Just for a moment, imagine yourself at a family gathering for the holidays. Look out onto the faces of the people you love. Feel the stripping away of the stress of daily life and the warmth of realizing that these people that you love also love you back. Nice feeling, right? I would venture to say that oxytocin plays a big part in that feeling. Many of us know about oxytocin and have probably encouraged our clients to get more social interaction with others to alleviate symptoms of anxiety and depression. After all, it is known as the “love” hormone. But not all of us have someone to love! Social isolation can be a stressor for many people. We are, after all, social beings. I’ve read that prairie voles have similar social conditions to humans when it comes to isolation. At some point, a few years ago, I became interested in the social and physiological implications of isolation among other mental health issues. Isolation seemed to be common in people transitioning and/or suffering from depression and anxiety. We all probably have those clients that are isolated and disconnected from others. Whether it is because the client has distrust for people, has a mental illness, just moved here, lives in a rural area, is mobility challenged or any number of other issues. In some of the more difficult cases, clients can be resistant to self-care suggestions and/or have lifestyle structures that prove difficult. It can be hard for our clients to know what is healthy alone time verses unhealthy alone time. When I first started out, I panicked when I kept finding my skills were lacking in this area because my suggestions to clients were largely limited to my own experiences. I realized after working full-time and going to grad school full-time, my lifestyle left me with little free time to socialize. I had no family in Denver and I set my life up to be dedicated to my goals but not dedicated to seeking connections with people.
There is also the issue of technology fostering disconnection even though it appears connection should be easier. One of the ways I have grown into my therapyhood (that’s a word) is to help clients find other ways to be connected even if that meant they were doing it ‘alone’. It was through my own journey that I researched alternative ways of thinking about this issue. Denver, for some people, is perceived to be an isolating place. There are many activities around the city, but mostly, I hear complaints from clients that when they put themselves ‘out there’ to try to make friends, they felt shut down or ignored by the object of their efforts. I have to admit when I moved here my experiences had been somewhat similar. I did not share that with clients necessarily, but I am uncertain I was able to confidently respond with effective tools that would help them when I struggled too. At that time, in just wanting to be accepted by others, most connections I found were unhealthy and probably produced negative effects of oxytocin (for another time). To make things worse, some of the clients that I came across were resistant or unable to make changes in their lives and were less likely to find what they were seeking, which was connection. Certain clients can further internalize the voice of society regarding being alone and isolate even more, which can turn to loneliness and shame. Research I have come across contend that loneliness and depression share some characteristics, but are in fact separate from each other, and that loneliness increases the risk for depression.
One of the ways that I approached this gamut of problems with clients that are isolated is to talk about the science of neurotransmitters in the brain and how they can be produced with a little manipulation from them. More specifically, I began discussing ways to stimulate oxytocin and possibly vasopressin in the brain. Oxytocin is known for its ability to make people feel more connected when they are with others, but what about ways to increase oxytocin when you are not around people.
First, a few facts about oxytocin. Oxytocin is produced by the hypothalamus and then released by the posterior pituitary. It can also be synthesized in many peripheral tissues including the heart and sex organs. Oxytocin is released in response to activation of sensory nerves not only during labor and breastfeeding, but also in response to skin-to-skin contact between mothers and infants, during sexual intercourse in both sexes, in connection with positive, warm interactions between humans and interaction between humans and animals (in particular dogs), in response to several kinds of massage and even in response to suckling and food intake. It can also play a role in generosity and helps with trust and depressive feelings. Oxytocin can also amplify both positive and negative social experiences equally depending on the area of the brain where receptors take up the neuropeptide, but that is for another time. Vasopressin is molecule that has a similar structure to oxytocin and can act as an agonist (activator at the receptor). Oxytocin agonists or antagonists (blocking at the receptor) are able, because of their similar structure, to bind to the oxytocin receptor (OTR) and create physiologic responses.
My interest in discussing this topic is that it is very easy to find oxytocin stimulation when one has companionship in the form of a partner, friends and family around. The problem arises when someone has completely isolated themselves or have very little access to support. How do we as therapists help these clients find connection or at least mimic the physiological response to companionship by manipulating certain molecules. Here are some of the ways that I have suggested clients elicit production of oxytocin and vasopressin in an effort to help increase connected emotions.
- Oxytocin or vasopressin supplementation. Since I am not a doctor, I cannot recommend particular frequency, dosage or brand. I simply mention to clients that these exist but that I cannot suggest anything in particular and advise they check with their primary care doctor or psychiatrist.
- Orgasm via masturbation or intercourse increases plasma oxytocin. Of course, psychoeducation about healthy masturbatory habits will help the client normalize this behavioral intervention so that there is not further harm.
- Hugs provide skin-to-skin contact that releases oxytocin, but I also suggest clients hug themselves in a butterfly hug. I am unsure if this is as effective, but if nothing else, it may be possible to get a placebo effect from doing this.
- Petting an animal is something I suggest quite often. Suggestions for getting a faux fur blanket at work, in the car, and at home have also been effective when an animal is not accessible.
- Eating has apparent rewarding and also relaxing effects. It represents an important pathway to achieve wellbeing and stress relief and eating or overeating for self-soothing is very common. If I make this suggestion, I generally provide psychoeducation and determine boundaries as guidance. Mostly, the suggestion is framed in a mindfulness promoting way. Like savoring their favorite piece of chocolate, for example. Additionally, eating foods that contain tryptophan such as eggs, chicken, turkey, bananas, yogurt, whole grain rice and quinoa, sesame seeds, cashews, walnuts, salmon, spirulina, potatoes, beans and legumes. Dark chocolate has also been known to increase dopamine and oxytocin.
- Exercise is a great way to increase neurotransmitters. Whether it is at the gym or on a sports team, vasopressin and oxytocin are released in the plasma during exercise.
- Massage is a great way to get oxytocin. Oxytocin can be released by various types of sensory stimulation, for example by touch and warmth. Bloodstream levels of oxytocin have been shown to rise during massage. Clients can also self-massage.
- Intranasal administration of oxytocin causes a substantial increase oxytocin. It can be purchased online and possibly in health stores but recommendations cannot be made in this forum as to amount and frequency. It is a good idea to recommend the client speak to a doctor.
- Talking to mom or a loved one is also a way to get oxytocin even if it is just on the phone.Only, however, if the person is a loving and supportive connection.
- Singing or playing an instrument. The tactile and visceral experience can raise oxytocin levels in addition to other peptides. Listening to music can create this response as well.
- Travel, even alone. This can foster passive connection with others who are also traveling and can raise oxytocin. It is also more likely when you travel alone that you are forced to interact with others.
- People watching is a great way to trick the brain into releasing oxytocin. I suggest clients try to guess the story of others. If the situation organically arises, I invite clients to practice social skills. Occasionally, social skills are lacking in clients that are isolated.
- Reduce misconceptions of society. Your client might isolate because they see the world and other people as dangerous. Reframing distrust of society may help the client to feel less disconnected and alone and feel reconnected with society.
- Bumble, where best friends meet online. Suggesting this in the context of being alone is to suggest that the act of seeking others to connect with might trick the brain into releasing oxytocin. As an added benefit, it also increases the possibility of connecting with someone online or in person.
- Cryingfor long periods of time releases oxytocinand endogenous opioids, otherwise known as endorphins. These can help ease both physical and emotional pain.
- Looking at pictures of loved ones and recalling memories. When the memory of an oxytocin-producing event is repeatedly brought to mind, oxytocin is produced and fear systems are depressed. This means reduced anxiety for example.
- Vitamin B supplements take care of your brain’s health. They also support the promotion of dopamine and oxytocin levels.
So whether your clients are meditating, dancing, enveloping in the warm bath water or hot tub, going on a lone quest, watching a comedy, snuggling with a pet, playing an instrument, crying or any number of things mentioned here, the client is letting their body know that it is loved and taken care of. Translation=oxytocin production in one form or another.
- The Oxytocin-Oxytocin Receptor System and Its Antagonists as Tocolytic Agents/
International Journal of Endocrinology. Volume 2011, Article ID 350546, 8 pages. http://dx.doi.org/10.1155/2011/350546
- Nakajima M, Görlich A, Heintz N. “Oxytocin modulates female sociosexual behavior through a specific class of prefrontal cortical interneurons”. Cell. 2014;159(2): 295-305.
- Heinrich LM, Gullone E. “The clinical significance of loneliness: a literature review”. Clinical Psychology Review. 2006; 26: 695–718.
- Ohlsson B, Forsling ML, Rehfeld JF, Sjölund K., “Cholecystokinin stimulation leads to increased oxytocin secretion in women”.Eur J Surg. 2002; 168(2): 114-8.
- Pál Pacher, Sándor Bátkai and George Kunos. “The Endocannabinoid System as an Emerging Target of Pharmacotherapy”.Pharmacological Reviews. 2006, 58 (3) 389-462.