in Palmerston North. She began a BA in psychology while starting a family, and decided to train in clinical psychology where she had a particular interest in working with people with substance use issues.
One of your key practices is Acceptance Commitment Therapy (ACT). Could you explain what that is?
It is known as ACT rather than A C T, and in a nutshell it’s a values based therapy approach that assists people to live a rich and meaningful life. What I like about ACT is the philosophy is very unique. The philosophy is not striving for symptom reduction, which many mental health therapies focus on.
ACT flips it round and it says as part of a rich and meaningful life we have all kinds of experiences, some of them pleasant and others not, including thoughts, feelings and sensations that we live with. So, the philosophy is around interacting differently with those experiences so that you can still have that rich and meaningful life.
But the paradox is that when you take that approach many of those difficulties will reduce or they may go, through simply taking this approach. It’s not supposed to be the aim because in that philosophy it’s the struggle with those experiences that keep people stuck. It’s the not wanting to have them, or the avoiding things because of them. So in ACT it suggests we take those experiences along for the ride.
Can you tell us why you favour this approach?
I favour the approach because it’s one that works for me. I came across ACT training when I was working at MidCentral DHB in about 2014. In my internship we were taught CBT, and we were assessed on our capacity to use and be successful with that. I didn’t experience that CBT would be that useful for me, and I didn’t observe that it was always that useful for others because of that whole notion that you can’t always use logic to change your thoughts. For many people, using this form of rationalisation can be useful sometimes, but my experience with clients taught me that often they weren’t able to access this ability when they were most struggling, as they got caught up in the thoughts further.
There’s times when you can’t do this kind of rationalising. Thoughts come and go and when people are in an overwhelming state of distress they are not always able to access the capacity to process questions like ‘What’s the evidence and what might be another way of seeing this?’. At that time they might not have that ability, because of how the mind works under stress or distress.
I look at it like, CBT works for people sometimes, and then ACT works other times – so it’s good if people know both then you have a choice, or repertoire, of tools.
You have a particular interest in an integrative approach to psychological wellbeing. Can you tell our readers what this means in practice?
There’s a field that exists called integrative medicine and another termed functional medicine. There’s a movement happening internationally within different type of health disciplines to incorporate these types of approaches to explore what are called ‘root causes’ of health concerns, looking at things like dietary and lifestyle causes of ill health and therefore solutions that target these areas rather than medication management alone. It is a new area within mental health and includes the new science around the role of gut health and nutrition in psychological presentations. There isn’t yet a guide book for how you use it, so it’s an individually tailored and trailblazing area.
Being integrative in practice means taking the best of conventional approaches and merging that with other approaches that may not be considered conventional, but that still have some evidence for them to be useful. Whether that’s practice based evidence, what people are reporting is useful, or scientific forms of research.
So, I like to combine both of those things. I think what people report is useful for them is a hugely important form of evidence that we often don’t think about. For example, there might be people that work with an osteopath and report how much that benefits their mental health. We might not have a lot of research evidence for the effectiveness as a treatment for psychological difficulties, but their experience is that it’s useful.
The other aspect of being integrative is looking at the whole, and that my client is the master of their own ship. They are consulting with you to figure out how they might go forward. Rather than you telling them what they need to do it’s a team approach. It’s more collaborative, may include other health professionals, and you’re looking at every aspect of that person’s life. So you’re considering their diet and lifestyle as well as the areas a psychologist is known to look at around thoughts, feelings, sensations and behaviour.
When you look internationally there is a lot of interest in it. It’s been slower to be taken up in New Zealand, but it is happening now as there is an increasing understanding of the importance of nutrtion and gut health in mental health. We have ACNEM in Australasia (the Australasian College of Nutritional and Environmental Medicine) where I did some of my training in nutritional medicine, and we’ve also got the Integrative Australasian Medicine Association.
More and more research is coming out about nutrition and mental health and people are becoming increasingly aware of its importance. Some of the research and information is quite complex. Could you tell us in simple terms why nutrition is so important to our mental health?
Nutritional psychology or psychiatry is gut-brain axis work and the gut-brain axis is more than a bio-directional relationship because it interacts with many other systems in the body as well, especially the HPA-axis (our stress response).
There can be endocrine involvement, immune system involvement, and the gut microbiome – which is the ecological system of bacteria that resides within us. We need to honour and look after it if we want to function well.
Your brain determines what you experience is stressful, so it sends messages down into the gut and can impact it. What we put into our body forms every cell in our body. There’s information in our food, it’s not just as simple as fuel that we have to have just to run. That metaphor doesn’t work. We’re not just like a car that needs petrol and off we go. We actually need vitamins and minerals and essential fatty acids to form our neurotransmitters to make our hormones, and to support our immune system. There are various reasons why many of us do not have optimal intake or absorption of nutrients in the 21st Century.
There are new exciting fields like epigenetics and nutrigenomics – which is a fascinating field where they find that simply the type of food you eat can switch your genes on and off. An example being, if you have a risky gene for diabetes what you eat may switch that on or off.
The food we eat now has changed so rapidly over the last hundred years. Our diet has completely changed. We now have food products that just weren’t even foods that we’re now consuming. The diet is entirely different so people are prone to a lot more difficulties because of that. We also have a chronically stressful environment which is putting strain on our stress response, and we’re eating in a way that’s not going to optimize our ability to handle that. For example, vitamin and mineral deficiencies affect your HPA axis, your sympathetic nervous system response and parasympathetic response (the relaxation arm). So if you’re deficient in magnesium you’re going to have a jumpier autonomic nervous system, so it’s going to be more prone to that fight or flight response. Just simply because of that deficiency! So you can impact on that by correcting that deficiency and making that system stronger again.
Many people look to change their diet to treat their mental wellbeing in a holistic way, but overhauling your diet can seem quite overwhelming. What starting steps do you advise to address mental health in a more holistic way through diet and nutrition?
Definitely look at finding practical ways that fit into your lifestyle to get higher nutrient food into every meal. Generally the most common recommendation is to switch up breakfast because most people are having cereal or toast. That means they’re missing out on an opportunity to put into their body the protein they need which are precursors to neurotransmitters to have stable good energy, good mood, and cognitive functioning over the day. So, if somebody can eat eggs, that’s a great start to the day, for example scrambled eggs or poached eggs on left over veges like sweet potato. If people eat meat have a side of bacon, if not they can have avocado.
It’s about what people like and how they can get that protein, fat and carbohydrate mix in there. So, that would be the number one start. When people do that, generally they report back they notice their energy through the day gets a bit better. Try to get that protein at lunch time too. Mostly people are having quite good dinners but the rest of the day the blood sugars not going to be supported. People have flagging energy and start to get anxiety through the day, as their body starts to feel the strain of not having what it needs, and can produce a stress-response and cortisol. This state is not designed to be constantly elevated, and taxes the body of nutrients while contributing to stress, anxiety, and mood concerns.
Another starting step is caffeine. If people are experiencing energy, sleep or anxiety problems, we’re going to be looking at caffeine because it’s taxing the system, it’s placing strain on that stress response and also producing cortisol. People tend to rely on it because they may be in a burn out stage. Caffeine is propping them up, making it possible to get through the day but actually what they need is the opposite, they need some rest and repair. So, reducing that caffeine and having a break or cutting it right out to weekends.
Green tea is a great stimulating drink that can give you an awake feeling without the speedy stressed feeling that caffeine can give. It’s a different type of caffeine and it’s a lower amount, and there’s a lot of health benefits in green tea as it’s also an antioxidant.
Importantly, detect and correct any vitamin or mineral deficiencies – B12 and other B vitamins, folate, zinc, and magnesium are some of the most common deficiencies which can present like depression or anxiety, and negatively impact on energy and cognitive functioning.
Ancestral knowledge (looking at health from an evolutionary perspective) is a field you have a lot of interest and hold value in. Can you tell us more about what it means?
Ancestral health is about considering the bio-psycho-social mismatch that we have currently between our physiology and how we as humans need to be connected, active, well-rested and well nourished. The society that we’ve now created is very fast paced and quite isolative a lot of the time, with processed food and us being very sedentary and using screens till the wee hours and having this 24/7 instant gratification going on. We can buy anything, anytime or do anything, any time and we’re just not designed for that. Using ancestral knowledge, we can understand some of the behavior we find ourselves struggling with, which used to be adaptive but that is now malfunctioning for us because we’re in this environment.
Sugar is an example of this. Back in the day it just wasn’t available like it is now. If you came across honey in the environment, you eat all the honey and you don’t have an off switch because you might only come across that every so often.
We’re not designed to have an off switch for that situation, we’re designed to be able to indulge in this way. Now we’ve got honey at any moment and we still don’t have an off switch, so the way we’re wired to indulge because of scarcity can be problematic.
Can you tell us why you think ancestral knowledge is important to holistic health and wellbeing?
If you know about how we’re designed to be, and what we need to function optimally, then you can bring the best of that into this modern time. Ancestral health is definitely not about going back to living in caves. It’s actually about thriving now, but being able to understand that we can’t change our evolutionary design. We haven’t evolved to the point we can actually function well living this way. So, its understanding some basic things like the fact that you need to not have screen light exposure at the end of the day if you want to sleep well, if you want to produce your sleepy hormones – which are intricately connected to your feel good hormones the next day – you need to be off screens so your brain can produce melatonin, so you can have a deep sleep and you can wake up when the sun rises and get into the next day.
When we understand our physiological needs then we can find ways to incorporate daily nutritional and lifestyle behaviours that allow us to thrive in a pretty challenging environment.
Are there any up-coming events in these fields that our readers might be interested in if they wanted to learn more?
I’m the Wellington lead for the Ancestral Health Society of New Zealand which is a not for profit organization. We’re all just geeks that are interested in ancestral health and most of us are health professionals, but not all of us, and we really want to help New Zealand by providing this perspective for people that are interested in it.
We have a newsletter people can sign up for, people can support the society and we host events. We are hoping to do more small, local, community based gatherings on various topics within our expertise but coming at it from the ancestral perspective. We just had an Auckland one a few weekends ago which was on inflammation and health, and there was one down here in Wellington on the 19th August on men’s mental health. It looked at stress, busyness, what is it to be a man, and solutions for stress and depression.
The Society also holds a bi-annual symposium and that’s coming up in October in Queenstown, which is open to the public. That’s the great thing about it, it’s open to health professionals and it’s open to everyone. We enjoy everyone coming along and sharing their perspective or engaging and asking their questions.
Bi-annual Ancestral Health Symposium – https://ancestralhealthnz.org/event/symposium-2017/
If our readers wanted to learn more about you and what you do, how should they get in touch?
I have a website www.theintegrativepractice.com with a few blogs I’ve written, and a Facebook page where I share content on integrative and nutritional psychology regularly: https://www.facebook.com/theintegrativepractice/
Speaking with Karen gave me the opportunity to learn more about her work in integrative practice and how that supports holistic health. As Karen says, it is a trailblazing area in mental health, and after our conversation I felt optimistic and hopeful about seeing how this approach develops in the future.