Behavioral Nutrition

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The Amazing Health Benefits Of Chia Seeds

Published in MindBodyGreen


The Amazing Health Benefits Of Chia Seeds


I I am often hesitant about fad supplements, products that become popular overnight, or that claim to have great health benefits. However, the recent trend toward consuming chia seeds has not disappointed me!
I decided to incorporate chia into my family’s dietary routine, as it assists in weight loss as well as reducing glucose levels which can benefit diabetics.1 My whole family has benefited from its addition to our meals, and my husband has found chia to be the solution to reducing his sugar cravings. Many people consume chia before a meal to reduce hunger, and I've found it to be a great breakfast drink. I feel energized, satisfied and awake after a nice glass.
Although I'm not a long distance runner, indulging in chia loading is better than carbohydrates or energy drinks to enhance athletic performances for endurance events.2 Research has also demonstrated that the beneficial effects of omega-3, as found in chia, has helped those suffering with mood disorders. A meta-analysis of trials involving patients with major depressive disorder and bipolar disorder provided evidence that omega-3 in chia reduces symptoms of depression.3 Omega-3 fatty acids have been proven in increase brain function and decrease depression. So, incorporating chia into your diet on a regular basis helps not just your physical health but also your mental health.
The optimal daily consumption of chia is four tablespoons throughout the day, but you can gradually work your way up to that amount starting with one tablespoon a day.4 Adding just two tablespoons of chia seeds to your daily diet will give you approximately seven grams of fiber, four grams of protein, 205 milligrams of calcium, and a whopping five grams of omega-3. Chia has both soluble and insoluble fiber, which is a great benefit. That's why the seeds expand in liquids without losing any of the fiber content. If you consume four tablespoons per day of chia, you get 14 grams of fiber. By comparison, one packet of oatmeal has only four grams of fiber.
Although we eat a lot of salmon, no one in my family is very fond of taking fish oil supplements as a source of healthy fats. As chia is a very stable source of omega-3 fatty acids, we use it regularly to supplement our diets. A mere 3½ tablespoons contains as much omega-3s as a 32-ounce piece of salmon. Chia seeds can also be ground into flour as an alternative for those with gluten allergies, such as my oldest son.
Chia is often served in drinks or smoothies, but if you don't want to use it in a drink it's easy to sprinkle on your oatmeal, directly on your meals, or stir it into a Greek yogurt. Chia has a neutral flavor, so it goes with just about anything. And, as a bonus, chia seeds can be stored for long periods of time in your refrigerator or pantry without going rancid, which makes it easier to save money by purchasing them in bulk.
(1) Guevara-Cruz, M., Tovar, A. R., Aguilar-Salinas, C., Medina-Vera, I., Gil-Zenteno, L., Hernández-Viveros, I., Torres, N. (2012). A dietary pattern including nopal, chia seed, soy protein, and oat reduces serum triglycerides and glucose intolerance in patients with metabolic Syndrome1-4. The Journal of Nutrition, 142(1), 64-9. Retrieved from
(2) Travis, G. I., Jason, C. C., & Phillip, A. B. (2011). Omega 3 chia seed loading as a means of carbohydrate loading. Journal of Strength and Conditioning Research, 25(1), 61-65. Retrieved from
(3) Ross, B. M., Seguin, J., & Sieswerda, L. E. (2007). Omega-3 fatty acids as treatments for mental illness: which disorder and which fatty acid? Lipids in Health & Disease, 621-39. doi:10.1186/1476-511X-6-21
(4) Coates, W. (2012). Chia: The complete guide to the ultimate superfood. Sterling Publishing: New York, NY.


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Published March 4, 2013 at 8:51 AM

What Produce Should I Purchase Organic or Non-Organic?

I love to shop at the local farmers markets for my fruit and vegetables. By shopping local you know you are getting the freshest foods and, by getting to know your neighboring farmers, you can ensure that your purchases are organic. But, as we enter the winter season they become less available which leaves us with the supermarkets or organic food stores.

Buying organic in these markets can be quite pricy. Often, well intended consumers are left with a financial decision regarding which fruits and vegetables they should purchase organic or non-organic. When I go shopping for my family, I also adhere to our personal budget. But there are certain products I will not compromise on when it comes to buying organic. I say that because these products have the highest levels of contaminants. So, include space in your budget to purchase the following items in the organic section:

  • Celery
  • Peaches
  • Strawberries
  • Apples
  • Blueberries (Domestic)
  • Nectarines
  • Sweet Bell Peppers
  • Spinach
  • Cherries
  • Kale / Collard Greens
  • Potatoes
  • Grapes (Imported)

These foods have a tendency to absorb industrial chemicals and pesticides.  The Environmental Protection Agency states that an overconsumption of foods with these toxins can result in a decreased immune system, some forms of breast cancer, and gastrointestinal and nervous system disorders. Alarmingly, there is relationship between consumption of these foods and cases of ADHD in children. So, spend your money buying these products organic for the safety of you and your family’s health.

The good news is there are some products that you can buy in the regular produce section at a lesser cost than the organic product. These products absorb fewer industrial chemicals and pesticides than other produce. They include:

  • Onions
  • Avocado
  • Sweet Corn (Frozen)
  • Pineapples
  • Mango
  • Sweet Peas (Frozen)
  • Asparagus
  • Kiwi Fruit
  • Cabbage
  • Eggplant
  • Cantaloupe
  • Watermelon
  • Grapefruit
  • Sweet potato
  • Honeydew melon

It is nice to know that there are some options available to us in the grocery stores that we do not need to purchase in the organic section. Shopping locally and seasonally from your local farmer’s market is always the ideal situation.  However, this list can be used as a guideline when those options are not available

Happy shopping!


Did your parents influence your eating behavior?

From a strictly intellectual perspective there are many people who are aware of the importance of eating nutritionally and, as parents, many of us can try to present a positive example for our children which would allow for them to avoid eating a poor diet. 

However, there are many things that family members do to influence behaviors that are not necessarily what we may consider to be intelligent.  For example, there is research that has demonstrated relationships between parental influence on eating behaviors that does not reflect intelligence such as pressure from mothers towards their daughters to maintain an unrealistic body image (resulting in anorexia nervosa) or excessive overeating behaviors (resulting in bulimia nervosa) (Fairburn & Brownell, 2002).  However, most often this is not intentional behavior and it simply be a result of the parent’s contextualism, which is often associated with her culture or upbringing (Sternberg, 2006).

So, if we want to change this trend behavioral modification should start at the family unit and not just the individual child.

Fairburn, C. G., & Brownell, K. D. (2002).  Eating disorders and obesity: A comprehensive handbook (2nd ed.). New York, NY: The Guildford Press.

Sternberg, R. (2006). Cognitive psychology (4th ed.). Belmont, CA: Thomson Wadsworth.


Is technology is turning the tide for weight loss programs? 

The rapid increases in technological advances are both commended and criticized.  From a medical perspective, people are living longer due to scientific advances but some fear that quality of life is not benefited by this process.  From a business perspective, knowledge is shared at a rate that seems to triple every year yet many feel that this technology has decreased the development of face to face relationship and has caused the infamous “crack-berry addictions” (the obsessive need to check your Blackberry or other phone device continuously). 

In the area of weight loss technology, online dietary management programs have been popping up everywhere and with great success.  I experimented with Weight Watcher’s online point system and have used the online Atkins program (not an endorsement).  Now, a personal mobile device has been shown, in a scientific study, to have weight loss that is three times the amount of an individual not using the device (Xuemie et al., 2011).


The device is called SenseWare, which is an armband, and it provides data analysis of your total energy expenditure (kcal/min), active energy expenditure (kcal/min), total number of steps, physical activity levels and duration, sleep duration and efficiency, lying down time and on/off body time among others.  This wearable body-monitoring technology allows an individual to work in conjunction with their health provider to set health goals. 

Although I think this advance in technology is wonderful, I propose these questions to the readers: Should individuals increase reliance on technology or should they focus upon learning behavioral change management strategies? Which is a more effective psychological solution to achieve health goals? I think that we cannot turn the clock back on technological advances, but that we should incorporate motivational and behavioral psychological strategies while increasing a person’s understanding of personal cognitive styles to achieve weight loss so that it is effective in the long term. Regardless of your preference, technological advances are improving the ability to observe a person’s health behavior in a more effective manner that relying upon self-report data and this is beneficial to us both as patients and as professionals. 

Xuemie, S., Meriwether, R. A., Hand, G. A., Wilcox, S., Dowda, M. & Blair, S. N. (2010). Electronic feedback in a diet and physical activity-based lifestyle intervention for weight loss: randomized controlled trial. 2010 AHA 50th Annual EPI/NPAM Joint Conference.  Retrieved from:


Can men have eating disorders? Advice to a friend. 

I recently received a question from a female friend regarding one of her male friends.  She was unsure how to delicately approach him as she was concerned about his weight.  She stated that he is 5’9” and only weighted 95 lbs.  If this is true, he has a body mass index of 14.  Any body mass index under 18 is considered significantly underweight, so he is SERIOUSLY underweight.  Someone his size should weigh, at a minimum, 125 lbs. to about 160. Additionally he seems to demonstrate additional addictive behaviors. Many only associate anorexia with females.  However, this condition affects males as well.

Here are some of the questions I would like to ask him and discuss with him, but I do not have the right to diagnose him.  Regardless, we as a community should discuss how to work with our friends who have dietary challenges. If I was speaking to my friend I would have an informal discussion such as this:

Does he work out, or does he just live off alcohol, caffeine and smokes as you suggested?  The reason I am asking is because anorexia, which he may very well have, is not limited to just females.  More and more men are suffering from this as well.  I can’t diagnose it but either he is anorexic or he has a SERIOUS physical illness (or unknown drug addiction) and should seek medical attention. Either way he is starving his body and alcohol and caffeine are just empty calories. 

Anorexic individuals very often have control issues.  Perhaps there are things going on in his life that he feels he cannot control, such as his job, finances, relationships etc. When this happens people often look to things they can control, such as the food they eat.  Another associated condition is called body dysmorphia.  This condition occurs and is very often associated with anorexia or eating disorders, when a person looks in the mirror and what they see looking back at them is not reflective of reality.  He may look in the mirror and think he looks just great while the rest of us see that his is significantly underweight. Also, there could be issues of low self-esteem, need for acceptance, and he finds that not eating allows him to control these emotions.

So, what can you do to help change his behavior is the big question.  The best choice would be for him to go to a physician and let that person explain the severity of his low weight and how it severely impacts how his organs function and his overall health. But, you can’t force someone to go to a physician. There is a chance that if you start directing him on how to eat that he may retaliate and ignore you, or just eat less because of his fragile emotions.  Once he feels that he is on the defensive it is less likely he will listen to you. Try really hard not to be judgmental about his negative eating behavior, but express your concern that you never really see him eating.  Make sure he knows that you are concerned about his welfare and that you care for his health.  One thing that could help would be to invite him to situations that have food or where there is public eating going on.  Encouraging him to eat in front of others hopefully will make him more comfortable with the process.  If he likes to drink (which I am not encouraging) then bring him to a happy hour that has a buffet and maybe make up a small plate for him and others so as not to be conspicuous.

Clinically speaking, you want to encourage your friend to be interested in and intrigued by why he is not eating enough. Perhaps ask him if there are things going on in his life that are stressing him out (thereby causing the lack of eating) and be an open ear for him.  You do not have to make him feel that he needs to be heavy, just normal. Try and encourage him to snack throughout the day.  He may not be ready to sit down for a steak dinner at this moment, but small snacks will help him to not feel that he is overindulging. 

The best recommendation that I would give my friend would be to seek out qualified medical and psychological assistance, but often individuals without a lot of support systems are not open to this type of advice.  And, as the person of concern is a male, he may be reluctant to the option that he has an eating disorder.  Getting information and finding the right help is important. But, being a good friend and keeping an eye out for those who need assistance is the best thing a person can do.  We must break the stigma that eating disorders are only for females.


How much will it take to get you to just try one bite???

Ah yes, the age old drama of trying to get your kids to eat their vegetables.  My oldest son (10) will eat his vegetables on a regular basis because, basically, I do not give him a choice.  If he does not like something specific, such as brussel sprouts, I do not force him to eat them.  But I promote the importance of eating vegetables on a regular basis and he does understand this.  My youngest son (2 ½) is a completely different story.  He instinctively knows when something is a vegetable or has vegetables in it.  It is almost like he has internal radar for healthy food and immediately turns his head so far away from the food that I expect him to turn into the girl from the Exorcist and do a full head swing.  Visualize it. So, how do I make a 2 year old eat? Should I bribe him or reward him when he eats his carrots? 

My fear has been that bribery or rewards could psychologically damage him in the long run.  Perhaps I would set a standard of behavior where I would have to reward him to take a shower when he is 15.  That would not be acceptable. Many experts recommend the best choice is repeated exposure to a food, perhaps as many as 10 to 15 times before a child will consume a new food (Drotz, 2008).  Also, eating vegetables in front of your children is recommended.  This has not worked in my house with my youngest child.  So is it ethical for me to offer rewards, such as promising a toy or a sticker, if my child eats his vegetables?

According to a recent research study the answer, surprisingly, is YES! In a study by the Department of Epidemiology and Public Health, University College London, and the Department of Psychology, University of Sussex, they concluded that external rewards do not necessarily produce negative effects and may be useful in promoting healthful eating (Cooke et al., 2010).

The study took young children and presented them with vegetables and asked them to rate them with “yuckie”, “okay” and “yummy” smiley faces. One group of children received no intervention, a second group received a sticker if they would try the vegetable, and the third group received social praise for trying the vegetable. Over time, the children who received a reward increased the amount of vegetables they would eat and displayed an increase in thinking the food was “yummy” over longer periods of time.  So, I am going to the grocery store to buy more carrots and I think a couple of packets of Thomas the Train stickers.  Wish me luck!

Cooke, L. J.,Chambers, L.C., Añez, E. V., Croker, H. A., Boniface, D., Yeomans, M. R., & Wardle, J. (2010). Eating for pleasure or profit: The effect of incentives on children’s enjoyment of vegetables. Psychological Science, 29 December 2010.

Drotz, K. (2008). 5 steps to getting children to eat more vegetables.



Avoid the Blues… by Eating Whole Foods

Once again there is new scientific evidence that demonstrates a relationship between dietary habits and mental health.  In a recent article in the American Journal of Psychiatry, the authors presented research that women who consumed fresh “vegetables, fruit, beef, lamb, and whole grains demonstrated a lower likelihood of anxiety and depressive disorders” in comparison with women who ate more processed foods which are very common in the United States and other western countries (Jacka et. al, 2010).  This research study did incorporate age and physical activity and the results still demonstrated better mental health from those who eat more whole foods. 

This should not be a surprise because processed foods often lose the natural nutrients due to over cooking processes, the negative impact of canning and the over presence of aluminum due to this process, as well as all the unnecessary preservatives associated with processing foods.  Some simple steps to avoid depleting the nutritional qualities of the food you cook at home include steaming your vegetables instead of boiling them, as over cooking vegetable removes a majority of the vitamins necessary for our brains to function at their best possible state.  Also, consider getting your crock pots out and cook vegetables and meats together so that instead of boiling foods and throwing out the water that now contains the vitamins that were once in the vegetables, these nutrients stay in the sauce and will be consumed by you and your family.  Consider some simple dishes such as corned beef (remove extra fats) and cabbage with carrots, or stews with tomatoes and beef this winter.

To read more…

Jacka, F. N., Pasco, J. A., Mykletun, A., Williams, L.J., Hodge, A.M., O’Reilly, S. L., Nicholson, G. C., Kotowicz, M. A., & Berk, M. (2010). Association of Western and traditional diets with depression and anxiety in women. Am J Psychiatry. 2010 Mar;167(3):305-11. Epub 2010 Jan 4.


Let's be realistic about losing weight in America...

Over the past two years the AdCouncil, which is sponsored by the U.S. Department of Health and Human Services, initiated a public service announcement series focusing upon obesity prevention and weight loss (AdCouncil, 2007). This announcement is distributed to the media by commercials, websites, and newsletters. However, the most predominant form of media they are using to try and change attitudes towards preventing obesity is through television advertisements. The premise behind this initiative is a list of “100 Small Steps” that can be taken to change the behavior and attitudes of overweight adults and children so that they may adopt healthy behaviors (AdCouncil, 2007). The focus of these behavioral changes surrounds goals such as reducing portion size, increasing physical activities, and eating a healthful diet on a regular basis.

Some of the approaches this campaign uses to change attitudes are to make losing weight and reducing obesity seem very easy to obtain by taking small steps. Some examples of the small steps they recommend include walking more by parking further from your destination, taking the stairs instead of an elevator, putting fast food dinners on a plate so that the true portion size is apparent, using spices instead of salt, walking the kids to school, and having fat-free milk products instead of creams (AdCouncil, 2007).

This campaign uses approaches such as using the media to influence thoughts by making the topic of obesity an availability heuristic by frequent short media commercials ( Schneider, Gruman, & Coutts, 2005, p. 173). By keeping the ideas short, simplistic, and frequent, those exposed to the commercials may be more likely to recall the content and place importance on the approach to attitude change by taking the small steps described by the AdCouncil. This public service advertisement attempts to change attitudes by framing obesity in a negative light while making commentary in the commercials that suggests that everybody is losing weight by taking small steps.

This approach to attitude change used in the Small Steps advertisement is supported by social psychological research in that the exposure to the solutions and the upbeat tempo of the advertisements is consistent with health promotion for those who are not quite obese as well as secondary prevention for those who are suffering from obesity but are looking to prevent the serious diseases associated with obesity and additional weight gain ( Schneider, Gruman, & Coutts, 2005, p. 184). The theory of planned behavior supports this approach to attitude change in that the commercials enforce subjective norms about the behavior of not being healthy as well as making it look very easy to stop being obese and unhealthy which can enforce a person’s perceived behavior control ( Schneider, Gruman, & Coutts, 2005, p. 192).

small_steps_shrek.gifI do not think that this advertisement campaign is very likely to lead to a behavioral change that is significant enough to reduce the rate of obesity in the United States. I am stating this opinion because, although the public service advertisements contain valuable information to make small changes in a person’s life, with regard to health behavior there is not an actionable plan that contains a social support network. For example, making a change to having better portion control or increasing the frequency of walking with the assumption that this behavior change will be easy is not well supported by this campaign. Most likely it will be hard to achieve if there is not any emotional support from friends or family, if there is not any esteem support, or if there is not any tangible or instrumental support to enforce purchasing healthier foods or receiving daily positive, networked support ( Schneider, Gruman, & Coutts, 2005, p. 200). This advertisement could take a different approach in order to bring about a change in behavior by incorporating fear appeal by showing the end result of obesity such as diseases, illnesses, and eventual death in the same aggressive manner that many of the drunk driving or smoking campaigns have taken in the past ( Schneider, Gruman, & Coutts, 2005, p. 185).

AdCouncil. (2007, December 24). Obesity prevention. U.S. Department of Health and Human Services. Retrieved from

Schneider, F., Gruman, J., & Coutts, L. (Eds.). (2005). Applied social psychology. London: Sage Publications, Inc.


Holistics Answers to My Drama?

The uses of complementary interventions are helpful in the treatment of anxiety and depression as they can support psychological treatment, psychotropic medications, and herbal medication regimes. Relaxation is one such complementary intervention that can be helpful for anxiety and depression in a variety of ways. For example, relaxation can act as a biofeedback mechanism to reduce blood pressure, decrease the heart rate, and control respiratory responses. Bourne (1995) explained that relaxation therapies can include natural breathing techniques and muscle group tension and relaxations. Relaxation therapy may be practiced 20 minutes per day in a quiet location with a comfortable temperature, preferably on an empty stomach, in loose clothing with a passive attitude (Bourne, 1995).

Relaxation therapy is not just beneficial to those who suffer from generalized anxiety disorders; it is beneficial for rare or special circumstance anxiety situations such as being pregnant or going to the dentist. Maternal anxiety is a fairly common occurrence during pregnancy and postpartum; however it is not recommended for the woman to consume drugs or herbal remedies to assist with reducing the anxiety so relaxation therapy is a natural solution. Relaxation therapy has been proven to reduce anxiety levels, maternal heart rate, as well as a reduction in cortisol (Teixeira, 2005).

Also, going to the dentist can bring about severe anxiety in patients and it may not be possible to take a sedative or a psychotropic medication if the patient has to transport themselves to or from the dental office. A worse scenario is that the anxiety can be so severe that patients avoid dental treatment all together and have poor dental health. In these cases relaxation therapy is an excellent alternative and patients should be encouraged to assess their coping skills and utilize a relaxation therapy prior to treatment that has worked for them prior (Biggs, 2003).

Meditation is an additional alternate therapy that can be of assistance to those suffering from anxiety or depression. Meditation can come in the form of a quiet, relaxing therapy in which a person works to gain control over their own physical responses to stress and they learn to control thinking patterns that may cause unnecessary stress responses to normal situations (Anxiety Disorders Treatment Center, 2007). For some meditation comes in the form of prayer to a higher power. Many find that prayer can help build confidence and can help a person feel that they are not alone but this technique often is benefited by professional help as well (Holistic Online, 2007).

Acupressure is a holistic therapy that involves pressure to specific areas of the body to release stress. Often this comes in the form of reflexology which is pressure point therapy for the feet or massage therapy in which trigger points (areas of tightened muscles) receive pressure that releases the muscles and the connective tissue. LaTorre (2000) notes that acupressure, albeit developed in ancient China, is used effectively by practitioners today to help release energy tensions which can cause a sense of relaxation and a reduction in anxiety. Massage therapy is perhaps the more popular alternative in Western culture but more traditional acupressure therapies can be accessed in most major cities.

An additional holistic therapy for the treatment of anxiety and depression that is very popular in Boulder, CO (where I reside) is yoga. Yoga is a tradition that comes from India which has evolved into a variety of practices such as raja, karma, bhakti, jnana, and tantra yoga (Carrico, 1997). The benefits of yoga include the mental and physical relaxation states which are similar to the properties of meditation as well as the focus on breathing techniques and physical stretching which are associated with relaxation. This activity can be performed alone but is most often performed in a social situation which can be beneficial to the anxious or depressed individual as it can help develop social support networks (Carrico, 1997). YogaBeach.jpg

Personally I believe in the biopsychosocial model of treatment for anxiety or depressive disorders as well as most all treatments. From this perspective I believe that psychotropics have their place in treatment, professional psychologists and counseling therapy are often necessary, and social techniques, which often come in the form of holistic therapies, are equally important. From a professional perspective it is important to inform or refer the patient to someone who can explain all of the available treatments for anxiety and depression so that the most effective treatment, or combinations of treatment, can be utilized.

Anxiety Disorders Treatment Center (2007). Meditation. Generalized Anxiety Disorder. Retrieved November 5, 2007 from:

Biggs, Q.M. (2003). The effects of deep diaphragmatic breathing and focused attention on dental anxiety in a private practice setting. Journal of Dental Hygiene, 77(2), 105-133.

Bourne,E.J.,(1995) The anxiety and phobia workbook - A step by step program for curing yourself of extreme anxiety, panic attacks and phobias. NY: MJF Books.

Carrico, M. (1997). Yoga journal’s yoga basics: The essential beginner’s guide to yoga for a lifetime of health and fitness. New York NY: Fitzhenry & Whiteside, Ltd.

Holistic Online (2007). Overcoming fear and anxiety with prayer and spirituality. Anxiety. Retrieved November 6, 2007 from

LaTorre, M. A. (2000). Touch and psychotherapy. Perspective in Psychiatric Care, 36(3), 105-6.

Teixeira, J. The effects of acute relaxation on indicies of anxiety during pregnancy. Journal of Psychosomatic Obstetrics and Gynaecology, 26(4), 271-6.


I don't get depressed or anxious with my herbals!

The U.S. Food and Drug Administration (FDA) is the body that regulates and evalutates psychotropics to ensure their safety including psychotropics used to treat anxiety, depression, and sleep disorders (Schatzberg, Cole, & DeBattista, 2007). However, there is a huge market for herbal medications to treat these disorders that can be purchased over the counter or in herbal or natural grocery stores. As the herbal market is not regulated by the FDA, the efficacy of these suppliments can not be demonstrated and there are also possible negative side effects or contraditions with additional herbal substances or psychotropics.  Herbs.jpg

One of the most popular herbal suppliment is St. John’s Wart. St. John’s Wart, also known as Hypericum perforatum, has been used throughout the centuries to treat depression. This herbal substance is usually administered in a dosage of 900-1800mg per day and can have side effects of gastrointestinal disorders, rash, or fatigue (Schatzberg, Cole, & DeBattista, 2007). St. John’s Wart is usually administered in a pill format that contains the flowers, stems, and leaves of the plant ( Balch & Balch, 1997). This herbal supplement is also assumed to be of assistance for nerve pain.

Omega-3 fatty acids are often supplemented to manage bipolar disorders. Omega-3’s are recommended to be administered at a dosage of 9.6g per day and there may be side effects such as a fishy odor (as they often contain fish oil) or having gastrointestinal discomfort (Schatzberg, Cole, & DeBattista, 2007). Omega-3 fatty acids are found in a variety of fish such as mackerel, anchovies, salmon, herring, whitefish, shark, bass, tune, and bluefish and the recommended amount of consumption is approximately two or more servings a week for those at risk for heart disease ( Hausman & Hurley, 1989) . The recommended amount for bipolar disorder is not specific.

DHEA (dehydroepiandrosterone) is an over the counter supplement that is used to combat depression and it is usually administered in 50-450mg per day. Women should be aware that the side effects could include masculinization or voice changes (Schatzberg, Cole, & DeBattista, 2007). Saliva tests that measure depression have found that those suffering from this psychopathology often have elevated levels of cortisol and inadequate levels of dehydroepiandrosterone (Murray & Pizzorno, 1998).

Kava (Piper methysticum) is a very popular over the counter medication that is used to treat anxiety and it is usually administered in 75-150mg doses. Side effects can include central nervous system depression or feelings and behaviors similar to intoxication (Schatzberg, Cole, & DeBattista, 2007). Kava is also considered to be a diuretic and long-term use can cause a yellowing of the skin, hair and nails (Eades, 2000). However, uses often report significant reduction of anxiety after one week of consumption.

Valerian (Valeriana officinalis) is a supplement that is utilized to help with insomnia and anxiety as well as for help with headaches, dysmenorrheal, or intestinal pain. The average dosage of an extract of 300-600mg is usually taken in a tea anywhere from one to three times a day (Schatzberg, Cole, & DeBattista, 2007). Valerian should not be taken with alcohol, antihistimines, or psychotropics as it is a sedative (Holford, 2005).

Ginkgo (Ginkgo biloba) is a very popular herbal supplement that has gained fame for claims of improved memory functioning and assistance with sexual dysfunctions. Ginkgo is usually administered in doses varying from 60-240mg per day and side effects include allergies or increased potential for bleeding in the elderly (Schatzberg, Cole, & DeBattista, 2007).

Folate and B vitamins are supplements that are often helpful to those suffering from depression or anxiety. For those suffering from these psychopathologies a dosage of 500μg per day of folate and a dosage of 1,000-2,000μg of B12 are recommended. If these vitamins are taken in doses that are too high, side effects may include nausea, seizures, burning sensations, or contradictions with anticonvulsants, barbiturates, or estrogen (Schatzberg, Cole, & DeBattista, 2007). However, if a person is experiencing anxiety and inner tension it may be a sign that there is a deficiency of folate and the B vitamins so the dosage should be monitored and potentially increased (Holford, 2004).

S-Adenosylmethionine (SAMe) is considered to be helpful for depression and is taken in dosages ranging from 400-1600mg per day. Nausea is considered to be one of the side effects associated with SAMe (Schatzberg, Cole, & DeBattista, 2007). SAMe is associated with having a stimulatory effect on norepinephrine and serotonin in animal studies and may be associated with the restoration of beta muscarinic receptors which help increase membrane fluidity ( Williams, A. (2005).

Inositol is considered to be helpful for depression and it is administered in dosages ranging from 6-12g per day. Similar to omega-3 fatty acids the side effects include gastrointestinal distress and a fishy odor (Schatzberg, Cole, & DeBattista, 2007). Inositol may help with the treatment of agorpahobia and panic attacks as well as anxiety as it is associated with increasing cerebrospinal fluids assisting in neurotransmission (Werbach, 1999).

5-HTP ( 5-Hydroxytryptophan) is a herbal supplement that is fairly new to the United States and it is used to treat depression, insomnia, and migraines and the usual dosage is 100mg per day and it should only be taken at night (Murray, 1998). Some side effects associated with 5-HTP include drowsiness and interactions with antidepressant psychotropics as this supplement claims to provide neurotransmitter support.

There will continue to be problems with standardizing herbal and alternate treatments for a variety of reasons. Besides not conforming to FDA standards there are issues such as potency in herbal supplements and inconsistent dosage standards. Further clinical research studies would help with this process and it would be helpful if the studies could further focus on the pharmacodynamics and pharmacokinetics of herbal and alternative treatments.

Balch, J. F. & Balch, P. A. (1997). Prescription for nutritional healing: A practical a-z reference to drug-free remedies using vitamins, mineral, herbs & food supplements (2nd Ed.). Garden City Park, NY: Avery Publishing Group.

Eades, M. D. (2000) The doctor’s complete guide to vitamins and minerals. New York, NY: Random House, Inc.

Hausman, P. & Hurley, J. B. (1989). The healing foods: The ultimate authority on the curative power of nutrition. Emmaus, PA: Rodale Press, Inc.

Holford, P. (2004). The new optimum nutrition bible (2nd Ed.). Piatkus Books.

Holford, P. (2005). Optimum Nutrition for the Mind. Basic Health Publications.

Murray , M. (1998). 5-HTTP: The natural way to overcome depression, obesity, and insomnia (2nd ed.) New York, NY: Bantam Books.

Murray , M. & Pizzorno, J. (1998) Encyclopedia of natural medicine (2nd Ed.) Roseville, CA: Prima Publishing.

Schatzberg, A.F., Cole, J.O., DeBattista, C. (2007). Manual of clinical

psychopharmacology (6th ed.). Washington, DC: American Psychiatric Publishing, Inc.

Werbach, Melvyn R. (1999). Nutritional influences on mental illness, (2nd ed.). Tarzana, CA: Third Line Press.

Williams, A. (2005). S-adenosylmethionine (SAMe) as treatment for depression: A systematic review. Clinical & Investigative Medicine, 28(3), 132-9.


Natural Anxiety Solutions

Anxiety and insomnia are illnesses that can dramatically affect the day to day activities of otherwise highly functioning individuals depending upon the degree and severity of the symptomologies. Anxiety has a variety of categories and causes such as generalized anxiety disorder (GAD), stress-related anxiety, panic disorder, social anxiety, medical illnesses, or anxiety as a subset of additional mental disorders (Preston & Johnson, 2007, p. 29-31). Symptoms of anxiety can vary greatly from having muscle tension, to feeling tense or edgy, to having full blown panic attacks with developing phobias.

Insomnia is equally as complex as anxiety with regard to levels of severity and treatment options. Over one third of adults in the United States suffer from this disorder and it can result in snoring, disrupted breathing while sleeping, restless leg syndrome such as kicking or jerking, narcolepsy, or feeling sleeping during the day as if there has been a switch between day and night sleeping patterns ( Schatzberg, Cole, DeBattista, 2007, p. 397).

Traditionally both anxiety and insomnia are treated with anxiolytic or hypnotic medications. However, there are also alternatives to anxiolytic & hypnotic medications that should be assessed because often situations arise, such a pregnancy or an inability to mix medications, that do not allow for a patient to consume anxiolytic or hypnotic medications. Additionally, alternative and complementary and non-pharmacological approaches to treatment of anxiety and sleep disorders may be necessary because the root of the disorder may be an allergic reaction to food or nutrients so behavioral and nutritional approaches to managing these illness should be investigated (Sahley, 2002, 52-3).

Patients suffering from insomnia can benefit from behavioral approaches to treatment so that long term changes after the cessation of the medication can be maintained. One example of behavioral management surrounds redefining behavior that can take place in the bed or bedroom. For example, those suffering from insomnia should not eat in the bed, watch TV in the bed, or read in the bed. Rather, the bed should only be used for sleeping purposes (the exception being intimacy) and if a person is not feeling sleepy they should not remain in their bed ( Schatzberg, Cole, DeBattista, 2007, p. 401). Additional examples of alternate approaches to treatment include sleep restriction therapy (reduction in time spent in bed), bright light therapy (exposure to a light box), or continuous positive airway pressure (which is helpful for those whose insomnia results in sleep apnia).

Those suffering from anxiety may benefit from the utilization of relaxation and biofeedback techniques. Biofeedback works in a congnitive fashion to teach a person how to control their bodily functions and reactions to anxiety inorder to reduce over all stress ( Lederman, 1995). Relaxation techniques include progressions relaxation which is purposeful relaxation of the muscles in a controlled manner.

milk.jpgNutritional changes can also benefit those suffering from disorders that traditionally require psychopharmacological treatments such as anxiolytic & hypnotic medications. For example, Balch and Balch (1997, p. 133) recommend that those suffering from anxiety, panic attacks, or insomnia should avoid coffee, soda, black tea, large amounts of animal protein, sugar, or alcohol. Additionally, it is recommended that those suffering from anxiety should increase consumption of vitamin B complex, drink milk, increase intake of calcium, magnesium, phosphorus, potassium, and selenium (Werbach, 1999, p.70-79). For those suffering from insomnia the same advice can be given but it is additionally important to rule out any potential food allergies or reactive hypoglycemia (Werbach, 1999, p.320-25).  

Combining psychotherapy and pharmacotherapy with different forms of anxiety can be beneficial. Pharmacotherapy may be an excellent solution for those suffering from acute anxiety that is associated with a life altering event such as a death of a loved one, a divorce, or the loss of a job. In these instances it is important to understand the relationship that depression, anxiety, and stress have with the activation in the amygdala (which manages aggression and fear responses) and the role of the hippocampus (which manages declarative memory) as these areas of the brain may be hypersensitive to certain events and patients may respond to longer-term psychotherapy to help re-write the manner in which these areas of the brain interpret events (Sapolsky, 2003). Regardless, a holistic approach to managing anxiety and insomnia is the ideal treatment scenario.

Balch, J. F. & Balch, P. A. (1997). Prescription for nutritional healing: A practical a-z reference to drug-free remedies using vitamins, minerals, herbs, & food supplements (2nd ed.). Garden City Park, NY: Avery Publishing Group.

Lederman, R. P. (1995). Treatment strategies for anxiety, stress, and developmental conflict during reproduction. Behavioral Medicine, 21(3), 113-22.

Preston , J. & Johnson, J. (2007) Clinical psychopharmacology made ridiculously simple (5th ed.). Miami, FL: Medmaster, Inc.

Sahley, B. J. (2002). The anxiety epidemic: A wounded healer tells you how to use gaba and other amino acids to control anxiety and panic attacks. San Antonio, Texas: Pain & Stress Publications.

Sapolsky, R. (2003). Taming stress. Scientific American, 289(3), 88-95.

Schatzberg, A.F., Cole, J.O., DeBattista, C. (2007). Manual of clinical

psychopharmacology (6th ed.). Washington, DC: American Psychiatric Publishing, Inc.

Werbach, Melvyn R. (1999). Nutritional influences on mental illness, (2nd ed.). Tarzana, CA: Third Line Press.

I can't eat that...I'm still a size 0!

There is an incredible wealth of information available to the public regarding the treatment of nutritional disorders.  For example, the Eating Disorder Referral and Information (2007) website has links to university and hospital affiliations, they publish recommended nutritional advice, and alternate treatments are available to the public.  They suggest that there are biochemical predispositions and psychological situations that may be responsible for binging, purging, or starvation that are, in fact, a way that a person copes with issues and that after psychological care a dietitian should be an integral part of the recovery process (Eating Disorder Referral and Information, 2007). so%20sad.jpgAn additional psychological recommendation comes from the Ai Pono Women’s Program which is a treatment facility in Hawaii that focuses on eating disorders.  They have an in-service treatment program that has four phases and during phase 2 and 3 nutritional education is introduced to patient suffering from eating disorders.  In this process Ai Pono states that the patients discover the differences between emotional hunger and natural hunger, they assess how cognitive experiences with associated food experiences, and they work to help patients understand the relationship between food and interpersonal relationships (AiPono, 2007).

Werbach (1999) has detailed the importance of having a diet rich in complex carbohydrates and minimizing sugar for those who suffer from eating disorders; however there are more specific recommendations available from Alpha Nutrition Health Education (2007) which suggests that there are trigger foods that act like narcotics and cause eating disorder behaviors to escalate.  One example is the consumption of wheat or milk as these products can act like an endorphin to the body.  Specifically wheat gluten and milk have been shown to act as exorphins that can contribute to mental disturbances in the same manner that narcotics do.  This may be associated with the addictive patterns of bulimia.
AiPono. (2007). Women’s program: Components. AiPono Hawaii.  Retrieved July 28, 2007 from the World Wide Web:
Alpha Nutrition Health Education (2007). Trigger foods and opioids. Nutritional Rescue.  Retrieved July 28, 2007 from the World Wide Web:

Eating Disorder Referral and Information Center (2007). Getting help: Treatment options. Treatment – There is Hope! Retrieved July 28, 2007 from the Eating Disorder Referral and Information Center:

Werbach, Melvyn R. (1999). Nutritional Influences on Mental Illness, (2nd ed.). Tarzana, CA: Third Line Press.

Am I really what I eat??

The idea that diet is a function of your environment, as stated by David (1991), has a clear impact from a sociological standpoint when evaluating the eating conditions that are available for a person.  The entire idea that has been culturally imprinted upon Americans in which “you are what you eat” is somewhat fair in the sense that a balanced diet for a person who is eating nutritionally will encourage a person to strive to avoid fatty foods; however this seems not to be the case when you incorporate the socioeconomic factors associated with obesity (Winter, 2005). Sadly the availability of cheap, trans-fat ridden food product is more available to the poor because of the cheap cost so the poorer groups actually do become what they eat, which unfortunately is fat and I have a passion to change this.

There are serious differences between what I was taught as a child and the intake of ounces of whole grain bread, cereal, crackers, rice, or pasta or the 2 cups of fruit that are recommended by the Food Pyramid (United States Department of Agriculture, 2007). Personally, I am very lucky in that my mother did not introduce me to processed foods and I only discovered them upon reaching the grade school level in which I sat with other children at the lunch table and had to ask a fellow class mate “what is a Twinkie”?  I seriously had no idea even at age 6 because my mother did not introduce sugars into my diet.  However, I was not without good treats but my intake upon those treats was managed and, in retrospect, that was my mother’s way of trying to keep me from having diabetes which is prevalent in both my maternal and paternal family tree. I have kept with my mother’s advice regarding my diet and, of course, expanded my own education surrounding this topic and remain non-Type II diabetic.

With this in mind I constantly struggle with forces, such as cravings that occur when I endure natural female cycles, that cause me to want to throw away all rational and I just binge on salty foods although I maintain a normal body mass index. There is evidence that eating behavior is influenced by female menstrual cycles and therefore it is important, if you are developing a behavioral intervention plan that incorporates dietary needs, to understand this reality (Swenne, 1992).  Cultural norms have influenced my own desire to maintain a positive body-image, which is based upon how I feel and not how others think I should look, encourages me to be a health size 8 as a 5’7 female; however I am often discouraged to follow my diet due to pressures from society that I should be thinner and many women feel the same pressures which often forces us to take on unhealthy eating patterns (Serdar, 2005).

David, Marc (1991). Nourishing Wisdom: A Mind-Body Approach to Nutrition and Well-Being. New York: Harmony/Bell Tower.

Serdar, K. (2005). Female body image and the mass media: Perspective on how women internalize the ideal beauty standard. The Myriad: Westminster College Undergraduate Academic Journal, 2(1).

Swenne, I (1992). Weight requirements for return of menstruations in teenage girls with eating disorders, weight loss, and secondary amenorrhoea. Acta Paediatr, 93(11), 1449-55.

United States Department of Agriculture (2007). Inside the Pyramid. Retrieved June 21, 2007 from the World Wide Web:

Winter, M. (2005). The ecology of obesity. Human Ecology, 33(3), 2+. Retrieved June 21, 2007, from Questia database.

Food Pyramid…?

Based upon the most recent “Food Guide Pyramid” it is recommended that a person consumes 3 ounces of whole grain bread, cereal, crackers, rice, or pasta, a male should consume approximately 3 cups of vegetables and a female should have approximately 2 ½ cups, fruits should be consumed in the amount of approximately 2 cups for both men and women, dairy products should be consumed in the form of 3 cups, meats and bean should be consumed in portions of 5 to 6 ounces based upon age and sex, and healthy oils should be limited to 5-6 teaspoons based upon age and sex (United States Department of Agriculture, 2007).


This is very different from the food pyramid that I was taught in grade school some 25 years ago. What I recall studying was not nearly as detailed, the portion sizes were not as defined, and the details surrounding appropriate fats were not elaborated upon.  David (1991), when referring to Americans’ quest for the perfect diet, explains that there is not one solution for all of us.  Upon reviewing the Food Pyramid I am actually shocked at the quantity of consumption that is recommended and it is no surprise that we have an obesity epidemic in the nation.  Although I do agree with USDA Secretary Mike Johannes’s statement (as quoted by Krisberg) that the new food pyramid allows for more flexibility for the individual, and that following the suggestions of the USDA by making moderate dietary changes will have long term benefits for the individual, I still am surprised by the quantity of recommended consumption (Krisberg, 2005).
I personally find that a nationally recommendation for food consumption does not reflect our own personal nutritional needs, our cultural biases, our lifestyles, or our geographical locations (David, 1991). 

David, Marc (1991). Nourishing Wisdom: A Mind-Body Approach to Nutrition and Well-Being. New York: Harmony/Bell Tower.

Krisberg, K. (2005). USDA debuts new interactive food pyramid web site. Nation’s Health, 35(5), 7-7, 2/5.

United States Department of Agriculture (2007). Inside the Pyramid. Retrieved June 21, 2007 from the World Wide Web:


The female booty once again is celibrated!

pear.jpgI must be very, very, very healthy if I follow the “a big butt is healthier than a fat gut” article which stated that a pear shaped female figure is heathier;  there is a great deal of research that concludes excess weight around a female’s waist rather than her hips can be attributed to increased incidences of cardiovascular disease (Gambacciani et al., 1997 & Brannon and Feist, 2004). So that is great!  My booty should be celebrated! However...I still need to lose a little weight. Additionally my multicultural friends have different takes on their weight loss plans.

There are cultural differences regarding fat distribution in the body and it seems to vary based upon whether or not someone has immigrated to another culture, what their original ethnicity is, and what the lifestyle is of any particular culture. For example, the body mass index of Japanese men living in Japan is significantly lower than that of Japanese men living in Hawaii or California, a study from Israel concluded that ethnic differences in hypertension or weight related disorders remained the same regardless of whether or not someone immigrated to a different country, and an additional study indicated that Germans and Danish people had significant differences in obesity rates possible because of the increased consumption rates of alcohol and smoking in the German population (Lahmann, Lissner, Gullberg, & Berglund, 2000). Another study, confirming cultural differences regarding body fat, found that Maori and Pacific Islanders had higher body mass index in both men and women versus European men and women (Metcalf, Scragg, Willoughby, Finau, & Tipene-Leach, 2000). So, although there is a lot of variation in the research I would conclude that there are cultural differences in fat distribution.

Brannon, L. & Feist, J. (2004). Health psychology: An introduction to behavior and health (5th Ed.). CA: Wadsworth/Thomson Learning.

Gambacciani, M., Ciaponi, B., Cappagli, L., Piaggesi, L., de Simone, L., Orlandi, R., & Genazzani, A. R. (1997). Body weight, body fat distribution, and hormonal replacement therapy in early postmenopausal women. Journal of Clinical Endocrinology and Metabolism, 82(2).

Lahmann, P. H., Lissner, L., Gullberg, B., & Berglund, B . (2000). Differences in body fat and central adiposity between swedes and european immigrants: The malmö diet and cancer study. The North American Association for the Study of Obesity, 8, 620-631.

Metcalf, P. A., Scragg, R. K., Willoughby, P., Finau, S., & Tipene-Leach, D. (2000). Ethnic differences in perceptions of body size in middle-aged european, maori and pacific people living in new Zealand. International Journal of Obesity, 24(5), 593-599.



My hips are at their “set-point”…so I have no choice but to love them...because they are set?

There are a lot of conceptions about how weight loss, gain, and maintenance are managed and one of these theories is called the set-point theory. Set-point theories suggest that attempts at permanent weight loss are a waste of time. Set-point theories reflect a belief that a person falls in a weight area that can be changed or altered by specific psychological methods (Pinel, J. 2006). This is based on an assumption that our bodies are triggered, because of an increase in hunger, to crave a meal and upon consuming the meal we return to our natural set-point until time has passed and energy has been expended resulting in a craving for the next meal. This may have originated from ancestral times in which food was scarce but today we live in a world full of over-portioned, calorie packed, convenient and cheap food (Brannon & Feist, 2004).

Hunger is critical in managing energy needs and resources, and the human body responds based on feedback from internal triggers regarding if it is hungry, tired, lacking protein, fat, etc. (Pinel, 2006). However, theories about weight behavior, such as the set-point theory, may not apply in all cases. For example, families who do not understand the impact of portion control could be at risk for developing obesity because types of food and the amount in which they consume it can be way out of proportion with what the body’s set-point may require (Caprio, 2006).

An effective weight loss plan must go beyond set-point theory and should incorporate long-term health goals such as good cholesterol levels, low blood pressure, a healthy resting heart rate, a good body mass index, and a regular exercise program (Samuel, 2007). Blood glucose levels should also be monitored as they could play a role in how much hunger a person feels although there are controversial research results surrounding this topic (Pinel, 2006) Additionally a diet should incorporate foods that are healthy, preferably pesticide free, and should include vitamins and minerals rather than fillers (Dillon & Sternas, 1997).

If you want to change your set-point you might want to read: Hips that are not mine.jpg

Brannon, L. & Feist, J. (2004). Health psychology: An introduction to behavior and health (5th Ed.). CA: Wadsworth/Thomson Learning.

Caprio, S. (2006). Treating child obesity and associated medical conditions. The Future of Children, 16(1), 209+. Retrieved April 13, 2007, from Questia database

Dillon, D. L. & Sternas, K. (1997). Designing a successful health fair to promote individual, family and community health. Journal of Community Health Nursing, 14.

Pinel, J. (2006). Biopsychology (6th ed.). Boston, MA: Pearson Education, Inc.

Samuel, L. K. (2007). Behavioral change intervention program research. Health Psychology Course PSYC-8745-01


My (insert a hard-headed loved one's name here) will not listen to health advice and change their behavior. Why?

There are a variety of health-related theories that try to predict the profile of those who will or will not adhere to medical advice such as the behavioral theory, the self-efficacy theory, theories of reasoned action and planned behavior, and the transtheoretical model (Brannon & Feist, 2004). Unfortunately, rates of patients’ compliance with the advice of their healthcare provider are less that 50% and the rates of non-compliance are even greater when it comes to taking actions that are associated with medical preventive advice versus following treatment orders for existing diseases (Brannon & Feist, 2004). Often, when a behavioral strategy is determined by the patient the level of compliance is greater than when it is prescribed by a health care provider (Lyon & Konradi, 2000).

The behavioral theory proposes that using reinforcement techniques (both positive and negative) can change behavior by giving the patient reminder notes, commending the patient for adhering to the recommended behavior, or facilitating the patient’s own realization that will feel better by cooperating with the health advice (Brannon & Feist, 2004). AIDS patients have been analyzed in studies regarding behavioral theories and the negativity complexity associated with their medical dosing schedules, the adverse events associated with the high costs of the medications, and the realization that this will be a lifelong commitment regarding their treatment have shown an adherence to difficulties with maintaining a new behavioral program and often missed doses on a regular basis (Stein, Rich, Maksad, Chen, Hu, & Sobota, 2000).

The self-efficacy theory proposes that people who believe they have control over their environment and behavior can have an impact on their health and therefore can change their health behaviors (Brannon & Feist, 2004). Wiedenfeld, O'Leary, Bandura, Brown, Levine, and Raska proposed as early as 1990 that the self-efficacy theory (in association with the biopsychosocial model’s principles) demonstrated that patient’s had the ability to control phobic stressors could enhance immuno-enhancing effects (rather than an enhancement of immumo-suppressive behavior).

The theories of planned reasoned action and planned behavior suggest that a person’s intention to adopt new health behavioral patterns is associated with their attitude towards a the outcome of the behavior they must adopt, how much control they believe they have in the outcome (Brannon & Feist, 2004). Lastly, the transtheoretical model, with its goal to predict behavioral changes, suggests that there are stages in which a person transcends about their behavior change which include precontemplation, contemplation, preparation, action, and maintenance (Brannon & Feist, 2004).

These models are not completely successful in determining a behavioral change because, as Brannon and Feist state, past behavior seems to be more predictive for what present behavior will be even with the best of intentions (2004). So, if a person has been diagnosed with diabetes, these theories can not conclude if the patient will voluntarily lower their sugar intake or monitor their blood sugar levels on a regular basis even if they have the best of intentions.

Ignoring Danger.jpg


Brannon, L. & Feist, J. (2004). Health psychology: An introduction to behavior and health (5th Ed.). CA: Wadsworth/Thomson Learning.

Lyon, B. L., & Konradi, D. B. (2000). Measuring Adherence to a Self-Care Fitness Walking Routine. Journal of Community Health Nursing, 17(3), 159-169.

Stein, M. D., Rich, J. D., Maksad, J., Chen, M., Hu, P., Sobota, M., et al. (2000). Adherence to Antiretroviral Therapy among HIV-Infected Methadone Patients: Effect of Ongoing Illicit Drug Use. American Journal of Drug and Alcohol Abuse, 26(2), 195.

Wiedenfeld, S. A., O'Leary, A., Bandura, A., Brown, S., Levine, S., & Raska, K. Impact of perceived self-efficacy in coping with stressors on components of the immune system. Journal of Personality & Social Psychology, 90(59), 1082-1094