Dr. Christine Bjorndal, ND

 

Subheadline 

A six-year case study demonstrating the role of nutrition, lifestyle, and psychotherapeutic interventions in resolving complex mental health conditions.

 

Short Description 

This case report details the successful resolution of anxiety, depression, insomnia, and disordered eating in a 28-year-old female using an integrative mind–body–spirit approach. Through targeted nutritional support, lifestyle modification, and psychotherapeutic interventions, the patient achieved sustained mental wellness and significant life transformation over six years.

 

Abstract

This case report describes the integrative treatment of anxiety, depression, insomnia, and disordered eating in a 28-year-old female using a comprehensive mind–body–spirit approach. The patient presented with a longstanding history of mental health concerns, including social anxiety from childhood, depression with suicidal ideation, chronic insomnia, and a prior history of eating disorders, alongside hormonal and stress-related imbalances.

Initial care focused on establishing the physical foundations of health through targeted nutritional supplementation, dietary modification, sleep optimization, and support for neurotransmitter balance, adrenal function, and hormonal regulation. As physiological stability improved, treatment expanded to include psychotherapeutic and mind–body interventions, including cognitive behavioral therapy, mindfulness-based practices, self-compassion work, and strategies to address trauma, maladaptive thought patterns, and boundary-setting.

Over the course of six years, the patient demonstrated sustained improvement in objective measures of anxiety and depression, along with resolution of insomnia and significant behavioral and emotional shifts. This included increased self-awareness, improved resilience, and the capacity to make aligned life decisions, ultimately leaving an unfulfilling relationship and pursuing a meaningful career path.

This case highlights the importance of addressing both physiological and psychosocial determinants of mental health and supports the role of an integrative, staged approach in achieving long-term, transformative outcomes in complex psychiatric presentations.

 

Introduction 

Millions of people in the North America are affected by mental illness each year. Consider these facts 1:

• More than 1 in 5 U.S. adults experience mental illness each year
• More than 1 in 20 U.S. adults experience serious mental illness each year
• More than 1 in 7 U.S. youth ages 6-17 experience a mental health disorder each year
• 50% of all lifetime mental illness begins by age 14, and 75% by age 24
• Suicide is the 2nd leading cause of death among people ages 10-24

Naturopathic doctors are well-positioned with our unique training in a holistic approach to well-being to help patients navigate to mental wellness.

1. Reference: https://www.nami.org/about-mental-illness/mental-health-by-the-numbers/

 

Case Presentation

Patient Case Study – LH, 28 year old Female
LH presented to the clinic in September 2019 and her chief complaints were:  

1. Anxiety (primarily social anxiety) from birth to now.
2. Depression since age 13 to present  – with suicidal ideations and self-destructive tendencies leading to lack of self-care and feelings of self-harm
3. Insomnia since age 21/22 to now. In 2016 she did a 10 day vipassana meditation and experienced mental exhaustion and insomnia afterwards (from March – Dec 2019, slept 3-5 hours per night)
4. Eating disorders: anorexia and binge eating from around age 17 to 25; left with some disordered eating habits
5. Menstrual imbalances & PMS symptoms
6. Self-diagnosed with: adrenal fatigue, headaches, migraines, poor appetite and digestion, no sex drive, light headedness and poor circulation

 Key questions asked on initial intake are: Please explain why your commitment level is not 100% and What do you feel is causing any health problems you may have? LH answered as follows:

“Patterns of holding onto being sick and feeling undeserving that hinder my ability to let myself heal and be happy. A history from birth of anxiety and the development of depression in my teenage years in combination with parents and extended family who have poor emotional awareness and unresolved mental health issues. There was chronic stress and anxiety in the family and very little knowledge about how to manage it all. I am very sensitive and feel things very deeply. 

I also grew up in the country where we drank from a well and lived near two natural gas plants. My parents regularly used things like Roundup on crops and the farmers that lived in the surrounding area may have also been sprayed their fields with Roundup.”

LH sought my care as she was looking for guidance on how to remember how to take care of herself and do the things required to be well. After a mental breakdown in 2017, she has struggled to sustain a healthy lifestyle. She reports the following behaviors and lifestyle habits that support her health:

1. Eating healthy food as well as I can despite my current challenges with food
2. Getting back into riding and having a relationship with my horse
3. Always work towards practicing mindfulness 
4. Being realistic and trying to stay positive
5. Try to maintain an interest in spirituality
6. Try to be aware of and practice healthy thinking styles 
7. Try to do movement or yoga when I am capable 

In terms of behaviors/lifestyle habits that are inhibiting health or are obstacles, LH reported the following:

1. Prone to isolation/avoidant behaviors (which at times are vital and beneficial but are sometimes not healthy) 
2. Unhealthy eating patterns-partially due to lack of appetite but also influenced by a history of disordered eating
3. Struggle with communication-open and honest expression-very difficult to listen to, hear, and speak my truth-have boundaries 
4. Work: my current work (landscaping) is very draining and exhausting 

When asked “when do you think your health concerns began”, LH mentioned at birth – and stated “I feel like I was born into darkness. As a deeply feeling and highly sensitive soul born into my family as the second child, I didn’t feel guided by anyone. I felt completely lost.”  She found the teenage years difficult to manage, and now at age 28 she feels anxiety and depression have “taken over my life”.

Despite taking SSRI medication (Sertraline 25 mg), which helps her “function”, she is experiencing unwanted side effects of digestive upset, decreased appetite, heartburn, constipation alternating with diarrhea, lowered libido and flattened mood. As such, LH is hesitant to increase the dose of her medication. She has also tried to manage her mental health by taking emotional regulation courses. She reports that she was a vegan for 8 years. Now she is mostly vegetarian, prefers to not eat much meat or dairy and if she does, it is from ethical sources. In addition, she takes the following support:

• a Chinese herb for insomnia, anxiety, and depression 
• Medicinal cannabis with THC at bed 
• Magnesium bisglycinate
• Lavendar EO prn for tension headaches

LH reported she was experiencing considerable stress in the following areas of her life: work, significant other relationship, financial, health and spiritual.

She works for a private gardening company, and it has been a struggle since she has been working less for the past 4 years. LH is at the point where she doesn’t want to work and reports that “I am poor and sick, and I don’t know what to do.”

LH reports having a hard time with boundaries, speaking openly, being vulnerable and trusting people. She reports having a hard time making friends and finds herself socially isolated. She has recently moved in with her significant other and reports that her “patterns have gone off trying to accommodate his needs.”

LH started menstruating at age 16 and at that time only had three menstrual periods per year and no PMS symptoms. She sought western medical care and was diagnosed with PCOS. After getting acupuncture, LH reports that her cycle has been more regular – every 28-36 days. She reports menstrual cramps and moodiness as disruptive PMS symptoms. 

She reports feeling tired but wired at bedtime. She says she is “vibrating but exhausted and tired and can’t stop thought patterns.” It takes approximately 45 min to fall asleep, and she stays asleep throughout the night. On average, she is getting 6-7 hours of sleep and reports some restlessness in her legs on occasion. She does not recall if she is dreaming every night and states that typically she dreams when under extreme stress. She does not feel rested in the morning and doesn’t want to get out of bed to go to work. Despite this feeling upon waking, she reports decent energy throughout the day – rated at a 7/10 (with “10” being the best) and does yoga 3x per week for her exercise. It is noted that she also has a physical job as a landscaper.

Two key questions I ask patients (with a rating on a scale of 1-10 (with “10” being the best)) are: 

1. How much love do you have for yourself?
2. How much self-compassion do you have for yourself? 

LH answered a 2 out of 10 for both questions. In my professional opinion, this is where we need to start because how compliant do you think a patient will be with your treatment protocol if they don’t value themselves? 

LH reports that she is “aware of thoughts and sees them but there is so little energy to change the thought and there isn’t another voice to lift me up and move forward. I feel a heavy sense of defeat.” 

Objective Assessment

Calcium calf test: 170 – low

Blood Pressure on left arm: 98/60

Eyes: decreased pupil reflex 

Ears: tympanic membrane visible and cone of light clear bilaterally

Tongue: brushes

Mouth: no fillings

Weight: 125 pounds 

Height: 66 inches 

Anxiety Monitoring Form*: 42 – moderate anxiety (normal < 25)

Depression Monitoring Form*: 45 – extreme depression (normal <10)

Adrenal Stress Assessment: 64 – between 50-80-requires adrenal support (optimal <30)

ACE Questionnaire: 5/10 (score > 4 indicates trauma history)

Blood work from Dec 2017 (2 years old) – indicated:

• Optimal**: Hemoglobin 147 g/L (ref range: 120-160 g/L); Ferritin 69 ug/L (ref range: 12-300 ug/L); TPO 10 (ref range: <50), TSH 1.17 mU/L (ref range: 0.2-4.0 mU/L); Free T4 15.1 pmol/L (ref range 9-23 pmol/L); Free T3 5.0 pmol/L (ref range: 3.5 – 6.5 pmol/L); HgA1C 4.7 % (ref range 4.3 – 6.1%); Kidney and liver function – normal
• Suboptimal: B12 362 pmol/L (ref range: > 150 pmol/L)
• Not measured: all hormones, cholesterol, fasting glucose

Nervousness evidenced by picking of the fingernails, bouncing of legs, hard to make eye contact and a nervous laugh. 

* Mind over mood assessment scales by Christine Padesky from Cognitive behavioral therapy 

** Values in Canadian ranges

Assessment: Anxiety, Depression, Eating disorder history; Adrenal fatigue; Stress; Childhood trauma; possible hormone imbalance

Visit #1 Plan: It was explained to LH that the goal in working together is to address her chief health concerns through naturopathic medicine with the following physical level modalities: orthomolecular medicine, dietary suggestions, counseling, homeopathy and botanical medicine. I discussed that there are four “macro” areas to address when it comes to health: physical, mental, emotional, and spiritual. I explained that physical support can be divided into three big picture systems: 

1. a) hormone balancing
2. b) neurotransmitter support for optimal mood and
3. c) proper function of detoxification organs (liver, kidneys, colon, etc.) & immune function

 

To support the physical, mental, emotional and spiritual aspects of mental health I focus on these key areas: 

1. nutrition+ supplementation
2. sleep
3. exercise
4. stress management*
5. thoughts awareness and management*
6. emotional awareness and management*
7. how you behave and react in the world*
8. boundary setting/maintaining*
9. address trauma history through self-compassion and spirituality*
10. role of the environment – from three perspectives: a) quality of air, food and water – chemical perspective b) neuroplasticity c) genetics vs epigenetics

* I have additional training in the mental, emotional & spiritual levels of health and support patients with six psychotherapeutic techniques: Cognitive Behavioural therapy (CBT), Mindfulness based therapy, Compassion focused therapy, Gestalt psychotherapy, Compassionate Inquiry and Integrative reprogramming technique

 

At the first visit, I assess for nutritional deficiencies, as well as supplement quality and necessity. Most people are taking either the wrong form of a nutrient, the wrong dose, taking too many supplements or are taking supplements that have non-medicinal ingredients that are not beneficial. 

 

In terms of root cause medicine, it was noted the LH has the following areas to address: 

Trauma history (ACE score of 5), inflammation, dysbiosis, drainage, cell polarization; thoughts, nutrition/neurotransmitter; possible hormone imbalances

 

To support neurotransmitter and hormone formation, LH was prescribed the following supplements in addition to what she was already taking:

• Niacinamide 500 mg per cap – 2 caps at breakfast
• Multi B6 – 1 cap at breakfast
• Mg malate/citrate – 400 mg for muscle pain with breakfast
• Mg bisglycinate (200 mg per cap) – 2 caps at bed – for anxiety, sleep & depression

LH was already talking:

• Jia Wei Gan Mai Da Zao Tang 10-15 g per day for insomnia, anxiety and depression.
• Usually consume herbal teas such as rosemary, Passionflower, sage, lemon balm, nettle, pau d arco, damiana, Oat straw, alfalfa, and other digestive blends
• Medicinal cannabis 2016-current (CBD:11%/THC: 6%) – smokes
• Use smaller amounts of THC with CBD to aid in the above
• THC for sleep (prescribed by MD)
• Sertraline 25 mg (prescribed by MD)

She was asked to read articles I have written about mental health and the nutritional management of anxiety and depression and to complete the following questionnaires: Highly sensitive person, Detox, Candida questionnaires and return them to the office prior to her next visit.

Nutrition suggestions included:

1. Recommend working towards following The Essential Diet (get book or if you have Beyond the Label then it is included in that as the Mental Health diet) – start with a change that feels doable for you – i.e. either follow snacks, breakfasts; Tuesday; one dinner per week – start where you can and do what you can
2. Eat Tryptophan forming foods – eat daily. This serotonin pathway was explained.
3. Seed protocol for cycle
4. Water – minimum goal is ½ your body weight in lbs of ounces water – increase to 2L (64 oz – currently drinking 20oz) per day 
5. Eat protein at breakfast & lunch to balance blood sugar
6. Baking soda test – do and advise results

Lifestyle/Counselling suggestions were:

• Gratitude journal: 3 things you are grateful for every day
• Exercise: daily movement that you enjoy
• Do something that you love to do: sing, write, exercise, pottery, draw, play music
• Create vision for yourself of health: see yourself as energetic, healthy, etc – what is real was once imaged
• The most important relationship you have is the one you are having with yourself – the goal in the work I do w you is to help you get that relationship right
• Suicidal thoughts: red flag that in that moment you aren’t loving yourself. When you recognize a thought based in extreme self-criticism, do you best to move to a loving thought, such as, “I have a beautiful eyes” or “I want to be kind to myself”.
• Won’t get to ‘can’ by telling yourself that ‘you can’t’
• I want you to ask yourself – where you are living in your mind – past, present or future? Remember that all that exists is the present moment. If you catch yourself thinking about the past, redirect to the present moment, need to accept and let go of the past; if you are living in the future with your thoughts, redirect to the present moment and affirm the outcome you want to have happen as the future hasn’t unfolded yet. This is a very important shift to make as our thoughts create neuropeptides which affect the hormones that get produced. Therefore, your thoughts affect how you feel because of the hormones that get produced and this affects your reality. This is the field of psychoneuroimmunology and the work of Candice Pert in her book “Molecules of Emotion”. To learn more, please watch this video https://drchristinabjorndal.com/what-is-psycho-neuro-immunology-and-why-its-so-exciting/ 

She was encouraged to get current labs and test the following: CBC + Differential, Cholesterol panel (HDL, LDL, Triglycerides), Fasting Glucose, Liver enzymes (ALT, AST, ALP, GGT), Bilirubin, Ferritin, TSH, Vit B12, Cortisol (am) + Estradiol, Progesterone (to be tested on day 21 of your cycle, with Day 1 being the first day of flow)

I followed up with LH the following month. During that time, her partner lost his job. Despite her stress being higher, LH didn’t feel her anxiety had gotten worse. She reported improved sleep and way more energy in the morning.

On objective evaluation, her symptom picture as noted on the Anxiety & Depression Monitoring forms were 39 and 40, respectively. This is a slight improvement from last visit.

• Blood work findings: B12 is suboptimal; Progesterone is Low 4.0; Cortisol suboptimal at 340

LH was prescribed the following additional supports: 

• Methylcobalamin (B12) – 2,000 mcg in morning

• JR Nervotine – 2 tsps 1x/d in the morning – in water – 10 min away from food. This is a botanical formula that I compound with the following botanicals – Avena sativa (Oats), Borago officinalis (Borage), Hypericum perfoliatum (St John’s Wort), Melissa officinalis (Lemon Balm), Nepita cataria (Catnip) and Passiflora incarnata (Passionflower) – in equal parts
• Vit D – 5,000 IU 1x/d with food
• Progesterone support — Evening primrose 2 g 2x/d – Days 15 – Day 1 of menstrual cycle
• Mg malate/citrate – 400 mg for muscle pain – on the following menstrual cycle days: Day 33, Day 34 + Day 35/Day1 – 400 mg 2x/d – for menstrual cramps

LH was taught about the nervous system, psychoneuroimmunology and neuroplasticity. I explained that the “king” system in your body is your nervous system – and we have two states: parasympathetic (relaxed) or sympathetic (stressed) – the thoughts we think create neuropeptides, which then affect the hormones that get produced, and these hormones in turn affect how we feel and this results in our nervous system being in either a sympathetic or a parasympathetic state. 

When we are in a sympathetic state, we “flip our lid” and lose contact with our prefrontal cortex which is where we have executive thinking (i.e. can be calm, think clearly and rationally). When our “lid is flipped” we then operate from a part of the brain called the amygdala – and we operate from a place of fear to stimuli we perceive as threatening. This can leave us in one of the “F” fear states: fight, flight, freeze or fawn. 

A foundational step in healing is to shift your nervous system to a parasympathetic state by making the 7 R’s/Awareness of the thought emotion cycle a daily practice. LH was encouraged to read chapters 18 & 19 in Beyond the Label: 10 Steps to Improve your Mental Health with Naturopathic Medicine

7Rs/Breaking the thought emotion cycle:

I want you to take a few deep breaths where you focus your attention on something in nature to reset your nervous system at these different times throughout the day:

• when you catch your thoughts
• before eating
• Before bed
• upon waking
• in a line up
• after going to the bathroom

1. Write down the thought you recognize and reframe. Also, stay neutral with reframes if going from the negative to the positive is too big of a leap.
2. Goal is to shift your physiology to produce hormones that support you in shifting from sympathetic state (stress) to a parasympathetic (relaxed) state as your thoughts affect the hormones you produce (psychoneuroimmunology)
   1. Don’t get attached to outcomes – try to focus on what you want without attaching to it. Question whether you are attached to an outcome when you experience intense or uncomfortable or “negative” emotions (i.e. upset, disappointment, discouraged, setbacks)

1. Need to change the conversation you are having with yourself – if you wouldn’t talk to your best friend the way you are talking to you – then why are you talking to yourself that way? Move to self-compassion from self-criticism

I also taught LH about a hormone balancing reframe from referring to the week before her cycle begins to “kindness week from PMS” (which has a negative connotation for women). During kindness week, I encouraged LH to do less for others and more for herself during this time – i.e. schedule a massage, take a bath, start a book, watch a movie she’s been wanting to get do; go to bed early. This is the time of the month that progesterone declines and we need extreme self-care to support our hormones. 

 

In addition to nutrition suggestions from visit #1, it was suggested to:

• Caffeine – reduce consumption by 50%. 
• See if she can make healthier choices around food
• Baking soda test – come back to in a future visit as LH didn’t have time to implement all the suggestions provided in the first visit. 

 

One month later, LH experienced noticeable improvement from following the nutritional suggestions, taking the tincture and supplements, as well as practicing the 7 R’s of working with problematic thoughts several times throughout the day. 

 

On objective evaluation, her anxiety and depression monitoring form results were 25 & 17 respectively – almost in the “normal” ranges. She also reports no cramps or premenstrual symptoms. In this visit, I continued counselling around limiting beliefs and 

• Discussed boundaries and how to recognize that you need to. LH was encouraged to recognize and implement a boundary as a recovering people pleaser. Encouraged her to read chapter 19 in Beyond the Label discussing the steps to setting a boundary. 
• LH was also feeling “lost” with what to do as a career – I encouraged her to read “Nowhere is it Written”. We agreed that for the next few months it was about working on her health and feeling as good as she can before embarking on any big life changes, such as going back to school.
• LH was given the distorted automatic negative thought sheet to complete from cognitive behavioral therapy and bring back next visit

I also taught LH about the 4 Agreements as sometimes breathing from the 7 Rs isn’t enough to settle our nervous systems. In those situations when you feel “triggered”, “activated” or “hooked” by a thought, the prescription is to take that thought through two of the 4 agreements: ask yourself if you have taken something personally or made an assumption:

1) Taking things personally: we have to remember that the most important opinion when it comes to ourselves is ours. The quote by Dr. Wayne Dyer – “other people’s opinions of you are none of your business” – is a helpful reminder. People pleasing and putting others’ opinions ahead of our own is a tough game to play. It puts us at the mercy of others. It is best to value your opinion. There is a difference between valuing another’s opinion and squashing your own.

2) Making assumptions: if we are doing this, we need to check in the other person vs creating a story in our head that might not be true. We want to deal with facts, not fiction. Be aware of when you may be creating a story and bring yourself back to the facts by checking in.

LH was offered this reframe regarding social anxiety and being in community or relationships to “I am learning to be in relationship with others” versus “I don’t know how to be in a relationship”.

I followed up with LH in January 2020, and there had been significant stress since the last visit as a close friend of hers had attempted suicide. Through this difficult time, LH remained stable, and she was convinced that in the past she would not have. As I am a suicide survivor, I shared an “out there” spiritual concept of Soul contracts that I first learned from Colin Tipping’s book “Radical Forgiveness” and subsequently learned more about in Neale Donald Walsch’s book “Little Soul and the Sun” –  which is summarized as: you are here on your own spiritual journey to learn spiritual lessons. The question is: what those lessons are for you i.e. forgiveness, compassion, love and acceptance of self, etc.

In follow up visits for the next five years (from Feb 2020 to Jan 2025), LH remained anxiety & depression free with objective results on the monitoring forms of 14 and 17, respectively. 

Our visits primarily focused on the developing emotional intelligence with teachings from the work of Byron Katie, boundary setting and maintaining, addressing emotional activation and shadow work, shifting distorted automatic thinking patterns with psychotherapeutic techniques from Gestalt, compassion and cognitive behavioral psychotherapy, working on core beliefs, shifting the voice of inner critic to self-compassion and teachings from Kristen Neff’s work. As well, I addressed liver and digestive health, environmental medicine and revisited lab work annually.

Over time, LH gained the emotional courage to live on her own and leave the significant relationships she was in. She also saved her money to go back to school and offer equine therapy. Her primary love since she was a little girl was always horses. It was heart opening for me to work with LH over the years and watch her turn her passion into a career while regaining her mental health in the process. I suspect that it was through learning to trust her mind, body and spirit that she was able to gain confidence to take the steps to follow her heart’s path.

 

Author Bio:

Dr. Christine Bjorndal, ND is a naturopathic doctor, author, and educator specializing in mental health, with a focus on anxiety, depression, and mood disorders. A graduate of the Canadian College of Naturopathic Medicine, she is recognized as a leading voice in integrative mental health and is the founder of a naturopathic mental health clinic in Edmonton, Alberta.

Dr. Bjorndal’s clinical approach emphasizes a root-cause, whole-person model that integrates nutrition, lifestyle medicine, and targeted supplementation to support brain health and emotional resilience. Drawing from both professional expertise and her own lived experience with depression, she is deeply committed to helping patients understand the biological, psychological, and lifestyle factors influencing mental health.

She is the author of several books, including Beyond the Label: 10 Steps to Improve Your Mental Health with Naturopathic Medicine, and is an international speaker who educates both practitioners and the public on evidence-informed, integrative approaches to mental wellness.