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Dr. Thomas Johnson discusses Harvard Medical School's A Guide to Cognitive Fitness, focusing on the importance of managing stress for cognitive health.

A Guide to Cognitive Fitness Part Four
From Dr. Thomas Johnson, NCSP, CPQ - Health Psychologist
May 2025

From the author: "This is a photo of me and the Queen Anne Tower House I purchased for my group practice after I was fully licensed and credentialed. It has served our clients and my colleagues very well and was a big plus just working together in this unique environment."
Photo courtesy of Dr. Thomas Johnson

The Harvard Medical School’s A Guide to Cognitive Fitness: Part Four - Stress Control
Edited by Dr. Alvaro Pascual-Leone - Neurologist

This is the fourth and final article featuring what contributes to cognitive fitness according to the 2025 version of A Guide to Cognitive Fitness.

At the outset I would like to emphasize the fact that plant-based nutrition is the foundation for all of the factors that contribute to cognitive fitness. Part One focusing on nutrition was published in the March 2025 edition of All-Creatures.org. Part Two focusing on cultivating positivity and the importance of identifying your purpose was published in the April 2025 edition of All-Creatures.org. Part Three focusing on exercise was published in the May 2025 edition of All-Creatures.org. This final edition focuses on stress control.

What is cognitive fitness?

“The word 'cognitive' relates to thought processes and 'fitness' means being able to do what you aspire to do, while feeling satisfied with it…memory is a key component, but cognitive fitness also encompasses a variety of brain based skills, such as reasoning, learning, problem solving, perceiving the world around you, processing what you see and hear, communicating, and making sound decisions. It includes the ability to focus attention, comprehend new information, use language effectively, interact with others, control impulses, weigh options, and formulate and pursue plans.” (p.4).

This 2025 publication builds on the 2002 publication Stress Control: Techniques for Preventing and Easing Stress by Harvard Medical School Special Health Report Editor in Chief Dr. Anthony Komaroff. In this publication Harvard introduced The New Healthy Eating Pyramid.

I had the privilege of reviewing and analyzing this publication for the National Association of School Psychologists Communique (April 2003 Communique – online edition). In my review I stated: The Harvard Medical School’s New Healthy Eating Pyramid “is highlighted as one of the building blocks of an effective stress management program. This plant-based pyramid, which is very different from the more familiar USDA food pyramid, was featured in a recent Communique Extra! article published in October of 2002 (i.e. see Dr. Thomas Johnson Communique, October 31,2002). In brief, the foundation of the pyramid includes daily exercise and weight control, whole grains at most meals, regular consumption of healthy plant oils such as soy, olive, canola, peanut, etc., vegetables in abundance, two to three servings of fruit a day, one to three servings of nuts and legumes. Daily consumption of multivitamins and calcium are stressed in The Healthy Eating Pyramid. Various animal foods and animal products such as butter and dairy are presented as optional foods that should be used sparingly, if at all. Certain refined foods such as white rice, sweets and refined pasta are also listed as foods that should be used sparingly.” ( p.2).

It has been my practice since even before this publication came out to include in my list of recommendations to patients the importance of plant-based nutrition along with additional elements of the stress control publication. Most of the patients coming in for evaluations and/or psychological treatment are looking for empathic understanding and a treatment plan that will help cope with the stressors in their lives. Follow up recommendations are offered to the patients and referral sources whether that referral provider was an educator or health care practitioner.

In addition to the above recommendations, I provided to all patients (free of charge) the Physicians Committee for Responsible Medicine (PCRM) publication GOOD Nutrition: THE POWER OF A PLANT BASED DIET. It is also referred to as the VEGAN STARTER KIT.

The benefits of this vegan diet include the following:

1. Reduced risk for heart disease.
2. Lower blood pressure and cholesterol levels.
3. Better blood sugar control.
4. Healthy weight maintenance.
5. Lower cancer risk. (p. 1).

The president and founder of PCRM, Dr. Neal Barnard offers this inspirational statement in this publication. “I was raised a meat eater in a Midwestern family. My interest in plant-based nutrition began after medical school. My father was a physician who specialized in diabetes treatment when clinicians viewed the disease as a one-way street. That’s why I founded the Physicians Committee for Responsible Medicine and began extensive research into how diets affect our health. We’ve come a long way and today I hear from people all over the world who have successfully reversed type 2 diabetes, managed heart disease, shed unwanted pounds, and dramatically improved their lives with a plant-based diet.” (p.23)

Dr. Kim Williams also was quoted as follows: “I became a vegan in 2003 because I was concerned that my LDL ‘bad’ cholesterol was too high. As a cardiologist and former president of the American College of Cardiology, I let my patients know that plant-based diets lead to better outcomes, reduce health risks, and have a much more favorable effect on obesity, compared with the standard American diet. They say knowledge is power. In this case being aware of risk factors helps motivate people to make a difference.” (p.23)

As it turns out this is an introduction to the health and learning benefits of veganism for many of my patients, students and consultees. To PCRM’s credit this is a scientifically and ethically based publication that patients are unlikely to get in most other health care practitioner’s offices. In my experience patients are more likely to get a diagnosis, one or more drug prescriptions and drug facts listing possible side effects of the drugs being prescribed.

Stress is defined in the 2025 publication in the following way:

“Stress is the state of mental or emotional strain, or tension, that results from adverse or very demanding circumstances. The human body was built to withstand a certain degree of stress, and, in fact, we all perform better under a certain amount of stress - but the amount we can each handle varies greatly. When stress becomes overwhelming or is chronic and constant, it can take a toll on your health. Many studies link excessive ongoing stress with heart disease, stroke, headaches, back pain, trouble sleeping, and irritable bowel disorder. Continuous stress also effects your brain.” (p.44)

“Chronic stress can lead to shrinkage in the prefrontal cortex-that part of the brain involved in planning, judgment , and decision making . At the same time stress hormones increase the number and activity level of neurons in the amygdala the region that perceives threats and processes fears. Long after the traumatic situation has passed, someone with PTSD will continue to relive and respond to the event as if it were ongoing.” (p.45)

The following are a list of ways to manage stress:

Practice deep breathing

Whenever you engage in this strategy the oxygen signals your brain to reduce its production of stress hormones. Your heart rate steadies, and blood pressure drops, and you will feel calmer and more focused.

Meditate or pray

Most of the patients, clients or students coming into my office for services are introduced to meditation in addition to healthy lifestyle practices like healthy nutrition. In mindfulness mediation the client learns to shift attention to the inward and outflow of breath. Negative thoughts will likely come up and the client learns to let them pass without judgement. Some clients are receptive to mantra meditation in which they repeat a meaningful word like “shalom” or sound like “om”. This helps to keep the mind anchored in the moment. Another meditation that I practice daily is the body scan meditation which is a mindfulness practice where the meditator systematically brings attention to different parts of the body noticing the sensations without judgements.

While I was attending a course at the Harvard Medical School participants heard from neuroscientist Dr. Sara Lazar and her research comparing meditators vs nonmeditators. She found that compared with nonmeditators “meditators had a thicker cortex in a region of the brain essential to executive functions like planning and decision making in fact the cortex in the meditators resemble that of individuals 20 years younger suggesting meditation may help compensate for age-related shrinkage in this region. In later research Lazar and her colleagues also noted several other structural changes in the brain including changes to the hippocampus an area that is smaller in people who have survived trauma as well as to a region of the cerebellum that is associated with empathy and compassion. These changes occurred without any reduction in the participants external stressors this really suggests that meditation may have a bit of an anti-aging effect Lazar said” (p.46).

As I reflect on different clients, I have had over the years who decided to try meditation two clients come to mind. The first example is a Bates College student who was having a very difficult time concentrating. He decided to try meditation as a strategy to increase his attention and concentration skills. He learned how to meditate, and after a period passed as often happens when students go home between semesters, he came back into counseling; I asked him if he was finding the meditation helpful. In response he stated, “It has changed my life!” He was very excited to elaborate and let me know how very helpful these new skills were in being able to concentrate and listen to lectures.

Another example comes to mind. This second client was a middle age married man with two adult children. He was suffering with ongoing symptoms of anxiety and depression. He was taking an SSRI (anti-depressant medication), but it wasn’t very helpful if at all. During counseling he shared that he was struggling with his sexual orientation. He was living in a generally unhappy marriage. He developed a crush on another man. Eventually he decided that he was more of homosexual or gay person who had been trying to live as a heterosexual marriage partner. After a period of time, he became more accepting of his sexual identity as a gay man. He learned how to meditate as part of his therapy and then took a brief break from weekly therapy sessions. After he came back into counseling, I asked him how his meditation practice was going. He very proudly exclaimed “I have substituted medication with meditation! He was particularly happy that he was no longer taking medication.”

Moving on to prayer, “For those who believe in a higher power prayer can have similar effects to meditation. Different forms of prayer—for example, those involving repetition movements or repeating a word, reciting a psalm or manipulations beads or another object may have distinct effects on the brain. The focused repetition of words or action puts the mind into a more alert state. Prayer might also serve as a buffer against mental decline.” (p.46).

Listen to Music

Dr. Pascale-Leone points out that “Music can mentally transport you to another time and place, calm frayed nerves and even exert physiological changes on your body—like slowing heart rate and lowering blood pressure. Studies suggest that listening to music during a challenging situation can reduce levels of anxiety and perceived stress and improve your ability to cope. Music also touches areas of the brain associated with memory and emotion. This may be why some people with late-stage Alzheimer's disease perk up when they hear songs from their youth and are able to recall every word.” (p.47)

Stop multitasking

According to neuroscientists our brains are designed to do one thing at a time not simultaneously talk on the phone, answer emails and fill out a spreadsheet, etc. Too much multitasking simultaneously can increase stress levels and create a sort of bottleneck that reduces efficiency and our ability to successfully complete any one of these tasks.

Embrace nature

Again quoting Dr. Pascual-Leone, “Spending time outdoors in green spaces reduces stress, lowers blood pressure, and boosts mood. A study in the International Journal of Environmental Health Research found that spending just 20 minutes in a park was enough to improve people's overall well-being even if they didn't exercise while they were there.” (p.47).

In summary and conclusion, this discussion of The Harvard Medical School’s A Guide to Cognitive Fitness: Part Four Stress Control represents my attempt to highlight some of the most important concepts and examples of how to utilize knowledge gained by neurologists, physicians, psychologists and other scientists specializing in this field. This can help practitioners and clients/patients alike to understand and improve their cognitive fitness by utilizing knowledge gained by scientists studying this field.

The Queen Anne Tower House, built in 1895 for the Maine poet and novelist, Holman F. Day.
Photo courtesy of Dr. Thomas Johnson

Biographical Notes

Dr. Thomas Johnson completed his graduate studies as a US Public Fellow at Brown University in social psychiatry and medical sociology. He earned his master's degree from Harvard University in counseling psychology and doctor’s degree in counseling psychology from the University of California at Berkeley. He completed his internship at Duke University. In addition to his work as a practitioner he has had faculty positions at Rutgers University, the University of Southern Maine and Bates College. He is the founder and first president of the Maine Division of the American Association of Marriage and Family Therapy. Dr. Johnson is currently limiting his practice to consulting psychology and research.

Learn more about Dr. Thomas Johnson and see his other contributions to All-Creatures here!

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Posted on All-Creatures: May 13, 2025
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We began this archive as a means of assisting our visitors in answering many of their health and diet questions, and in encouraging them to take a pro-active part in their own health. We believe the articles and information contained herein are true, but are not presenting them as advice. We, personally, have found that a whole food vegan diet has helped our own health, and simply wish to share with others the things we have found. Each of us must make our own decisions, for it's our own body. If you have a health problem, see your own physician.