Immunity and Mental Health: PACER Integrative Behavioral HEalth

Immunity and Mental Health: PACER Integrative Behavioral HEalth

i’d like to welcome everybody today’s presentation 
of integrated behavioral health i’m your host dr dawn elise snipes today we are talking about 
immunity and mental health what’s the connection and what can we do to improve both of them let’s 
briefly talk about the effects of poor immunity on mental health and health and then 
we’ll move on to what we can do about it when we are sick our hpa axis is activated 
unfortunately when our hpa axis is activated our immune system goes down so it it’s an 
interesting um kind of turn of events and if you remember your hpa axis is your threat 
response system so when you are sick your body registers that as something’s broken in 
the factory and we need all hands on deck to get it fixed so that hpa axis is activated in 
order to protect you but unfortunately um part of that when cortisol is released it acts 
to suppress temporarily the immune system when the hpa axis is activated for too long or 
chronically um it has long-standing effects uh causing inflammation and also reduced immunity 
so that hpa axis always comes back to either support us or bite us in the butt we need to make 
friends with it there can be an illness cascade when we have poor immunity you can get a virus 
and then you’re more susceptible to other things when we have a low immunity we are also 
more susceptible to things like cancer and bacterial infections and you may be 
like cancer yes when we’re under stress because of illness or because of you know just 
stress that hpa axis is activated our body is actively you know running hot if you want to 
think about it that way and creating a plethora of oxidative stress and that oxidative stress can 
contribute to cancer if our body can’t clear it out effectively it can also there are also a 
lot of other things that can contribute to cancer but one of the most fabulous findings that they 
have discovered over the past i don’t know decade is that there are treatments now that actually 
serve to activate or enhance the immune system to target those uh cancer cells so we know that there 
is a relationship between cancer and immunity and we know that there is a relationship between 
stress and immunity which is one of the reasons if you go on the american cancer society page 
stress is one of those things that people can do in order to help prevent cancer is it going 
to do everything no but it’s certainly one of those ways to um assist yourself and 
and not work against your your body when you have poor immunity you have slow recovery 
from injury your immune system is designed to take care of pathological invaders but 
it’s also designed to help you recover when you get a cut when you break your arm 
when you you know do any of those things when your immunity is low it exacerbates 
current physical issues if you’ve got autoimmune issues then as your immune system decreases 
those autoimmune systems issues can get worse your diabetes when you are ill when your immune 
system is low and you’re getting more of these infections that hpa axis is activated which 
makes it more difficult to control blood sugar chronic hpa axis activation and poor immunity can 
also contribute to systemic inflammation which we know not only impacts the immune system when 
there’s inflammation the immune system kind of   goes into overdrive but we know when people have 
systemic inflammation there’s also a link between that and the development of clinical depression 
as well as it increases your risk for dementia autoimmune issues get worse when your immune 
system is not healthy it impairs your sleep now this is sort of indirect but when you have 
poor immunity and you’re getting sick think about how well you sleep when you’re sick or even 
when your allergies are really bothering you a lot when you can’t breathe when your body factory 
is not running at a hundred percent it does impair your sleep when that hpa axis is activated 
it impairs your sleep because of impaired sleep but also because your body is directing energy 
towards that immune system when you’re sick you’ll have likely low energy and it can disrupt 
your circadian rhythms when you have poor immunity and you’re getting sick frequently then 
you’re probably not keeping to that same   schedule that you normally do which disrupts your 
circadian rhythms which may disrupt your sleep which contributes to hpa axis activation it 
goes back to that stress response your body trying to balance and protect itself as much 
as possible and when it thinks there’s a threat viral bacterial physical emotional cognitive it’s 
going to activate affectively when we are when our immune system is poor then that low energy that 
difficulty sleeping and those frequent illnesses uh and increased inflammation can make depression 
worse or can trigger depressive episodes when we have poor immunity and we’re frequently 
getting sick it increases anxiety it increases anxiety about getting sick when you’re 
healthy it increases anxiety about uh things getting worse or getting bad illnesses 
when you do get sick you know you start having   a sniffle and you think oh my gosh is it covered 
or is it tuberculosis or is it something else so it can increase health anxiety and it can also 
increase anxiety about getting others sick when you frequently get sick you may think twice 
about going to visit your elderly relatives or your grandbaby that was just born 
it can contribute to grief because you’re frequently sick you may not be able to 
engage in the things that you wanted to engage in you may not be able to do some of the things 
that you wanted to or engage with people like you wanted to and those are all things to 
grieve remember grief is not just about death it is about not getting to access something 
that’s important to you having something that’s important to you taken away when people develop 
chronic immune issues um it can people can develop grief because they have to acknowledge that okay 
now i’ve got this chronic illness and that’s going to change what i envisioned the rest of my life 
like being like doesn’t mean it has to be bad recognizing we can live in the and we can have 
an autoimmune issue you know diabetes rheumatoid arthritis lupus any of those things you know 
there are lots and lots of autoimmune issues and still have a rich and meaningful life but 
part of that is going to revolve around doing as much as we can to reduce our stress regulate 
that hpa axis reduce inflammation and bolster the immune system loneliness can also happen because 
of immunity if you can’t go see all those people then you might start feeling lonely because you’re 
isolating in your own house and loneliness re leads to reductions in oxytocin leads to feelings 
sometimes of depression which again goes back to our old friend the hpa axis increasing stress 
cognitively when you’re sick you have difficulty concentrating when you are not sick and even 
when you are sick a lot of times you may have preoccupation with either preventing getting sick 
or you know noticing every single symptom like i’ve got a little bit of a runny nose 
i wonder if that means i’m getting sick   or preoccupation with trying to avoid 
getting sick so you spend a lot of time and anxiety and emotional energy worried about 
getting sick whereas if your immune system think about it as your armor if your immune system or 
your armor were intact if it were you know fully functioning you might not have to worry about that 
as much environmentally when we get sick a lot we have reduced productivity even if you are going to 
work you’re probably not getting as much done but a lot of times you start having days off from work 
and you know having difficulty with that increased medical bills even if it’s not going to the doctor 
even if it’s buying over-the-counter medications a lot of times if you’re getting sick frequently 
you’re going to have increases in medical bills and environmentally again you’re going to have 
more safety concerns if you know that your   immune system is in the crapper you’re going 
to have more anxiety about exposing yourself to the general public about going grocery shopping 
about going to walmart about going anywhere where you might encounter bugaboo relationally you 
may have voluntary or forced social withdrawal you may withdraw and choose not to interact 
with other people because you’re afraid   that they’ll get you sick or you may have forced 
social withdrawal because you’re sick and you don’t want to get other people sick so you have to 
stay home the more frequently that you’re sick the less interaction that you’re going to have which 
can contribute to you know difficulty in nurturing relationships if you don’t feel like you can ever 
go visit your grandchildren or your elderly parent or or whomever because you’re afraid of getting 
them sick or because you’re sick all the time you don’t have energy then you may start feeling you 
know isolated so what do we do about it regulate that dagum hpa axis and that is easier said 
than done because remember any sort of stress is going to activate that axis so we need to 
do as much as we can to infuse um pleasantry pleasantness into our life and to bolster our 
system to enhance it to make it feel stronger first if you do have medications take all of 
your medications you don’t want to develop bacterial or bacteria or viruses that 
are resistant to certain medications that is so important whether you’re talking 
about taking antibiotics for an ear infection   or for tuberculosis if you’re prescribed 
antibiotics or antivirals it is important to take them as prescribed the doctor when my son was 
very little because when i was little they didn’t have this idea but when my son was very little 
explained to me that it’s important not to overdo antibiotics when we take antibiotics it doesn’t 
when you take it it doesn’t say oh there’s that little germ that’s causing her to be sick it goes 
in and starts wiping out entire colonies of either gram-negative gram-positive or both types of 
bacteria and you need bacteria in your gut in order to break down food in order to make hormones 
and neurotransmitters in order to regulate your system in order to regulate that hpa axis when 
your gut’s unhealthy it communicates to your brain through the vagus nerve and it says something’s 
not right here and when that happens then the hpa axis again activates so antibiotics are important 
sometimes when your body can’t do its job but our pediatrician and i’m not a medical doctor so i’m 
not making recommendations but most doctors now are relatively hesitant to prescribe antibiotics 
if you don’t have a super high fever or haven’t had the illness for you know a certain 
period of time so the first time you wake up and you have the sniffles and a low-grade fever 
they may not give you antibiotics right away and it’s important to really consider the cost 
benefit of if i take these you know number one a lot of times when people get a cold it’s actually 
a virus and antibiotics do nothing for a virus and number two you know is it worth 
taking the antibiotics and wiping out the bacterial colonies in my gut that’s 
that’s a consideration now obviously at a certain point it’s important if your body 
can’t fight off the bacteria on its own   but that is a consideration consider vaccinations 
and i know some people are very anti-vaxx and some people are very provacs i’m not saying 
either way but it’s important to consider your health your situation your beliefs about 
vaccinations and then make decisions from there eat colorfully antioxidants are in colorful 
foods antioxidants help get rid of that and clear out all of that oxidative stuff all 
of the oxidative stress in our body so antioxidants can reduce physiological stress 
eat colorfully yellows reds purples and even greens green apples green grapes there are greens 
that you can get even if you don’t like broccoli but leafy greens are some of your healthiest 
foods they have figured out ways to dehydrate them and turn them into superfood 
powders or even capsules now some people are choosing to do that in order to get some of 
their antioxidants in you know i prefer to get it as fresh as possible myself but i happen to love 
green leafy vegetables so but eating colorfully is really important every day try to aim to have 
three colors on your plate at every single meal consider eating an anti-inflammatory diet 
when your body is inflamed when there is are things causing inflammation it activates 
that hpa axis and suppresses your immunity things that increase inflammation can be like 
omega-6s as well as highly processed foods you can go online and read about 
anti-inflammatory diets but consider minimizing some of those things that are 
known to cause inflammation   in order to you know give your body the best um 
best shot possible don’t add to its stress if you don’t do anything you know if you’re neutral 
that’s better than adding to stress now of course every once in a while people are probably going 
to eat processed foods and that is entirely um entirely okay when we drink water our 
hydration helps our kidneys and our liver uh but particularly our kidneys filter out 
some of the toxins if we don’t have the water pushing through then our body has a hard time 
getting the sludge out think about it that way think about the sludge if you have a house 
and you have the the gutters up there   um you have a harder time getting the sludge 
through the gutters if it hasn’t rained in a while so make sure you stay hydrated gut 
health is important paying attention to your gut when your hpa axis is active it’s going 
to speed the rate that everything goes through your system because it’s saying it’s not time to 
rest and digest it is time to fight or flee which means you’re not going to absorb the nutrients 
that you need as as effectively vitamin d is super important for immune health you 
get vitamin d from the sun and you get it in a lot of the foods that you eat are enriched 
with vitamin d your doctor can do a blood test to assess your level of vitamin d because low 
levels of vitamin d are associated with depression seasonal affective disorder inflammation and 
reduced immunity so this is one of those that we want to get but vitamin d is not water soluble 
so you can overdose on it so to speak and it’s important not to do that so that’s why you don’t 
want to start taking like super mega doses of vitamins because it can throw everything else out 
of whack sleep hygiene is important if you have poor sleep then you are going to have difficulty 
functioning during the day you’re going to be fatigued and that hpa axis is activated cortisol 
levels have been shown to be significantly higher in people who are sleep deprived and interestingly 
enough exercise can actually help low and moderate exercise not super intense but low and moderate 
exercise can actually help reduce inflammation in the body so exercise can be helpful 
exercise also helps keep our joints mobile so we don’t develop stiffness exercise at low 
levels can help reduce cortisol levels which can be beneficial remember cortisol is your 
stress hormone and when we’re under stress   our immune system is suppressed oh that kind 
of kind of rhymes anyhow exercise can be good when we exercise it also increases our level of 
oxygenation because we’re breathing more and a lot of times when we exercise we tend to drink 
more water and that can help us with hydration affectively it’s important to do what we can to 
regulate that hpa axis meditation can be super helpful for giving your body basically a time 
out for putting that hpa axis sort of on pause in order to meditate the first thing that i 
recommend doing in all of my meditation videos is make sure you feel safe and one of the 
reasons that our hpa axis is often activated is because of a lack of a sense of safety so 
when we meditate the first thing we do is make sure we feel safe make sure we’re an environment 
that’s safe and then we are helping ourselves quiet the mental noise one way or another through 
guided imagery through progressive muscular relaxation there are a lot of different ways to 
meditate but meditation has been shown to reduce cortisol levels and increase serotonin dopamine 
and gaba levels in people so meditation can be super helpful mindfulness is 
also important being aware of how you feel on a moment to moment if you’re 
mindful you can pick up on little signs that you might be starting to get sick and you can start 
taking better care of yourself it’s important to pay attention to what you’re doing as well when i 
was in college uh i had a bad habit during finals week of not sleeping much and eating like crap 
which are two things that activate that hpa axis and reduce my immune system and almost inevitably 
after finals were over i’d end up getting sick and if you look back at your habits you will often 
notice if you’re not being mindful and to of your health and doing things that you need to do you 
are much more susceptible to illness because a lot of things that we want to do in excess may take 
away from the things that we need to do for health mindfulness is important mindfulness also helps 
you recognize for example if you didn’t sleep well last night i didn’t sleep well i got plenty of 
hours but i felt really fatigued this morning when i got up so i checked in with myself and i said 
you know what i’m going back to bed instead of going to the gym this morning i felt that it was 
more prudent for me to go back to bed and try to you know clear up that fog a little bit and when 
i woke up i felt much better when you’re mindful sometimes you can’t go back to bed so what do you 
do if you know that you’re foggy if you know that you’re not on your a-game in order to prevent 
adding additional stress throughout the day how can you mitigate because you know life’s going 
to happen what things can you do to mitigate that happiness is important infuse happiness which 
i’ll just kind of jump down to laughter too they’ve done studies that have actually shown that 
laughter enhances the immune system it releases endorphins that help you feel better that increase 
pleasure and laughter you know does all kinds of positive things as well as increasing oxygenation 
do things try to do something every single day that makes you laugh you know and and i’ve told 
you before whether it’s going on youtube and finding funny animal videos or listening to your 
favorite comedian or just watching your dog be a complete little derp whatever it is that 
makes you laugh do that at least once a day preferably more than that it’s good to laugh 
and develop distress tolerance skills because life does happen and i’ve talked a lot in other 
videos about distress tolerance skills you can watch up on those read up on those later if you’re 
not familiar but it’s important to recognize that sometimes unpleasant things happen and having 
the skills to be able to tolerate that distress when it does happen especially if it’s not 
something that you can control is really important cognitively focus on the facts and i always ask as 
evidenced by if you are going to say you know if my son was going to say mom this dinner sucks 
okay well i can’t fix it if i don’t know what that means so this dinner sucks as evidenced by 
thankfully he would never say that to me because it would hurt my feelings but um you know i need 
to understand what about it is problematic or i hate my job or my job is awful okay if that’s 
true what about it is awful you know people can’t adjust if they don’t know specifically what’s 
wrong address any cognitive distortions again i’ve talked in multiple videos about cognitive 
distortions if you want to read up on those but especially catastrophizing personalizing mind 
reading and all or none thinking and develop psychological flexibility so you can deal with 
life when it happens you don’t have to react immediately you can be mindful acknowledge how 
you feel in the moment and then evaluate your options and choose in your wise mind what the next 
best step is to improve the next moment you don’t have to stay stuck in anger if you feel angry 
you feel angry acknowledge it non-judgmentally and then say all right what is the next best 
thing that i can do to address this situation environmentally wear a mask socially distance 
regularly wipe down frequently touched surfaces wash your hands those things we’ve been hearing 
for months on end maybe years depending on you know the environment you grew up in but 
those are all really important wearing a mask if if you have a reduced immune system wearing a mask 
right now you’re supposed to wear a mask you know constantly but you know henceforth you know in 
the future that may not be true but when you are sick wearing a mask can help prevent others 
from getting sick or if you have a reduced immune system you know you’re susceptible especially if 
you are older or if you have autoimmune conditions wearing a mask for example during flu season may 
be prudent that’s something you need to think about for your own self and maybe discuss with 
your doctor regularly wiping down those frequently touched surfaces we talked last week about things 
like our mobile devices our purses our briefcases even door handles and the knobs on the cabinets in 
the kitchen can be really disgusting harbingers of bacteria so wiping those down frequently 
can help prevent the spread of disease wash your hands with soap for at least 20 seconds 
but interestingly enough it’s also important to get dirty sometimes our bodies our immune system 
is built up when it’s exposed to bacteria when it’s exposed to viruses i’m not saying go out and 
expose yourself to everything what i’m saying is don’t be afraid of occasionally getting dirty in 
the 80s and the 70s you know we used to go out and get dirty and play in the dirt and play outside 
and there was not hand sanitizer everywhere um and when you know so so we developed a 
something of an innate immunity to certain really common bacteria out there now bacteria 
and viruses are always mutating and there’s unfortunately new ones that occasionally occur 
so you’re not going to be immune to everything but if your immune if your immune system has a 
memory of certain viruses and certain bacteria then it’s primed it’s it’s able to scan for those 
invaders and notice them sooner and say oh i know how to deal with this so that can be good to 
develop a little bit of immunological memory my point being again i am not saying by any means 
go out and try to get sick but recognize that you also don’t have to live in a complete bubble 
all of the time a lot of times your body has adjusted to the bacteria and viruses in your area   think about like thanksgiving and christmas 
and when you’re interacting with people who are flying in from other places a lot of 
times you’re more susceptible excuse me a lot of times you’re more susceptible 
to bacteria because those people   have been living in a different 
microbiome than you have interpersonally social supports can be 
one of the greatest buffers against stress   and hpa axis over activation so think about 
improving communication with the people that are important to you even if you have to socially 
distance for a while how can you communicate with them especially using their love languages 
how can you be improve your honesty with them how can you increase your awareness of what they 
need and be more sensitive to their temperament at and their preferences excuse me um how can 
you practice kindness in your relationships and nurture those relationships how can you 
be more respectful of other people’s opinions and preferences you know thinking 
of course of their temperament and how can you demonstrate an attitude of 
gratitude towards people and i encourage you to look back at the um uh video on meditation and 
the loving kindness meditation can really help you work on developing that attitude of gratitude 
uh towards other people you are likely not going to agree with and maybe not even like 
everything that everybody in your life does all the time that’s kind of unrealistic but having an 
attitude of gratitude that they are in your life can go a long way to being able to love 
them as human beings to respect them their for their similarities 
and their differences to you   and to accept when they do things when they have 
behaviors that you disagree with and address those things it’s important to educate our clients 
about immunity and what they can do to enhance it sometimes it’s important to refer them back to 
their physician or to a registered dietitian but it is important to educate them about the 
importance of it some people have need to eat gluten free there are gluten-free options of foods 
to eat that can help you get a well-rounded diet some people uh want to eat you know there 
are always fad diets that are going on that often involve super restriction of certain 
types of foods and i encourage them number one to evaluate how they feel when they 
are restricting their diets that much number two i encourage them to talk with their 
doctor about it number three i encourage them to look back at their energy levels their immunity 
and you know all those other things and their mood and when they’re on that diet and or when they’re 
eating in that fashion to identify how they feel some people when they eat a certain way feel much 
better even if it means cutting out you know whole swaths of food and that’s something again more 
for a registered dietitian and or doctor to really hone in on with them because maybe they 
you know with celiac disease for example where there’s a gluten sensitivity there are certain 
swaths of food that people who have celiac disease can’t eat and it’s a matter of figuring out okay 
if you can’t eat that then what else can you eat in order to have a well-rounded diet and make sure 
you’re getting all the nutrients that you need it’s also important for clients to 
assess their relationship with food some people swear off certain types 
of food because they’re afraid of it   like they swear off fats completely and fats 
are really important for the development of um for your body to be able to break down to make 
your gonadal hormones for your body to be able   to process fat soluble vitamins you know 
we need a certain amount of fat in our diet so those things are important in 
terms of vitamin d versus d3 vitamin d d3 is the form that we need our body to absorb 
there are vitamin d gets broken down in the body what’s important to recognize is how much your 
body needs is going to vary partly depending on where you live how strong the sun is how much 
time you spend outside and your immune system some people will need supplemental vitamin d 
either through their the foods they eat or through supplements but again it’s important to recognize 
if you like megadose on one you may actually inhibit the absorption of other things some 
some vitamins that you can take that people can megadose on may actually cause their body 
to do things like leech calcium from their bones so you want to be aware of the impacts of excess 
of a vitamin as well as deficiencies and and take that into consideration stress can also 
contribute we see it impairing the immune system in people when they start to develop 
cold sores or they start getting canker sores more easily we even see it 
my cats unfortunately two of my cats uh got a virus when they were little and they have 
an immune reaction when they get stressed now they get this really bad upper respiratory 
infection unless i’m giving them uh supplemental lysine now again i’m not 
recommending you go out and start taking tons of supplemental lysine i’m just telling you for 
my cat that’s one thing that we do to bolster uh their immune systems to help them avoid having 
an episode with the immune system compromise all of the vitamins and 
minerals do work in synergy   to do what they need to do one of the ways that 
you can have clients assess their nutrition is by having them download a nutrition app and that can 
be super helpful um it’s for for them to figure out what am i getting enough of what am i getting 
too much of if possible and what am i not getting enough of and a lot of times i know on mine mine 
shows that i’m always getting too much sodium so that’s something that i try to work on in 
order to reduce the stress on my body but i also notice that zinc is one of those minerals that i 
often don’t seem to get quite enough of and and that’s something that i also work on discovering 
foods there’s a website self nutrition is good as as well as world’s healthiest foods um 
i think it’s dot-com but it could be.org if you want to find out what types of foods 
have a certain vitamin or mineral you can go to those websites and find out you know like 
cashews for example are a powerhouse of copper and walnuts are a powerhouse for 
omega-3s now if you can’t eat nuts obviously those two suggestions are not going 
to be helpful but you can find vegetarian options vegan options gluten-free options 
it may just take a little bit of looking zinc is definitely important for everybody in   maintaining the immunity maintaining 
your health maintaining your energy but as always it’s a balance it’s a balancing 
act and getting your nutrition from natural foods because they found that most of the 
vitamins and minerals are much more bioavailable when they come from food itself as opposed 
to you know a pill that is you know chemical it our body’s better able to use it because it’s 
already in the ratios that it actually needs to be to be more effectively bioavailable when you’re 
cooking vegetables you know as a side i’ve kind of gotten off onto onto nutrition here make 
sure that the more colorful your vegetables are the higher in antioxidants and nutrients they 
are if you cook them till they’re gray that’s not going to do you a whole lot of good have them as 
bright and colorful as you possibly can like kale i steam until it goes from kind of what i call a 
dingy green to a really bright bright green and that’s enough it tenderizes it it takes the bitter 
out of it and it’s ready to go so it is so it is important to you know not just assume that you’re 
getting everything you need because you’re eating food but you need to make sure that you’re 
not you know cooking all the nutrients out of it and that you’re getting as much as possible 
chewing well and that’s one of those things that i am not good at i eat too fast but chewing well 
can also be important to help your body be able to break down the foods in your gut and make 
the hormones and neurotransmitters that it needs i appreciate all the interaction um 
if there are no other questions then i will end for today but i really appreciate 
everybody taking time out to be here with me i know you do have things going on and i 
apprec but i do appreciate you attending and interacting and looking for ways 
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Dr. Dawn-Elise Snipes is a Licensed Professional Counselor and Qualified Clinical Supervisor. She received her PhD in Mental Health Counseling from the University of Florida in 2002. In addition to being a practicing clinician, she has provided training to counselors, social workers, nurses and case managers internationally since 2006 through AllCEUs.com Want to chat with me? Join me at https://members.docsnipes.com/ For $10/month you get access to my daily tips for health and wellness and you can text chat with me privately.

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#immunity #autoimmune #mentalhealth

Effects of Poor Immunity
Physical:
HPA-Axis Activation
Illness cascade (viruses, cancer, bacterial infections)
Slow recovery from injury
Exacerbate current issues
Inflammation
Autoimmune
Sleep impairment
Low energy
Circadian rhythm disruption
Affective:
Depression
Anxiety
Grief
Loneliness
Cognitive
Difficulty concentrating
Preoccupation
Environmental:
Reduced productivity/$
Increased medical bills
Safety concerns
Relational
Social withdrawal (voluntary or forced)
Difficulty nurturing social relationships
Improve Immunity
Physical:
Regulate HPA-Axis
Take all medications
Don’t over-do antibiotics
Consider vaccinations
Eat colorfully
Anti-inflammatory diet
Hydration
Gut health
Vitamin D
Sleep hygiene
Exercise
Affective:
Meditation
Mindfulness
Happiness
Distress Tolerance
Laugh
Cognitive
Facts—As Evidenced By
Address cognitive distortions
Psychological flexibility
Environmental:
Wear a mask
Socially distance
Regularly wipe down frequently touched surface
Wash hands
Get dirty (immunological memory)
Relational
Social support can be one of the greatest buffers—
Communication (love languages)
Honesty
Awareness
Kindness
Respect (temperament)
Attitude of Gratitude

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