Topic: MIND

3 Steps to Navigate COVID-19 Anxiety

Medical response centers in Chengdu, China developed an integrative intervention model to address the psychological distress caused by COVID-19 and deliver much needed mental health support1 (Zhang, et al, 2020). This new report utilizes information gathered from natural disasters like earthquakes combined with the current virus outbreak. Overall, they found people need more information, more assessment tools, and more coping methods.

They also advise having and utilizing a Personal Resilience Plan. This must be tailor-made for each of us, by us, since we all respond to stress in different ways through the lens of our unique experiences, values, and expectations. Your resilience plan needs to reflect your values, strengths, and resources. Building this helps ourselves and our families, as well as the communities and organizations we are connected to.

Building your Personal Resilience Plan can take some creativity and self-reflection as well as evaluating your support resources. To get started, I will review the 3 features of resilience that repeatedly emerge in scientific research, 3 types of coping needed to get through challenging times, and offer 3 deeper reflections as an avenue to building personal resilience. I invite you to take a few minutes to answer the reflective questions along the way and write out an emotional emergency preparedness plan with your family that includes outside resources such as community-based support, as well as resilience we nurture within ourselves.

What are 3 common features of resilience?

1) Recovery that is swift and thorough. (Q: What will help me recover from this setback?)

2) Sustainability of purpose in the face of adversity. (Q: What is the purpose that drives me to move forward?)

3) Potential for growth. (Q: What am I learning from this experience?)

What are 3 types of coping?

1) Problem-solving based coping to prepare for or fix things you can.

2) Emotion-based coping to navigate a spectrum of emotions including fear, anger, loneliness, and grief.

3)  Meaning-based coping for events that persist or remain unresolved, that may also spur growth.

But how do I get rid of the anxiety?

During the 1990s HIV/AIDS epidemic, Susan Folkman and colleagues found something profound in their work helping people respond and adapt to the direst of circumstances that included social rejection and stigma along with severe illness and death2-3. They found that life in the face of certain death brings more than sorrow and painful emotions to the heart. People in the worst of situations could experience joyful emotions and engage in positive social interactions. Wellness means much more than the absence of negative emotions (so no need to rid yourself of them before experiencing joy); rather it’s the co-occurance of both troubling and positive emotions. Being able to hold them both closely reflects emotional maturity.

This sentiment is seen in much older communications that we don’t often come across in the scientific literature. A 12th-century German Benedictine abbess, philosopher, and Christian mystic, Hildegard of Bingen, described how we are meant to fly like eagles with two wings: one wing of suffering and one of grace4. We cannot soar with only one of these wings, but need to hold in our awareness the pain along with the glory, simultaneously. This dichotomy is a beautiful albeit challenging tension to hold as we connect deeply with seemingly opposing realities. Some might say we need one to experience the other.

3 Ways to look deeper into your personal resilience:

Here are 3 exercises you might write down on your own or with your family to prepare yourself for the challenges of our current changing situation: 

1)  Recognize what is most difficult for you right now and lean into what you are experiencing. Arguing with your anxiety, escape-avoidance coping (substances, entertainment) and blame will bring temporary relief at best. Reaching out, reaching inward, or upward in new ways will promote flexibility and growth. Share your concerns with others and reflect on what frightens you deeply. Spend time connecting with what is hardest for you right now while also standing into the joy of each breath we are given.

Q: During this crisis, what might you have to let go of? In what ways might you be more connected?

2) Write a story with you as the resilient hero. In what ways are you already resilient? If you experience discomfort thinking of yourself in this way, first start by thinking of someone you know who exhibits openness, flexibility, grit, and adapts to new challenges again and again. Then think back to a difficult time in your life where you persevered, changed course, thought outside the box, and applied skills that brought about positive change. Describe it in detail.

Q: What are the attributes you have that allow you to continue in the face of hardship? How have you already made the world a better place?

3) Take wise and compassionate action. There are some scary knowns and unknowns right now. Move forward with the next right thing and realize this may change from moment to moment. Invite clarity about what the next mindful action you could take is and how it relates to what you value most.  Center yourself in each decision with breath to engage those parts of your rational and compassionate brain. Practice trusting your internal reserves as well as how you might support others.

Q: How would you like to look back on this pandemic years from now? What role did you play?

One thing we can count on: everything is transient. Our security is that everything changes.

Q: How might the current difficulties transform you?

How to Manage the Psychological Effects of Quarantine

(Below is an excerpt from Psychology today. Click Read More at the bottom for access to the full article.)

Psychology, Quarantine, and Consequences

Although social media can mitigate the effects of quarantine for many people, it can’t replace human interaction in physical space. Compound that with being confined to a small area—perhaps a room in an apartment when an infected person needs to isolate from family—and then consider the many worries about the possibility of getting infected, or infecting other people, not to mention the financial consequences. You get a recipe for real psychological distress.

A recent review of the psychological impact of quarantine reports that most studies of quarantined subjects observed effects such as confusion, anger, and post-traumatic stress symptoms, sometimes lasting even three years after the end of the quarantine.

A study from Canada examined the psychological effects of quarantine during the SARS outbreak of 2003. The median duration of quarantine was 10 days. They found a high prevalence of psychological distress symptoms. Twenty-nine percent of participants reported symptoms of post-traumatic stress and 31 percent of respondents reported symptoms of depression. Participants in this study described a sense of isolation and were particularly affected by the lack of social and physical contact with family members.

Being quarantined at home with other family members can be a blessing or a curse. It is an opportunity for families to come together and strengthen their bonds. But being constantly together involuntarily can put considerable stress on relationships. Small children may be overjoyed at the opportunity to be with mom and dad almost all the time; adolescents, on the other hand, may be less enthusiastic, and tensions can arise.

The Mentally Vulnerable, the Elderly, the Hospitalized

People who are particularly vulnerable to suffering psychological distress during and after quarantine are those with a history of psychiatric illnesses.

If a person is already suffering from anxiety, the sense of helplessness and lack of control induced by a forced quarantine can only exacerbate the anxiety. For people who are claustrophobic, being confined to a small space can be extremely stressful. People with suicidal ideation can be particularly at risk under these circumstances.

Another vulnerable population is the elderly, who are confined to their homes or in facilities, where infection can spread easily if not prevented. Because older people are more at risk for mortality, their quarantine must be more complete. And, since they are often dependent on others as it is, their increased helplessness can lead to elevated anxiety and depression.

Also, people who are confined in hospitals, whether because of the coronavirus or for other reasons, can find themselves isolated from their family and friends when hospitals impose restrictions on visitors, which is already happening.

Mitigating the Effects of Quarantine

Research shows that quarantine is better tolerated and compliance improves when people get information about the nature of the disease and the benefits of quarantine.

It is far better to get people to agree to quarantine by convincing them and offering information, than by forcing them. That increases their sense of agency and reduces helplessness as they become active participants in their circumstances. This is an important psychological concept. When faced with external pressures, the feeling of agency enables a person to feel more like a survivor than like a victim—increasing their sense of control.

Keeping people informed about the consequences of breaking the quarantine and explaining how isolation can actually save lives and benefit the community can turn quarantine from a scary nuisance into a truly meaningful act of altruism—a form of self-determination in the face of tremendous pressures.

  • It is critical not to abandon those who are most vulnerable. People who suffer from mental illness need to have access to therapists and medications—with telemedicine if need be. Mental health professionals, community and family members need to be aware of the challenges that isolation presents to the people under their care—or those in the community—and check on them often.
  • Older adults, living alone, need to be contacted often and reassured, while at the same time making sure they are not unduly exposed to the virus, given their health vulnerability. If there aren’t family members around, it becomes the responsibility of the community.
  • Those in nursing homes or hospitals still have access to people who care for them, as long as they are able to understand and interact. Phone, texting, email, even posted letters can make a difference. The act of reaching out is more important than anything that needs to be said. Patients who are isolated need to know that they still count. 

Social distancing could have devastating effect on people with depression

As the coronavirus advances across the country, more Americans are staying in their homes. That sort of “social distancing” is considered essential to slowing the spread of the virus and easing the burden on the beleaguered health infrastructure.

But for those suffering from depression, especially those who struggle with suicidal thoughts, it is definitely not what the doctor ordered.

Any “isolation is so devastating to our own mood because we’re left stuck with our own thoughts,” said Emily Roberts, a Manhattan-based psychotherapist. “If you’re struggling with a mental health disease, if you are relying on therapy which requires you getting out of your house, it’s going to be very hard to motivate yourself to get the help you need.

“The fact that there’s so much of an urgency to disconnect creates a lot of fear with people.”

The potential side effect of the crisis is something mental health professionals are scrambling to address amid the uncertainty of COVID-19, especially as health resources are diverted to the most immediate concerns. The scale of those concerns in turn is precisely what makes this time an unprecedented stressor for even the most well adjusted among us.

“It’s unclear from one day to the next what any local community is going to do in response to the coronavirus, if people are going to have to stay at home, which then has implications on how we work on caring for them,” said Lynn Bufka, associate executive director for research and policy for the American Psychological Association.

“What’s going to be the implication for disruption? Not everyone is going to be able to continue to get the help they need. Clinicians are very much thinking right now about how to do that.”

Meditation Relieves Perceived Stress And Leads To Specific Cerebral Changes

For researchers at IMT School for Advanced Studies Lucca, a study evaluating the effectiveness of Transcendental meditation (TM) among healthy participants led to promising findings.

According to new research, released in the journal Brain and Cognition, Transcendental meditation was linked to reductions in perceived stress. The technique, first developed by Maharishi Mahesh Yogi, involves the use of a mantra practiced with eyes closed, a few times a day.

Researchers studied 34 healthy participants, half of which incorporated Transcendental meditation to their daily routine for 40 minutes per day. The other half carried on without meditation implemented into their normal daily routine.

Before the participants began their routines, psychometric questionnaires were administered to measure levels of anxiety and stress. Additionally, functional magnetic resonance imaging tests were conducted to gain further insight into stress levels at a neuropsychological viewpoint, by measuring brain activity and changes in functional connectivity in certain brain areas. The tests were then initiated again at the conclusion of the study.

“Transcendental Meditation (TM) is defined as a mental process of transcending using a silent mantra. Previous work showed that relatively brief period of TM practice leads to decreases in stress and anxiety,” researchers stated.

It’s Easier to Beat Social Anxiety Than You Think

Researcher Stephen Porges discovered that when we are with other people, we unconsciously exchange signals that influence how safe we feel. Strangers trigger the release of stress hormones which cause the urge to escape. But if the stranger’s body language signals us that they are not a physical threat, what Porges calls the Social Engagement System activates the parasympathetic nervous system (PNS) enough to override the urge to escape.

What about emotional safety? When people are sizing each other up, no signals of emotional safety are being sent or received. In the absence of calming signals, some feel emotionally safe and others do not. A person with a solid history of being accepted does not need signals from others to feel at ease. He or she has what attachment theorist John Bowlby called internal working models of secure relationship. This internal resource signals the PNS to override the negative effect of whatever stress hormones are present.

But a person with a history of being judged and criticized lacks internal working models of security. With insufficient internal emotional support, they are vulnerable to stress hormone effects. They depend on signals from others to feel emotionally safe. Unfortunately, in social situations, signals may be mixed. Or there may be too many people sending signals for the signals to be processed.

Do you need to build an internal working model of a secure relationship that can carry you through the stress of social situations? Here’s how. Think of the people you are physically safe with. From that group, identify a person you feel emotionally safe with. Look for someone who does not judge you. When with a non-judgmental person, you unconsciously receive signals that there is nothing you need to be on guard about. Because of this calming effect, the memory of the person’s presence can activate your PNS and keep you calm in a challenging situation. You simply need to pre-link the person’s presence to the situations you will encounter.

To set up the linking exercise, list the situations to be encountered. One by one, link each situation to the memory of your friend’s face, voice quality, and touch. These are the three areas that convey the signals that activate your PNS. Don’t imagine yourself in the situation. That could cause stress. Instead, imagine a cartoon character in the situation. A cartoon character in a stressful situation is amusing. We don’t take their predicament seriously because, no matter what happens, cartoon characters always find a way out.

1. Link to Their Face

Imagine the cartoon character in that situation. Pretend your friend is holding the cartoon touching their cheek. Keep that in mind for a few seconds to link the cartoon character’s situation to the calming effect of your friend’s face.

2. Link to Their Voice

Pretend you and your friend are looking at the cartoon together. Imagine talking about the situation the cartoon character is in. In a few seconds, that links the situation to the safety signals in your friend’s voice.

3. Link to Their Touch

While talking about it, imagine your friend is giving you an affectionate hug (or whatever touch is appropriate for your relationship). This links the calming signals coming from your friend’s touch to the situation the cartoon character is in.

Continue the linking exercise using a cartoon character as a stand-in for yourself until you have linked each situation to your friend’s face, voice quality, and touch. Linking a stressful situation to a calming person is powerful. The PNS calms us by overriding the effects of stress hormones. It is activated by a person who accepts us completely. We feel our guard let down when our PNS is fully activated by another person’s signals that we are safe in every way.

Having an optimistic partner may stave off cognitive decline

Does your partner see the glass as half full or half empty? Do they tend to expect things to turn out for the best or the worst?

Researchers at Michigan State University in East Lansing have found that by having an optimistic outlook, a person can help the long-term physical and mental health of their partner.

Such is the power of optimism that it can help stave off the risk of various health issues, such as cognitive decline, dementia, and Alzheimer’s disease, as a couple grows old together. 

This is a boon given that most industrialized societies are aging. According to the Population Reference Bureau (PRB), in the United States alone, the number of people aged 65 years and older hit a new high of 52 million in 2018. The PRB predict that this number will nearly double by 2060.

Not only that, but there are 5.8 million people in the U.S. living with Alzheimer’s disease — the most common form of dementia — and someone develops the disease every 65 seconds.

“[M]any industrialized societies are aging at a very fast rate. This presents a lot of unique challenges that we might not be ready for,” said Dr. William Chopik, speaking to Medical News Today

Dr. Chopik is a co-author of the new study, which appears in the Journal of Personality

In addition, he noted that people are living longer than ever, “which translates to a large number of individuals living with cognitive impairment and dementia.” 

“As a result,” he said, “we were motivated to find out what predicts cognitive decline, and we discovered that a lot of it has to do with you, but some of it also has to do with your romantic partner.”

Identifying the link

The study followed 4,457 heterosexual couples from the Health and Retirement Study for up to 8 years.

It showed that there was a potential link between marriage to an optimist and the prevention of cognitive decline.

But how does optimism — the general expectation that good things will happen in the future — in a partner affect long-term mental health?

“Optimists do all sorts of healthy things,” said Chopik. “They are more physically active, maintain healthy diets, and avoid harmful things [such as drugs and alcohol].”

Optimists lead by example, and partners often follow their lead, says Chopik, noting that people typically spend a lot of time with their partner.

Researchers found that in looking at predictors for Alzheimer’s disease or other forms of dementia, a lot revolve around lifestyle choices.

“Compromised health earlier in life, in combination with some genetic factors, is among the largest preventable risk factors for cognitive decline,” said Chopik.

“So, basically, we know that being physically healthier — for example, being more physically active, eating a healthy diet, being more mobile, avoiding major illnesses — is associated with reduced risk for cognitive decline.” 

“But we were most interested in what predicted the healthy living. It turns out being optimistic about the future helps a lot.”

Is It Possible to Program Your Happiness?

Happiness researchers base their work on the fundamental idea that psychology needs a better understanding of the factors that help people feel better. Rather than just focus on psychological disorders or problems, happiness studies use positive psychology as their theoretical basis.

From your own experience, you know that life goes better when you’re happy than when you’re not. You wake up in the morning eager to start your day, focusing on what you’d like to achieve. However, a thought enters your head reminding you that you have some unpleasant tasks ahead of you in the coming hours. Perhaps, instead, you remember an argument you had with a close friend the day before, filling you with regret and disappointment in yourself. Your good mood disappears, and your happiness starts to plummet.

What if you could overcome these detours to your feelings of well-being by shifting your focus away from those negative thoughts? Researchers in positive psychology propose that you can increase your happiness levels by thinking not about what’s going wrong but instead about what could go right.

The “best possible self” intervention is a simple exercise in which you visualize your best possible future. Going one step further, you could also take a few minutes and write down what you would consider your best possible future life. A “hoped-for possible self” is, as the term implies, the sense of who you could be rather than who you are at the moment. On the negative side, a “feared” possible self is one you dread.

According to a new study by Johannes Bodo Heekerens and Michael Eid of the Freie Universität Berlin (2020), there is considerable evidence suggesting that the best possible self-intervention in which you focus on your hoped-for possible self can improve feelings of optimism and positive affect.

However, the German authors note that studies evaluating the long-term benefits haven’t been established. Moreover, studies measuring the impact of this intervention haven’t always defined their outcome measures in precise enough terms, such as distinguishing between momentary changes in affect vs. affect in the past week. Adding to this problem, previous researchers haven’t always distinguished among the more nuanced aspects of positive outcomes such as life satisfaction, optimism, and happiness.

The authors concluded, “inducing an optimistic outlook encourages positive emotions,” a finding in line with the “process” approach to understanding emotions. According to this view, you can regulate your emotions by changing your outlook. Similar to other studies showing the benefits on emotion of such interventions as positive self-affirmations, the best possible self intervention isn’t one that will change your life forever. If done right, though, it could help you feel better for perhaps as long as a week. You will not, however, experience a “lasting change in well-being” (p. 20), as some advocates have claimed about this procedure.

In view of these mixed findings, how can you take advantage of that momentary bump in your happiness that a positive self-intervention can stimulate? In the first place, the authors note that you need to take it seriously and become sufficiently engaged in the activity. Just imagining your life going better when you wake up in the morning and then going about your daily routines without giving the matter further thought isn’t going to alleviate whatever bad mood you happen to be experiencing.

It seems clear that, with these qualifications in mind, there are benefits for your mood in the moment of taking the time to see yourself as able to achieve your goals and overcome your present obstacles. Even if this effect only works for a week, as suggested by the German study, there’s nothing to stop you from engaging in it again after your mood starts to slump downward. That increased positive emotion may also help you become more successful in what you’re trying to achieve even within that brief period of time. Other people will respond more favorably toward you which, in and of itself, can help you feel better about life.

To sum up, it’s important to look carefully at whatever new fads for improving your happiness might seem to offer. In the case of dreaming up your best possible self, the research seems to support its benefits, if not in the long-term, then for your present levels of fulfillment.

9 Ways to Find Your Purpose As You Age

Purpose and Health

In general, surveys show that older people are happier people. But getting older is not a bed of roses either. Eventually, the losses pile up.  Friends, family members, or partners may die.  You may acquire one or more chronic illnesses or become disabled.  You may feel that your choices are narrowing. 

But fortunately there are still ways to find meaning in your life despite these losses.  “Fortunately,” because recent research reveals that living with a sense of purpose—acting in accord with your most cherished values and goals– has numerous benefits for both physical and mental health. For example, feeling that you have a purpose decreases your chance of premature death, according to a study of almost 7000 adults between the ages of 51 and 61.  Amazingly, those without a sense of purpose were almost twice as likely to die in the four years of the study. 

Other studies show that a sense of purpose promotes healthy behaviors and is associated with better physical and mental health outcomes.  A 2019 study by a team of British researchers found that a sense of purpose also promoted happiness and a sense of well-being among adults 50- 90. The same researchers observed that older adults with a sense of purpose were more likely to have close friendships, enjoy the arts, practice healthy habits, and experience less chronic pain and illness.  A recent study of seniors in a retirement community suggests that a sense of purpose might even alleviate loneliness.

According to this NPR article, it doesn’t matter what your purpose is as long as you have one. But where do you look to find your unique purpose as you age?  

Nine Paths to Purpose

For part of the answer, I returned to a favorite book: Viktor Frankl’s Man’s Search for Meaning. In this short, powerful book, Frankl describes his daily experiences and observations while a prisoner in the concentration camps of Nazi Germany. There he developed his beliefs about what can sustain the desire to live even under the most inhumane and desperate circumstances.   

Frankl observed that those inmates who had a sense of purpose were more likely to survive the degrading conditions of the camp. While the rigors of aging in no way compare to life in a concentration camp, they have in common the need to find meaningful goals when life gets rough. 

Below are nine paths to purpose that can be helpful to anyone at any age, but they are especially relevant to older adults.  I’ve drawn on Frankl’s work for #1, #2, and #9.  The ninth path may not strike you as particularly cheerful, but I think you’ll find it bracing and even inspiring in its own way.  By the way, you don’t have to choose just one path. You might find yourself following each of the nine paths in turn, even in just one day.

     1. Work mission. 

Some older adults are able to continue the paid work they love to do. Their motto is: “Never retire.” Other active older adults use retirement as an opportunity to try out a second career.  Still others find employment where they can, because earning an income is either necessary or a source of independence and pride.  Many older adults find meaning in unpaid work such as volunteer work, personal projects, or home improvement. 

One reason Frankl was motivated to survive the daily torment of the camps was because of a book he wanted to finish.  Although he was forced to relinquish his manuscript when he entered the camp, he wrote his key ideas on scraps of paper and stuffed them in his pockets.  After his liberation from the camps, he wrote that book and many others.

If you are no longer motivated by traditional work goals, however, you could find your particular purpose in one of the motivators below.

     2. Love and friendship.  

Finding meaning in the love of another person is an inspiring motivator.  For example, Frankl was able to survive the camps in part by imagining a future reunion with his wife.  Many older people find meaning in relationships with spouses, friends, children, and grandchildren and in taking care of beloved others.

     3. Compassion for others. 

Compassion and concern for others may protect against feelings of meaninglessness, accord to this study.  As one senior said, “If you’re feeling lonely, then go out and do something for somebody else.”  Even making brief connections with relative strangers—acknowledging their presence, wishing them a good day, giving a compliment–can be a source both of meaning and happiness.   Listening to someone with an open mind, reaching out to someone who may be lonely, or sending a card can provide good cheer to someone who is down in the dumps.

4. Small joys and pleasures.  

But what if you don’t have some lofty-sounding “purpose project” in your life? Just learning to appreciate small pleasures is a habit worth cultivating.  Noticing a bird or plant outside your window, having a warming cup of coffee, exchanging hugs—these tiny moments when noticed and absorbed provide a source of satisfaction to both body and brain. 

According to the “Bold School” newsletter of the Washington Post, researchers have studied a population in Okinawa, Japan, where people live longer than anywhere in the world.  Researchers attributed this longevity to the practice of “ikigai:” “This ‘sense of life worth living’ includes looking for joy in small things, being present and creating a harmonious atmosphere.”

     5. Staying strong and healthy.

You won’t be able to accomplish much if you lack energy and strength.  And just staying strong to perform the normal activities of daily living is an accomplishment in itself, because it means that you can still be independent.  Take walks, go to the gym, get a personal trainer, eat right–you know what to do!

     6. Creative projects and play.

Creative activities, humor, and play of all sorts can provide a purpose for many people. Hobbies, sports, and experiences such as art, travel, music, nature, reading, and culture can touch us deeply and enlarge our capacity for empathy.  They may also reduce symptoms of chronic pain and worry by making life more enjoyable, according to PT blogger David Hanscom.  Expressing your identity through art or actions is a way to be happy, a way to affirm who you are, and a way to find purpose.

Click Read More for more Tips.

The Surprising Reason Mindfulness Makes You Happier

Experiencing positive feelings can improve our health and quality of life. However positive emotions are difficult to change because almost half of our happinessseems to be a function of genetic factors. Nevertheless, some practices have been shown to increase positive emotions, including practicing gratitude, spending money on others, doing lovingkindness meditation, and practicing mindfulness. Mindfulness is both a set of skills and an orientation to life that involves maintaining open attention on whatever is happening in the present moment and bringing an attitude of acceptance and openness to whatever is going on internally or externally. Some studies have shown that mindfulness interventions increase positive feelings but we don’t really know why this happens. A recent research study sought to delve deeper into this issue.

Observing your present-moment  experiences

 One facet of practicing mindfulness  involves slowing down and deliberately focusing on different aspects of your experience such as what you feel in your body (e.g.,body temperature, breathing, muscles) your thoughts, emotions, your senses (what you see, hear, taste, feel or smell) or what is happening around you (e.g., listening mindfully to someone who is talking). When your attention wanders, you begin to notice this shift and deliberately bring it back to whatever you have decided to focus on. This deliberate direction of attention is called Monitoring.

Monitoring your ongoing experience may make you feel happier by helping you slow down to appreciate things or to notice more of the happy things that are going on around you. You may begin to pay more attention to the trees and flowers, enjoy the feel of the sun on your skin, or bask in the warmth of your partner’ or child’s  loving gaze.

On the other hand, paying attention to both positive and negative feelings as they arise may also make you more aware of negative feelings and sensations like tension in your body. Some feelings or thoughts may be uncomfortable or difficult to tolerate. Positive feelings may be observed but then quickly replaced by negative ones. Therefore it may take more than Monitoring to help us be happier.

Accepting your Inner Experiences

A second facet of mindfulness is Acceptance. Practicing acceptance means allowing your experiences (e.g., thoughts, feelings, sensations, cravings) to be as they are, viewing them with kindness, gentleness and openness. It is the middle ground between suppressing your feelings or over-identifying with them. When you sit with difficult experiences and give them space they can become less aversive. Acceptance is the opposite of judgment or clinging. Judging and criticizing yourself means not accepting that things are as they are and cannot be changed in this moment. Clinging means not allowing positive experiences to end, forcing ourselves to feel happy when we don’t, or trying to avoid the natural pain and ups and downs of life.  Acceptance can increase positive feelings because it can change the meaning of our stressors, making them more tolerable. By not trying to force our lives or experiences to be a certain way by judging less, we can be more open to the present moment and our naturally arising feelings of contentment, interest, pride, joy, curiosity and so on.

The Study

The researchers compared the effects of two different mindfulness trainings – Monitoring Only (teaching only 1 skill) versus Monitoring + Acceptance (teaching both skills) with a control condition (no treatment or inactive treatment) in two different studies of stressed community adults. One study used in person mindfulness training while the other study taught these skills via smartphone. Both positive and negative emotions were assessed at the end of the day (diaries) and also at 4 random times each day using the smartphone for 3 days before and after the study.

Results showed that while all the active mindfulness interventions (Monitoring Only and Monitoring + Acceptance) reduced negative feelings equally from before to after the study, they differed in their effects on positive feelings. For improving positive feelings the Monitoring + Acceptance group had a significantly stronger effect, compared to Monitoring Only and Control conditions.

These results mean that practicing mindfulness  can make us happier only if we learn to tolerate, make space for, and accept whatever experiences arise, rather than judging them, letting them define us, or running away from them. Perhaps Acceptance leads to a mindset shift in which we can let go and be ok with things as they are, rather than focusing on what we don’t have, what we should have done, or what might happen in the future. Letting go of trying to control everything can make space for you to take a breath and feel the joy of the present moment, whether it’s walking your dog, hugging your child, having lunch with a friend, or doing interesting work. Becoming aware of what you feel, negative thoughts, or the tension in your body (Monitoring) is only part of the work.  You also need to practice allowing those feelings and sensations to be there without trying to force them away, worrying about them, letting yourself be defined by them or judging yourself for having them.

Below is an exercise to help you practice acceptance in your daily life:

Allowing the Feeling In

If you are struggling with feeling something that you don’t want to feel (e.g., anger or sadness), try to make room for that feeling. Start by giving it a name  {e.g., I’m feeling angry) and then notice where you feel it in your body (e.g., your chest). Try to bring curiosity to the experience, letting the anger be there and noticing if it moves in your body, goes down or increases, whether it’s hot or cold, expansive or tight, and other qualities of it. Notice what the anger makes you want to do (e.g., shout and scream) and notice that you have a choice whether to do that or not. You can just watch the impulse to begin with to give yourself more time to process the situation before you act.

3 things you should do every day to improve your memory

In 2009, after Nelson Dellis’s grandmother Josephine passed away from Alzheimer’s disease (which may have a hereditary component), he was inspired to find ways to keep his own brain healthy and sharp.

“I was a good student, but my memory was average,” Dellis, 35, tells CNBC Make It.

Dellis scoured the internet looking for tips to improve his memory and joined a few forums where professional “memory athletes” (people who train their memory skills for high performance) chatted about different memory techniques. Then he listened to “Quantum Memory: Learn to Improve Your Memory with The World Memory Champion,” an audiobook by Dominic O’Brien, a seven-time world memory champion.

“After that, I went off and, through trial and error, figured out what [techniques] worked well for me,” Dellis says.

Today Dellis, author of the book “Remember It” and a four-time USA Memory Champion (an annual competition for elite mental athletes), is a full-time memory coach based in Miami, Florida. He charges $250 an hour for private lessons to the likes CEOs and billionaires, including Mark Cuban and Sara Blakely.

Here are Dellis’ top three tips on improving your memory and staying sharp.

1. Go offline

Dellis says one the easiest memory tips that he’s learned over the years is to take time to totally disconnect from technology — including your smartphone — for at least an hour a day.

That’s because presence is important for memory, says Dellis.

“Your brain is a processing unit,” he says. “If your brain isn’t present to receive [information] (i.e., you’re distracted and not paying attention), how on earth do you think it’s going to be able to remember it? You’ll be surprised how powerful your natural memory is if you just try and pay attention.”

Dellis’s advice is supported by research: According to a 2017 study from the McCombs School of Business at The University of Texas at Austin, researchers found the mere presence of a smartphone reduces cognitive capacity, affecting one’s brain to hold and process data.

2. Think in pictures

“My goal whenever I memorize something is to turn it into a mental picture in my mind,” he says, which is “any mental representation of what you’re trying to memorize, using as many of your senses as possible.” It could be an association, a sound, a feeling — anything that’s “meaningful” to you, Dellis says.

That’s because it’s much easier to remember a picture of something that you are familiar with than words relating to something new and difficult, he says. (Studies in older adults have shown that pictures can help with memory.)

Dellis uses the example of remembering the name chervil (an herb) to buy at the grocery store.

“Most people might not even know what that is. So I might break that word down into what it sounds like: ‘sure-vill.’ So maybe my meaningful image could be, me saying ‘sure!’ enthusiastically to a ’vill’ain. The more context the better. Maybe I’m agreeing with this villain, because if I don’t, he’ll take all the chervil in the world and secretly garnish all the food in the world and ruin the taste of everything,” Dellis says.

The “more over-the-top and bizarre you make the image, the better.”

To practice, Dellis suggests that when you meet someone for the first time, turn their name into mental images, as he did with chervil.

“You’ll have a higher chance of remembering the person’s name, and you’ll be training your brain to get better/quicker at thinking in pictures,” he says.

3. Explore your ‘memory palace’

When you’re thinking in pictures, you need a place to store those images. So most memory athletes use a technique called the “memory palace,” according to Dellis. The technique (which dates back to the ancient Greeks) has to do with remembering things based on location

According to Dellis, a memory palace works like this: Think of a familiar place (like your house, apartment, office, etc.) and imagine a mental pathway through it. To store your images, simply imagine or “stick” each image on a location along the path in your mind. The idea is that later on when you want to retrieve the information, all you have to do is think of your memory palace, walk back through it in your mind and pick up the images you left there.

It sounds a bit crazy, but it works, according to Dellis and it allows top memory athletes to memorize thousands of pieces of information, he says.

“It’s an effective way of stringing together sets of memories because it uses more and various parts of the brain than simply short term recall (visual, emotional, language, imagination and short term memory),” neuroscientist Tara Swart tells CNBC Make It.

To practice, Dellis suggests choosing three familiar places and selecting 10 locations along your mental path through each. Start by storing daily to-do lists and grocery lists there as practice.

How to Maintain Memory as You Age

As we grow older, it is not uncommon for many over a certain age to begin associating these normal lapses in memory with fear of conditions such as Alzheimer’s disease or some other form of dementia. 

While the majority of those diagnosed with dementia tend to be older, our forgetfulness and memory loss don’t necessarily indicate the onset of such devasting diseases like Alzheimer’s. In fact, the Alzheimer’s Association provides resources on its website to differentiate these types of common slip-ups from the early signs and symptoms associated with dementia. 

As we celebrate and promote women aging well this month, here are some integrative approaches to maintaining your memory and cognition as you age.

Herbal Supplements

Herbal remedies have been used in China for more than 2,00 years to boost memory. Some with the most evidence behind them include: 

  • Turmeric: You probably know this herb as a spice, but it’s also used in numerous remedies in Asian medicine. Like all the herbal remedies mentioned here, it has strong antioxidant and anti-inflammatory properties. One study of 1,101 older people without dementia found that those with a high turmeric consumption had better cognitive function than those with lower consumption.
  • Ginseng: Ginseng can help improve learning and memory, potentially protecting against Alzheimer’s disease. One reason could be its ability to protect against amyloid-β and cholinesterase activity, both of which are associated with the development of Alzheimer’s disease. 

Healthy Diet

Maintaining your memory as you age also means embodying a healthy diet to minimize the risk factors associated with diseases like dementia. A diet high in healthy proteins, fruits and vegetables and low in saturated fat, sugar, and processed foods, can go a long way in preventing many health problems, including those connected to Alzheimer’s disease. 

In fact, a systematic review of 12 studies found that participants who strictly followed the Mediterranean diet had a better cognitive function, lower rates of declining cognitive functioning, and a reduced rate of Alzheimer’s disease. 

Yoga or Exercise

The benefits of exercise and yoga are extensive but, specifically, they can be utilized in treating the effects of depression, which can lead to chronic inflammation, especially as we get older. By engaging in any of the various types of exercise to combat depression, you can avoid the “foggy” feeling that limits the ability to concentrate in many depressed people.

Not only can yoga and exercise improve depression and mood, but there is also evidence they can lead to improvements in cognitive function, particularly attention, processing speed, executive function (decision-making) and memory in people with and without depression.

Sleep

The National Sleep Foundation provides the following information on the connection between sleep and memory:

“Healthy sleep puts us in the right state of mind to take in information as we go about the day. Not only that, we need a good night’s sleep to process and retain that information over the long term. Sleep actually triggers changes in the brain that solidify memories—strengthening connections between brain cells and transferring information from one brain region to another.” 

As the medical field continues to take a keen interest in sleep and the importance of getting regular, restful sleep for our overall health, the impact sleep has on our memory will only expand as studies continue to be published. 

Playing Games

And lastly, play games. Playing board games, crosswords, chess, bingo, or cards was found to slow mental decline for those in their 70s. So says a decades-long study of over 1,000 people in Scotland. Those who played games kept memory sharp and improved scores on thinking tests compared to those who didn’t play. It’s great to start early, but even those who increased gameplay in their 70s still benefited as they aged.

For women entering the later stages of their life, memory can serve as a foundational aspect of healthy aging. By embracing the approaches here, you can maintain your memory and cognitive function while also lowering your risk for diseases associated with dementia. Minor episodes of forgetfulness will most likely still occur every so often but your overall memory will hopefully remain in generally good health.  

A Practical Practice to Transform Your Health

Buddha was asked this question: “What have you gained from meditation?”

He replied, “nothing at all.”

“Then Blessed One, what good is it?”

“Let me tell you what I lost through meditation: sickness, anger, depression, insecurity, the burden of old age, the fear of death. That is the good of meditation, which leads to nirvana.”

People everywhere are anxiously working to be happier… and they are trying to buy happiness as evidenced by a quick stroll through the world’s biggest shopping center, Amazon. A search of Amazon inventory for “how to be happier” reveals over 100,000 things you can purchase to be more joyful.

But here, free to all, we are going to give you a valuable tool that is guaranteed to make you happier, and also improve your health. That’s right, nothing to buy. No elixir to take. No equipment to install. This gift comes without batteries and complex instruction manuals.

Meditation—the practice of training your mind to focus on a single point—is like sharpening the blade of a knife. It will sharpen your cognitive and emotional abilities and cut through to your true self. It reduces the noise in your life and provides a clear life signal. With meditation, we aren’t as cluttered or burdened, and we are able to show up as our best selves—full of purpose, enthusiasm, and compassion.

If life feels out of control, meditation is the way to get it back under control.

And here are the well documented scientific benefits:

  • Lowers blood pressure
  • Slows breathing rate
  • Improves rest and sleep
  • Boosts immunity
  • Lessens stress
  • Increases telomere length

Note the last bullet! Meditation increases telomere length.

This is vitally important and scientifically documented. Telomeres are these little endcaps on our chromosomes that serve a protective function so that when cells throughout our bodies replicate they continue to do so free of error. The telomere endcaps keep the gene-copying process happening accurately. Moreover, how robust and long these telomeres are correlates with the length of one’s lifespan. This research earned Elizabeth Blackburn the Nobel Prize in Physiology or Medicine 2009.

Let’s say this again: How robust and long these telomeres are correlates with the length of one’s lifespan. And meditation increases your telomere length – the longer the telomeres, the longer the lifespan.

Research shows that people who are chronically stressed have shortened telomeres. Telomeres are longer in those who regularly exercise. Telomeres are also longer in individuals who meditate.

There are tremendous benefits that accrue over time. In other words, long-time meditators have different brains than everyone else. Harvard researcher Sara Lazar published a groundbreaking study that showed meditation produces measurable differences in the brain as a result of the repeated practice of meditation. What was compelling in this research, however, is that these differences revealed themselves with only two weeks of practice. Yes, only two weeks of practice showed impressive changes.

So how do you meditate?

There are many forms of meditation ranging from Transendental, Buddhist, Vispassana, loving kindness, Taoist, Mindfulness, and Christian. There are also a variety of guided meditation that can be found on apps and YouTube. They are all valuable and worth exploring.

If you are curious to begin, seek out a certified instructor. To get you started, however, we suggest you might experiment with what is known as Mantra meditation adapted from the Chopra Center. Here are six simple steps:

1. Choose your mantra. Select a mantra. This is a short word or phrase—such as peace or love—to repeat to yourself as you meditate. “So Hum” is a popular mantra. It is a Sanscrit, that translates to “I am.”

2. Find a place to sit. Sit comfortably in a quiet place.

3. Gently close your eyes and begin by taking some deep breaths. Try taking a few “cleansing breaths” by inhaling slowly through your nose and then exhaling out your mouth. After a few cleansing breaths, continue breathing at a normal relaxed pace through your nose with your lips gently closed.

4. Begin silently repeating your mantra. For example, if using “So Hum” as your mantra, you could silently repeat “So” on your inhalation and “Hum” on your exhalation. As your meditation continues, allow the breath to follow its own rhythm. The repetition of your mantra should be effortless. Imagine you are listening to your mantra being whispered in your ear.  

5. Importantly, do not try and stop your thoughts or empty your mind.  As you meditate, you will find that your thoughts appear and distract you. This is normal. Whenever you become aware that your attention has drifted away from your mantra to thoughts or any other distractions while meditating, simply return to silently repeating the mantra. This is the practice of your meditation emptying the trash in your mind.

6. After 20-30 minutes, stop repeating the mantra. You have completed your meditation, but be sure to spend a few minutes relaxing with your eyes closed before resuming activity.

You may want to begin by practicing this Mantra meditation for five minutes and then increasing it to ten and continuing to add time to your practice.

It’s quite remarkable! This single, simple practice is guaranteed to transform you into a better version of yourself. Mindfulness and meditation really do make us happier and healthier.

And here’s the most important advice we can give you: Meditate once a day, and if you think you don’t have time to do that you should meditate twice a day.

20 Ways To Be A Happier Person In 2020

Looking to make 2020 your happiest, most fulfilling year yet?

If your mental and emotional wellness took a backseat in 2019, there’s no better time than right now to prioritize it. (If anything, it’ll make the election year just mildly more bearable.) Your mood affects everything in your life ― your relationships, your work, your self-care ― so improving it should be at the top of your goal list.

That might feel like a huge and lofty task, but small, actionable habits can help you get there, according to experts. Below are the most common happiness tips therapists recommend. Maybe they’ll sound challenging or unrealistic (more on that later), but maybe they just might change your life.

1. Conquer one anxiety

Give yourself a motivational benchmark to start conquering your biggest fears this year. 

“Single out the goal of selecting an anxiety that is holding you back, and thoroughly commit yourself to obliterating that fear,” said Forrest Talley, a clinical psychologist. “Hold nothing back in your assault; treat that fear as though it is enemy number one.” 

Perhaps you’ve been worried about signing up for a half marathon. Maybe you’re afraid to reach out to book agents because you don’t want to be rejected. Perhaps you’re fearful of having a difficult conversation with a toxic friend or family member and you’re putting it off. Set the goal, pick a reward you’ll get when you complete it, then get to it.

“The thing to keep in mind is that very often happiness is found just on the other side of a doorway guarded by our anxieties,” Talley said. “And the new year is a great time to start kicking down some doors.”

2. Lock down a sleep schedule that works for you

You may think you’re doing OK on sleep, but take a closer look at your schedule. Are you really getting optimal hours? Are you maintaining relatively the same bed time every night?

“Getting a [consistent] good night’s sleep is vital; chronic sleep deprivation is a huge problem, especially for those who work late or are extremely busy,” said Joanna Konstantopoulou, a psychologist and founder of the Health Psychology Clinic. “It’s not just the 40-hour marathons without sleep which can be detrimental to your psychological health, but simply losing an hour or two on a regular basis can have a significant impact on your mind and well-being.”

That last bit is important. If you’re constantly shaving off an hour here or there ― thinking you can get by on five hours a night ― it’s time to reevaluate that sleep schedule. 

“Start with small steps by giving yourself a sensible and realistic bedtime,” Konstantopoulou said. “Try to go to bed half an hour before your usual bedtime and stick to it. Evaluate this new habit every day by having a journal and writing down your progress.” 

She noted that this new routine will improve your memory, reduce anxiety, and “transport toxins out of the brain” to potentially prevent chronic illnesses.

3. Find one small self-care act that works for you and prioritize it

Pick a you-centric activity and engage in it regularly, said Elena Touroni, co-founder of The Chelsea Psychology Clinic.

“The most impactful mental health goal a person can set is the commitment to balance workload and responsibilities alongside activities that bring them a sense of well-being and enjoyment,” she said. “When there is an imbalance in what we’re giving out to the world, and what we’re taking for ourselves, that’s when our psychological resources get depleted.”

Her suggestions to get you started? Try beginning each day with a five-minute mindfulness meditation session. Want to go further? “Go to therapy to unravel a lifelong pattern, get a personal trainer, or make time for reading,” she said. “This commitment can be broken down into specific and concrete goals, depending on your personal preferences, but it all comes down to making self-care a priority.”

4. Spend 10 minutes a day outside

Go for a walk during your lunch break, spend a few minutes drinking your morning coffee outside or pick up running. It doesn’t even have to be for a long period of time.

“This year, resolve to spend less time inside and more time outdoors in natural settings,” said Michael Brodsky, a psychiatrist. “Research in multiple countries show that spending time in green spaces can lift your mood and relieve anxiety in as little as 10 minutes.”

5. Regularly practice a simple mindfulness exercise

“Many of us spend our days worrying about the future or ruminating about the past, thus, missing a great deal of what is happening in the here-and-now,” said Anna Prudovski, the clinical director of Turning Point Psychological Services.

Making an effort to be more present “increases the sense of well-being, promotes vitality, heightens our awareness, helps train our attention, improves the quality of our work, and enhances interpersonal relationships,” she said. Sounds pretty nice, right? “Be more present” can feel a little vague, so here’s how you can get started:

Each day, spend five minutes noticing your surroundings and how you feel. Do this by naming five things you see, four things you can physically feel, three different sounds you hear, two things you can smell, and one thing you can taste. It’s OK if you point out something far away from you. Then take a second to label how you’re feeling in the moment (like, “I’m frustrated,” “I’m bored,” or “I’m excited”). This is known as a grounding exercise, which experts say helps with anxiety.

6. Say nice things about yourself

Roseann Capanna-Hodge, pediatric mental health expert and psychologist, suggested an adjustment to your everyday vocabulary, both in your thoughts and out loud. 

“Instead of always focusing on the negative, flip your dialogue to only positive outcomes. For example, instead of saying, ‘If I get that job,’ switch it to, ‘When I get that job.’ Those subtle changes in using positive language helps to change your mindset to a glass half full instead of a glass half empty.”

You can also increase your positive thoughts by stating one thing you like about yourself when you look in the mirror each morning. Cheesy, but worth a shot.

7. Give up or cut back on one unhealthy habit

We know when things are bad for us, which can cause stress. You can curb that by reducing them or giving them up entirely, said Sarah C. McEwen, a cognitive psychologist. Think activities like high alcohol consumption or excessive caffeine consumption.

Getting those things in check “will all help to manage stress levels,” McEwen said.

8. Find a physical activity you love

“Exercise plays a large role in mental health,” said physician Jena Sussex-Pizula. “While studies are ongoing, a review article found consistent beneficial effects of exercise on depressive symptoms across multiple studies.”

How often? McEwen suggests 30 minutes a day if you can. “This [amount] has been shown to produce the most benefit for improving mood and reducing stress levels,” she said.

The most important part is finding something you enjoy. It doesn’t matter if it’s pilates, martial arts, spinning, running, dancing or lifting weights ― just make sure the activity is something that excites you.

9. Try meditation

Haven’t jumped on the bandwagon just yet? Now is as good a time as ever. McEwen suggests meditation for those who want to improve their level of stress resilience. 

“A mindfulness meditation practice will have a tremendous positive effect longterm,” she said. “I recommend allocating at least 30 minutes daily, which can be divided into morning and evening.”

Feeling intimidated by the concept? McEwen suggested trying a local class or an app like Headspace, Waking Up or Insight Timer. 

“Research has shown that the regular practice of meditation can actually improve your health because it lowers the negative effects of not only high cortisol, but also high cholesterol and high blood pressure,” she said. “Other great benefits of regular meditation include mental clarity and focus, improvement of memory and overall higher level of mental performance.”

10. Stop negative thoughts in their tracks

“Our thoughts are not always reality,” said Judy Ho, a clinical and forensic neuropsychologist and author of ”Stop Self Sabotage.” “And we need to get into the routine of challenging them and changing our relationships to our thoughts.”

You can do this by asking yourself a simple question when you’re beating yourself up. Next time you have a negative thought, ask yourself: Does this completely and accurately capture what’s going on?” 

Ho said from there, you can transform the thought using one of two tactics. One is called “yes, but” and one is called “labeling.”

“‘Yes, but’ involves recognizing a not so great thing, and [adding] something that is positive or shows progress,” she said. “Example: I did eat three cupcakes while trying to cut down on sugar, but I have been doing a great job with healthy eating and can start fresh tomorrow.” 

And as for labeling, try mentally recognizing or acknowledging that the thought you’re having is toxic. According to Ho, this “takes the wind out of the sails of a negative thought and reminds you that a thought is just a mental event, and nothing more.”

Click Read More for 10 more Mental Health Resolutions.

Finding life’s meaning can keep us healthy as we age

The older people get, the more their lives might change. For example, their friends and relatives may reach the ends of their lives, and people’s careers may begin to wind down.

According to a new study paper appearing in the Journal of Clinical Psychiatry, crossing this threshold reawakens people’s need to find meaning in life.

The study, which researchers at the University of California San Diego School of Medicine conducted, finds a link between having a sense of meaning and positive physical, mental, and cognitive functioning.

“Those with meaning in life are happier and healthier than those without it,” says senior study author Dilip V. Jeste.

A new priority

Although a search for meaning may be on our minds at various times in our lives, the new study suggests that when our lives are full of family, friends, and careers, it tends to fade into the background.

“When you are young, like in your 20s, you are unsure about your career, a life partner, and who you are as a person. You are searching for meaning in life,” says Jeste.

However, “As you start to get into your 30s, 40s, and 50s, you have more established relationships, maybe you are married and have a family, and you are settled in a career. The search decreases and the meaning in life increases.”

Jeste continues: “After age 60, things begin to change. People retire from their job and [may] start to lose their [sense of] identity. They start to develop health issues and some of their friends and family begin to pass away. They start searching for the meaning in life again because the meaning they once had has changed.”

As we become older, there seems to be a pressing need to know what we should be doing with — and what we should be feeling about — our remaining time.

For many people, finding meaning becomes a prerequisite for a happy ending to one’s life story. Without it, suggests the study, our declining years and the difficulties they may involve may be dominated by stress and its physical consequences.

Who participated in the study?

The researchers drew their correlations from 1,042 adults who took part in the Successful Aging Evaluation from January 2013 to June 2014.

The participants were residents of adult communities in San Diego County, CA. They were aged 21–100+.

The researchers performed three evaluations:

  • “A Meaning in Life Questionnaire” captured each participant’s current relationship with meaning, categorized as “Search” or “Presence.” The team asked the participants to identify with different statements, such as, “I am seeking a purpose or mission for my life,” or, “I have discovered a satisfying life purpose.”
  • Each participant self-reported their physical condition and mental status.
  • Each participant took part in a phone interview as a means of assessing their cognitive status.

What the study found

In terms of searching for meaning versus acquiring it, the data showed a striking inverse relationship between the two at age 60: “Presence” reached its highest level at that age, while “Search” hit its lowest.

This suggests that for many people, there was no further need to keep searching for meaning at that point; they had found it by the time they turned 60.

Using statistical models, the researchers found that physical condition correlated negatively with older age but positively with Presence. In fact, the correlation grew even stronger beyond the age of 60.

Mental well-being was positively associated with aging and Presence but negatively with Search. Cognitive function was negatively linked to advancing age and Search.

The study’s conclusion is that finding meaning in one’s life constitutes a sound strategy for thriving in later years — in part because it supports the preservation of a person’s physical and mental well-being.

As first study author Awais Aftab explains, “The medical field is beginning to recognize that meaning in life is a clinically relevant and potentially modifiable factor, which can be targeted to enhance [people’s] well-being and functioning.”

Jeste says, “It’s an exciting time in this field as we are seeking to discover evidence-based answers to some of life’s most profound questions.”

His upcoming research will focus on other personal attributes — including wisdom, loneliness, and compassion — and how they may affect a person’s search for meaning.

“We also want to examine if some biomarkers of stress and aging are associated with searching and finding the meaning in life,” he says.

3 Small Hacks for a Healthy New Year

As another year winds down, are you feeling a little exhausted and worn out?  If you’re nodding your head, know that you are in good company, with less than 20% of people reporting that they’re feeling on top of the world at this time of the year.  So as you head into a new year, how can you find the energy to be at your best for the people you care most about?

“Often we put in so much effort trying to serve others, that we can overlook what we need ourselves,” explained Tom Rath, author of Eat, Move, Sleep, when I interviewed him recently.  “Unfortunately, the reality is that when you’re run down and low in energy, you’re likely to be less effective at work and home.”  

In fact, studies have found that when your energy levels are high, you’re three times more likely to be engaged in your work, and be at your best for others.  The reality is that if you want to make a difference for others, you firstly need to take care of your own health and energy.

So what are the smallest choices that can have the biggest impact?

Research suggests that eating, moving, and sleeping well are the keys to having more physical and emotional energy throughout your day, and can act as buffers against stress.  When you eat, move, and sleep well, you can do more for others.  

Tom pointed out that it’s important to tackle each of these areas simultaneously, as letting one area slip can lead to a negative spiral of energy.  For example, a poor night of sleep can lead to skipping your gym workout and grabbing a high sugar snack from the vending machine later in the day.  On the other hand, doing any one of these things – eating, moving, or sleeping – well can lead to an upward spiral in the other two areas.

The good news is that changing the way you eat, move, and sleep doesn’t necessarily require a grand plan, but can start with the next small choice you make in your day.  Tom suggested trying:

  • Eating Wisely – Making better choices about what you eat can improve your energy and mood.  Foods that are highly processed and include sugars or trans-fatty acids can have a negative impact, whereas when you eat more green leafy vegetables, whole fruits, and whole foods, you’re more likely to feel calmer and happier and have more energy.  Studies also suggest increasing your protein intake while, at the same time, reducing carbohydrates, improves your health over time.

Your Wellbeing Hack: Be A Food Accountant – Most meals contain both good and bad ingredients such as high nutrient content, as well as an excess of sugar, and chances are you may eat some foods that are less than ideal, several times a day.  Try to do some mental accounting based on what you know about the components and ask yourself if what you are about to eat is a net gain or loss.  When you make a choice that does more good than harm, such as opting for a salad over a burger, the resulting net gain gives your body a positive charge.  But deciding to drink a sugary soda instead of water produces a net loss.  As you continue to ask this question, you should become better at making decisions in the moment.

  • Moving Regularly – Not moving well is one of the biggest global public health problems, and this includes not enough physical activity, as well as too much sitting.  When we sit for long periods of time, the electrical activity in our legs shuts off, and that can do more accumulative damage than not getting 30 minutes of cardiovascular activity each day.  Moving regularly, in small bursts of activity, improves your physical energy, and can also help you think better.

Your Wellbeing Hack: Get Moving – Challenge yourself to add a little bit more activity into your everyday routine.  For example, walk around while you’re on the phone, or go out for a brief walk to the second-closest coffee shop to grab your coffee.  And when you start to see the returns on energy from these movements, look for ways to move even more, while you’re getting work done, such as having a treadmill at your desk.  

  • Sleep Well – It’s important to see every hour of sleep as an investment in your future, not an expense.  Unfortunately, many of us have experienced cultures where you get bragging rights for how little sleep you can survive on.  However, losing 90 minutes of sleep can cost up to a third of your productivity the next day, and can reduce your competency and creativity in afternoon meetings.  Over time, a consistent lack of sleep can be dangerous, as the effects are similar to being intoxicated as you go about your work and life.

Your Wellbeing Hack:Create A Bedtime Routine – Create a routine where you minimize bright light from any sources in the hours leading up to your bedtime, and ensure your bedroom is a few degrees cooler than the temperature you are accustomed to throughout the day.  Try to create a culture in your organization where enough sleep is highly valued and sacred, by discouraging late-night emails and having discussions about the effects of lack of sleep.

Cards, Board Games Could Be a Win for Aging Brains

Playing cards and board games like chess, bingo and Scrabble might be the mental workout you need to keep your wits as you age, Scottish researchers suggest.

People in their 70s who regularly play board games score higher on tests of memory and thinking skills than those who don’t. And 70-somethings who step up their game-playing are more likely to maintain thinking skills as they age, researchers say.

“Playing board, card and word games may protect people from cognitive decline, but this study wasn’t an intervention, so we can’t say that for sure,” said lead researcher Drew Altschul, a postdoctoral research fellow at the University of Edinburgh. “But it, at very least, is fun, inexpensive, and it certainly won’t hurt you.”

He doesn’t think it’s the social aspect of these activities that provides this brain-protective effect, but rather the challenge of the games themselves.

Unlike reading, writing, taking classes, visiting museums, libraries or friends and relatives, games appear to more actively engage abilities like memory, thinking speed and reasoning, Altschul said.

“So, this fits with what we call the ‘use it or lose it’ theory, that exercising your mental abilities more keeps them in better shape,” he said.

For the study, Altschul and his colleagues tested the memory, problem-solving, thinking speed and general thinking ability in nearly 1,100 70-year-olds. The tests were repeated every three years until participants reached age 79.

The researchers also asked how often participants played games such as cards, chess, bingo or crossword puzzles.

To isolate the effect of game playing, they took into account results of IQ tests participants took at age 11, as well as their income, education and physical activity levels.

People who played more games as they got older had less decline in mental skills in their 70s, particularly in memory function and thinking speed, researchers found. However, the study only found an association, not a cause-and-effect link.

How the brain changes with this type of activity is unknown, but researchers are working hard to learn more, said Rebecca Edelmayer, director of scientific engagement at the Alzheimer’s Association.

“There’s actually a lot of research that’s happening in this particular area right now focused on cognitive challenge, cognitive engagement and how we can use this as potentially a way to reduce our risk for cognitive decline,” she said.

Just like keeping the body active helps keep heart disease at bay, being mentally active may have the same effect on dementia, Edelmayer said.

“It seems that challenging and complex tasks, or even things like games of strategy, may require multiple cognitive functions that may be most beneficial for individuals as they age,” she said.

Edelmayer predicted that Alzheimer’s and other dementias will one day be treated much like heart disease. “You will see not only medications that are approved to treat dementia, but also ways that we could be changing and modifying our lifestyle to decrease our risk for cognitive decline,” she said.

A large trial is testing whether a combination of social and cognitive engagement, along with healthy nutrition, physical activity and effective management of heart health might help preserve mental function, Edelmayer said.

“Those factors, tested together, can potentially help us understand better what a recipe for beneficial lifestyle intervention would be,” she said.

The Evidence on Giving Thanks

Millions of people will gather with family and friends this week to celebrate what may be one of the most quintessential American holidays – Thanksgiving.

As its name implies, Thanksgiving is all about giving thanks – or showing appreciation or gratitude. It turns out there is a significant body of scientific literature demonstrating that thankfulness.

Alex Wood, Jeffrey Froh and Adam Geraghty conducted a comprehensive review on gratitude. They looked at how gratitude promotes well-being and, further, examined intervention programs that attempt to achieve positive outcomes by promoting gratitude.

The authors note that although we may feel grateful for specific events, gratitude can also be seen as “part of a wider life orientation towards noticing and appreciating the positive in the world.” (You may have heard the expression an “attitude of gratitude”).  Some people are more likely than others to notice and appreciate the positive in life. And this orientation seems to protect people from psychological distress.

Their review shows that gratitude is negatively related to depression. In one study, an attitude of “thankfulness” reduced the risk of disorders, such as major depression, generalized anxiety disorder and drug abuse. Gratitude has also been found to help people adjust to traumatic life events and their aftermath. On the positive side, a dozen studies have found a positive relationship between gratitude and feelings of well-being.

But what is the reason for these correlations? It could be that less depressed people are more likely to be grateful, rather than the opposite. To answer this question, scientists have developed intervention programs to promote feelings of gratitude and rigorously evaluated them. The authors review 12 studies that examined the effects of interventions such as daily listing of reasons to be grateful, thinking or writing more generally about gratitude and expressing gratitude with behaviors, such as writing a thank you note to someone.

The findings are very encouraging, with programs that promote gratefulness resulting in statistically significant increases in positive emotion, and decreases in negative emotion and worrying. A study of adolescents even found an increase in satisfaction with school after a gratitude intervention. More research, of course, needs to be done, but based on this review, promoting gratitude seems to improve well-being.

And more interesting evidence was published in 2017 in a separate review, which found that “the experience of gratitude” was greater in older adults compared to middle-aged and young adults.

An appealing part of the gratitude list idea lies in its simplicity. Anyone can do this – interventions are as straightforward as listing 3 to 5 things for which one is grateful before going to bed.

So as you gather with your family and friends this week, encourage each person to say something they are grateful for before your meal. And as we launch into the busy holiday season, the evidence certainly shows it is worth pausing – on Thanksgiving and every day – to give thanks for what we have.

The Hidden Powers of Gratitude

Scientific findings have revealed that when we make a habit of focusing on and appreciating the positive parts of life, we can enhance our overall well-being.

As one journal review noted gratitude is “related to a variety of clinically relevant phenomena.” These include positive outcomes in mental health (particularly around depression), adaptive personality characteristics, positive social relationships, and improved physical health (especially regarding stress and sleep).

So what are some of the seemingly magical rewards of gratitude? Here, in honor of our most appreciation-oriented month, I will share some of the findings on the exciting rewards of feeling thankful as well as a few tips on how to bring more gratitude into our daily lives.

1. Better Sleep

A good night’s sleep may be a few grateful thoughts away. In 2009, researchers discovered that gratitude predicted greater subjective sleep quality and sleep duration as well as less sleep latency and daytime dysfunction in those studied. The study was noted as being the first to show that a positive trait is related to good sleep quality above the effect of other personality traits. Thus, focusing on more positive thoughts of things we appreciate can be a wise addition to our nightly routine.

2. Lower Stress and Depression

When it comes to our mental health, gratitude can particularly benefit our levels of stress and depression. One 2008 study looked at the relationship between gratitude and perceived social support, stress, and depression during a life transition. What they found is that gratitude seemed to directly foster social support and to protect people from stress and depression.

Similarly, a more recent study from 2018 looked at the interaction between gratitude and depression in university students in China. What they discovered is that gratitude “may not only have a negative influence on depression, but may also counteract the symptoms of depression by enhancing a state of peace of mind and reducing ruminative thinking.” Anyone who’s struggled with depression knows what it’s like to be stuck in rumination. The notion that enhancing gratitude could serve as a tool to help alleviate depression is an optimistic finding worth further exploring.

3. Healthier Eating Habits

Recently, a group of high school students from four different schools was involved in a study in which their goal was to eat healthier. Some of the students were asked to write gratitude letters, as they simultaneously tracked their eating habits. What researchers found is that the students who expressed gratitude reported healthier eating over time. This led the team to conclude that “gratitude-based interventions may facilitate improvements in healthy eating behavior,” a goal that many of us have for our health.

4. Heart Health

When a group of patients suffering from hypertension was enrolled in a 10-week, gratitude-based intervention, they experienced statistically significant decreases in their blood pressure. The role of gratitude in boosting heart health is one that has been researched in many ways. One such study was authored by Paul J. Mills, a professor of family medicine and public health at the University of California, San Diego. After tasking asymptomatic heart failure patients with a “simple gratitude exercise,” Mills wrote:

We found that those patients who kept gratitude journals for those eight weeks showed reductions in circulating levels of several important inflammatory biomarkers, as well as an increase in heart rate variability while they journaled. Improved heart rate variability is considered a measure of reduced cardiac risk. It seems that a more grateful heart is indeed a more healthy heart and that gratitude journaling is an easy way to support cardiac health.

Given the enormous mental and physical benefits of gratitude, here are some suggestions for connecting with our feelings of appreciation:

Take Five to Feel Grateful

We should all aim to designate at least five minutes a day to reflect on what we’re grateful for. Yes, there may have been a maddening amount of traffic that made us late for work. Yes, our kid may have forgotten his bookbag again. Yet, what are some things in our day that we can step back and appreciate? When we’re wrapped up in our day’s tasks, whether it’s getting to the office or flying to another country, it’s easy to take note of and tally up our frustrations. We tend to take what is good for granted, while honing in on anything going wrong.

Yet, taking just minutes to shift our perspective, we may note something as simple as how delicious our morning coffee tasted as we inched along in traffic or how easygoing our partner was about driving our son his backpack at school. Instead of thinking about how long the line to get through airport security is, we may use that queue time to do our daily gratitude practice and marvel at how fortunate we are to be able to travel. These observations can be as small as appreciating a smile from a coworker or as large as connecting with the depth of love we feel for someone close to us. The important thing is simply to carve out that time to reflect.

Keep a Gratitude Journal

Personal stories of the rewards of gratitude journals have been reported by everyone from wellness bloggers to health researchers, from high school students to Oprah. These stories are backed by science showing that keeping a gratitude journal can enhance our happiness and well-being. I like these tips from TinyBuddha.com on how to get started. The most important thing to remember is there is no wrong way to keep this journal as long as we’re using it to connect to anything and everything that ignites our gratitude.

Write a Gratitude Letter

Greater Good Berkeley designed an exercise to write a thank you letter to someone who has offered us something meaningful and to deliver that letter in person. The instructions suggest we think of a particular person we have not yet thanked as well as something specific they have done for us. Doing this exercise helps us connect with our own feelings of gratitude but also encourages us to connect with someone who matters to us in a way we might not otherwise.

Each of these practices is intended to offer us a doorway through which to connect to our gratitude, however, each of us may find our own approach or technique that helps us focus on the positive aspects of our life or even just our day. In addition to making us healthier, this orientation can help connect us more deeply to positive emotions like joy and awe and can bring us closer to the people we care for. In this way, there is really no downside to making thankfulness, not just an annual cause for celebration, but a year-round goal and daily practice.

What connects depression, anxiety, and PTSD?

Mental health disorders, although incredibly prevalent, remain poorly understood.

According to the National Institute of Mental Health, almost 1 in 5 adults in the United States live with a mental illness.

About halfTrusted Source of the U.S. population will experience a mental health condition at some point in their life.

Medication and talking therapies are useful for many people, but understanding the neurological roots of these conditions is proving challenging.

Overlap and comorbidity

Post-traumatic stress disorder (PTSD), anxiety disorders, and mood disorders — such as major depressive disorder and bipolar disorder — have distinct symptoms, but they overlap significantly.

For instance, someone with generalized anxiety disorder might experience depressive symptoms, and someone with major depressive disorder might experience heightened anxiety.

Also, scientists have noted that these conditions often appear together, which they refer to as comorbidity. As the authors of the recent study write:

“Up to 90% of patients with an anxiety disorder meet criteria for a concurrent mood disorder, and as many as 70% of individuals with mood disorders meet criteria for an anxiety disorder during their lifetime.”

9,000 brain scans

This comorbidity and overlap of symptoms infer that there might be neurological similarities between the conditions. A recent study, featuring in JAMA PsychiatryTrusted Source, sets out to identify these shared neural features.

The authors, from various institutions in the U.S., Italy, and Germany, decided to collate and analyze brain scans from previous studies. They hoped to build a clearer picture of what is happening in the brains of people with these disorders.

To investigate, they looked at functional MRI (fMRI) scans from 367 experiments, which included data from 4,507 people with a mental health disorder and 4,755 healthy control participants. In total, they analyzed more than 9,000 brain scans.

These studies all investigated changes in brain activity while participants carried out cognitive tasks.

As far as the authors can identify, this is the largest analysis of its kind to date.

Joint features of multiple conditions

The scientists searched for brain regions that were either more active (hyperactive) or less active (hypoactive) in the participants with mental health conditions than among the control group. As expected, the researchers found that certain features of brain activity were consistent across mood disorders, PTSD, and anxiety disorders.

Perhaps surprisingly, they found the most significant differences between the two groups of participants when they searched for hypoactive regions. The authors outline their primary findings:

“[We] detected statistically robust transdiagnostic clusters of hypoactivation in the inferior prefrontal cortex/insula, the inferior parietal lobule, and the putamen.”

These regions are significant because they are all involved in emotional and cognitive control. Specifically, they play an important role in stopping cognitive and behavioral processes and switching to new ones.

Senior author Dr. Sophia Frangou explains: “These brain imaging findings provide a science-based explanation as to why patients with mood and anxiety disorders seem to be ‘locked in’ to negative mood states. They also corroborate the patients’ experience of being unable to stop and switch away from negative thoughts and feelings.”

The authors also outline how these findings lend support to earlier studies in people with these disorders, which found “deficits of large effect size in stopping and shifting responses in a range of tasks.”

In other words, individuals with these mental health disorders found switching between tasks as difficult as they found switching away from negative thoughts.

The hypoactivity in these regions might explain why the “locked in” states occur in both thoughts and behaviors.

Less hyperactivity

The scientists also identified hyperactivity in some regions of the brain. However, the differences were less pronounced than those that they found in the hypoactive regions.

In particular, the anterior cingulate cortex, left amygdala, and thalamus were more active in people with mood disorders, PTSD, and anxiety disorders. These regions are important in processing emotional thoughts and feelings.

For instance, the cingulate cortex helps regulate emotional experience and appraisal, while the amygdala, among other roles, helps people form and retrieve emotional memories.

Although this study is the largest of its type, there are certain limitations. For instance, as the authors explain, they focused only on adults. The differences in brain activity might not hold true in children or older adults.

The authors hope that, in the future, these brain regions might function as “targets for interventions aiming to improve clinical outcomes and reduce or prevent affective morbidity in the general population.”

Alcohol intake and reduced brain volume

Excessive alcohol consumption carries many risks, including heart and liver problems, a higher risk of cancer, and even brain damage.

Research has suggested that there is an association between high alcohol intake and reduced white and gray matter in the brain.

So far, most specialists have maintained that alcohol consumption leads to this decrease in brain volume, but could that conclusion be wrong?

Recently, a team of investigators from Washington University in St. Louis, MO, and Duke University in Durham, NC, has conducted a study that suggests that alcohol may not be the culprit behind lower brain volume.

Instead, the findings indicate that both reduced brain volume and a predisposition toward consuming higher quantities of alcohol may have the same underlying cause: genetic makeup.

Our results suggest that associations between alcohol consumption and reduced brain volume are attributable to shared genetic factors,” says senior author Ryan Bogdan.

“Lower brain volume in specific regions may predispose a person to greater alcohol consumption,” he goes on to note.

“The study is impressive because it uses a variety of approaches and data analysis techniques to reach findings that all converge on the same conclusion,” Bogdan also adds.

Are genes the underlying cause?

In the study — the findings of which appear in the journal Biological Psychiatry — the researchers analyzed the data from three separate brain imaging studies. These studies included one that recruited twins and non-twin siblings with different alcohol intake behaviors and one that involved children who had not had exposure to alcohol at baseline.

In the third study, the researchers had conducted analyses to determine gene expression in the brain using tissue samples that they had collected postmortem from donated organs.

In total, the investigators had access to data on 2,423 individuals. The three studies that the researchers accessed the data through were: the Duke Neurogenetics Study, the Human Connectome Project, and the Teen Alcohol Outcomes StudyTrusted Source.

“Our study provides convergent evidence that there are genetic factors that lead to both lower gray matter volumes and increased alcohol use,” says lead author David Baranger.

More specifically, the team found that individuals who had a higher alcohol intake had lower gray matter volume in the dorsolateral prefrontal cortex and the insula, which are two brain regions that play key roles in emotion, memory retrieval, reward cycles, and decision-making.

The researchers noted that, according to their analysis, lower gray matter in these two brain regions was actually due to a specific genetic makeup, which, in turn, was also associated with an increased risk of higher alcohol consumption, both in adolescence and in young adulthood.

“These findings don’t discount the hypothesis that alcohol abuse may further reduce gray matter volumes, but it does suggest that brain volumes started out lower to begin with,” Baranger clarifies.

Click Read More for additional details of the study.

Mindfulness at Work

Mindfulness is an age-old practice that has perhaps never been trendier in workplaces across the nation. Massive companies like Google and Intel offer meditation and mindfulness courses for their employees. And research suggests they’re on to something. A study recently published in the Organizational Behavior and Human Decision Processes Journal found that even just a few minutes of mindfulness per day makes employees more efficient and helpful.

But mindfulness at work doesn’t always take the form of a formal class. Plenty of workers—including CEOs—have implemented personal practices in their daily routines. This is good news, since research tells us when a CEO is stressed, the rest of the company feels it. And if those stress levels get too high, employees will likely move on.

Since it’s so critical for CEOs to keep their stress in check, we asked eight of them how mindfulness helps them do that—and what impact it’s had on their leadership:

CLEAR YOUR MIND

Perhaps the most popular form of mindfulness, meditation is a daily ritual for many CEOs—including Bobby Figueroa, who founded Gradient, an intelligent insights platform for Amazon. “As a CEO, you’re under a constant barrage of urgencies, perceived and real. Being mindful is my superpower for making better decisions in those moments,” he says.

Coline Juin tapped into that “superpower” a couple years ago when she launched Moona, a line of sleep products. “A retreat truly helped me experience its impact and tremendously decrease my—and I believe the team’s—stress level,” she says, adding that she’s now made mindfulness part of her corporate culture. “We’re already seeing the fruits in terms of team collaboration and lower stress levels. I’m confident it will be key to the overall success.”

POWER DOWN

“My rule is no screens on Saturdays,” says Nirav Shah, CEO of Sentinel Healthcare, a remote management solution for hypertension. “It allows me to recharge, spend time with family, and come back Monday better rested and with new insights.” She encourages her employees to unplug for the weekend too.

“My team looks to me to set these expectations. Having a healthy work environment—and a team that’s ready to do good, creative work—means taking breaks.”

SWEAT IT OUT

“My way to [practice] mindfulness is playing sports to keep my body active and settle my busy mind,” says Jurgi Camblong, CEO and founder of SOPHiA GENETICS, a biotech company committed to data-driven medicine.

That also does the trick for Scott Smith, the CEO of CloudApp, a cloud-based screen- and video-capture application. “Exercise is generally one of the first areas that’s forgotten when you start to get into a really high-stakes, emergency, or high-effort zone. You need to be able to step back and remember to take care of your physical self,” he says.

Often, he’ll opt for yoga because “it’s so easy to take 10 minutes for yourself, and to practice letting go of any stress and strain you’re holding.”

That exercise can double as your commute, says Sara Raffa, cofounder of Coterie, which sells and delivers curated party kits. She typically walks to work, which takes about half an hour each way. “Not only is it great exercise, but it gives me time to reset and focus at the beginning and end of each workday,” she says, adding that she’ll often use the stroll to catch up on news or call a friend. “Either way, it’s a great opportunity to feel both productive and relaxed, ready to take on the day or evening.”

GET LOST IN A BOOK

Linden Ellis, the other cofounder of Coterie, reads every night. “It’s my way of winding down and giving my brain a break,” she says. “I read novels that have nothing to do with business or leadership so that I can turn my attention to something completely different and get lost in a totally different world, if only for a short while.”

BE HERE, NOW

“For me [mindfulness is] doing an activity that requires my full attention,” says Ryan Napierski, president of Nu Skin, which markets personal-care products. “When I pray and meditate in the morning, I focus on that. When I mountain bike, I focus on the trail so I don’t crash. Or when I’m surfing, I have to use my whole body to push up at the right moment to catch that wave. I can’t be thinking of the next-quarter numbers.”

Practicing focusing on one thing has a real benefit, says Napierski. “These activities force me to have a single focus on what I’m doing right now. . . . So, when I am at the office, I can focus my efforts to be more productive and to be direct and decisive in my work.”

The Problem With Suggesting Exercise For Depression

Terri Cheney, a 59-year-old writer from Beverly Hills, has lived with bipolar disorder for the majority of her life. When a wave of depression hits ― a hallmark symptom of the mental health condition ― she says she feels as if she’s got a bad case of the flu. She wishes she could get up the energy to exercise, but on the days when even shuffling into the kitchen feels difficult, trying to endure an actual workout seems unbearable. 

“There are times when I simply can’t move,“ said Cheney, author of “Manic: A Memoir.” “The exercise advice is what makes me craziest. You know it’s good for you, but it’s a little fraught with danger. If you try and fail, you might feel worse.” 

You don’t have to Google long to learn that exercise is a go-to, expert-backed remedy for managing depression. In fact, physical activity is so beneficial that research shows it can be as effective as antidepressants for some patients ― or, at the very least, it improves symptoms if you’re on medication. A new study published in August also found that hot yoga was associated with reduced depressive symptoms, anxiety and hopelessness.

This boost is likely because exercise releases mood-regulating endorphins and serotonin, as well as prompts the growth of new brain cells and blood vessels that bring more oxygen into your body, said depression researcher Peter J. Carek, professor and chair in the department of community health and family medicine at the University of Florida. 

But despite experts’ enthusiasm for the potential of exercise, there’s often little recognition that the very thing that would make you feel better is really, really hard when you’re depressed. Worse, it may exacerbate the hopeless feeling that comes with depression.

In a small 2017 study in an outpatient mental health clinic, 84% of people acknowledged that physical activity usually helped them feel better ― and the majority wanted to be active ― but 52% blamed their mood as the reason they got less than the U.S. guideline of 150 minutes of moderate-intensity exercise per week. 

It’s true that exercise is one of the best things you can do for your mental health, but we also need to acknowledge that it’s often not as simple as lacing up your sneakers and heading out the door. It’s just not realistic to recommend that someone “go exercise” when getting out of bed seems like the most impossible feat. Advice like “take a walk around the block” or “motivate yourself with a post-workout treat” isn’t cutting it.

We asked experts for a few of their best tips to get moving when it’s the last thing you feel like doing (and also when it’s best to just take a pass). 

Take a shower

Chloe Carmichael, a therapist based in New York, said many of her patients complain that their depression makes it hard to get out of bed in the morning. She recommends they jump into the shower immediately after waking up. 

“For many people, their depression is worse in the morning. So I tell them to start with a very cold or very hot shower … it overwhelms them on a sensory level,” Carmichael said.

The point is to jolt your nervous system, which then may slightly improve how you’re feeling and may make exercise seem a bit more possible or manageable. You can also do this by deep breathing, explained Julianne Schroeder, a mental health counselor in Dallas. 

“You can affect change in your nervous system with breath moving in and out, allowing for physical and emotional release,” Schroeder said.

If you can, start really small

Frank King, a 62-year-old in Eugene, Oregon, who lives with depression, finds motivation by promising himself he only has to do the bare minimum, such as working out on his gym’s elliptical machine for a single minute.

“If I get on and do one minute, I can turn around and go home,” King said. “I make a game out of it. If I don’t want to get off, I say, ’I’ll do 15 minutes and then I can leave.’ If I make it to 15, I’ll say, ‘OK, I’ll do 20,’ and so forth. It’s not always a full workout, but it’s a better one than if I’d never left the house.”

Exercise at home in your pajamas 

Brenna Cliver, who runs health and fitness company Victoriam Performance and has experienced depression from time to time, said that when the idea of leaving the house is overwhelming, she gets moving at home in whatever clothes she happens to be wearing. By eliminating some steps ― dressing, packing, getting to the car, driving to the gym, finding parking ― the actual task of exercising seems easier. 

“I’ll stand up and do a minute of air squats or walking lunges or anything to get my heart rate up enough to feel a little different,” said Cliver, a 28-year-old from Edinburg, Texas. “This doesn’t usually solve the problem, but it slows or stops the sinking and leads to other positives, like showering, drinking water and eating real food.” 

Create or put yourself in a comfortable environment

If your depression is making it absolutely impossible to be in a crowd, find a place that feels less stressful and better suits your mood. 

“Going into the weight room is always a tough one when I’m depressed and self-conscious, and running outside is often too much stimuli, unless it’s away from main roads or sidewalks,” Cliver said. “But I can do the StairMaster in the back of the gym. No one will talk to or look at me. I can listen to music and zone out.”

Others might find nature or swimming to be comforting when they’re experiencing depression symptoms. Research also shows that being near water can have a calming effect.

“Water has a sense of buoyancy that changes the way you’re feeling. Choose the activities that feel good to you,” Carmichael added. 

Enlist social support 

For Jen Ngozi, founder of the networking and dance fitness company NetWerk, she depends on a group of friends to inspire her when she’s depressed. Not only do they provide companionship ― experts warn against isolation ― but they add some much-needed empathy when you’re in a dark place. 

“They will literally show up at my doorstep saying, ‘Get up, girl. It’s time to work out, period!’” said Ngozi, 30, who lives in Roanoke, Virginia. “As women, it’s so important to have a strong community of supporters around us, especially during times of depression.”

Know when it’s OK to cut yourself some slack

Bottom line: Show yourself some compassion. Depression already (unfairly and incorrectly) can make you believe that you’re worthless without piling on exercise guilt.

“It means acknowledging that as a result of being depressed, your motivation and lack of energy aren’t because you aren’t trying hard enough,” Schroeder said. “Your mind and body are affected by a physiological response to depression in an effort to preserve itself.”

That advice resonates with Cheney. If she’s absolutely not able to work out, “that’s when I go and make instant mashed potatoes and curl up and watch TV or sleep,” she said. Knowing her limitations and being kind to herself is one step toward feeling better.

Feeling Insecure? 6 Tips To Quiet Your Inner Critic

But it’s not an objective reporter. It likes to act as critic, judge and jury — especially when it comes to social situations. You know that voice, right? The one that says, “They didn’t text back. They must think I’m uncool/awkward.”

Those negative thoughts can hold you back from making new friends, connecting with colleagues or sharing your brilliant ideas in meetings. Especially for shy or introverted people, it can be a real handicap and even lead to loneliness or isolation. 

“That voice is there for all of us — obviously in varying degrees,” says psychologist and author Andrea Bonior. “With social media, especially, we look at what other people are presenting as, and we assume they are so confident because of how they appear … and we just make ourselves feel worse.”

Bonior is the author of The Friendship Fix and the forthcoming Detox Your Thoughts.

The critical voice in your head can also prompt you to adopt a persona to fit into social situations, says Steven Hayes, a psychologist and professor at the University of Nevada.

“It’s that problem-solving voice that says, ‘You will belong if you are special, and you’ll be cast out if you’re not,’ ” says Hayes, whose new book, A Liberated Mind, aims to help people learn to defuse these thoughts. “You step back and become a little distant, evaluating, listening to the inner chatter — ‘Am I doing this right?’ ” 

If you can turn down the volume on that voice, he says, you might find that you can more easily share the unique gifts you have to offer others.

And it can help you get emotionally closer to the people around you, Hayes continues.

“You’ve got to rein in the dictator within you,” he says. “You’ve got to put that voice on a leash.

“It’s good for paying taxes or fixing your car — that’s when you want that judgmental, problem-solving voice. Your friends are not a math problem.”

For some people, these negative thoughts become debilitating and require professional attention. For the vast majority, though, simple tools can help defang that inner dictator and stop it from holding you back when you want to connect with others.

1. Label the voice.

The voice does not define you; in fact, identify it as an independent entity and give it a name. Call it your unreliable narrator, your negative Nelly or your worry blob — “I’ve seen all kinds of labels,” says Bonior. “What that does is it separates it from yourself.”

“Mine happens to be named George,” says Hayes. “I say, ‘Thanks, George, for the advice. I’ve got this covered, George.’ “

Naming the voice almost turns it into someone else talking. “It’s just one little cognitive strand waving its finger at you,” Hayes says. “You don’t have to do what the dictator says.”

2. Set negative thoughts to music.

Distill your inner negative messages down to a phrase or two. It may help to take a few moments to observe and jot down your most recurrent thoughts. Once you’ve identified them, take the thoughts — “I’m not good enough,” “They’re never going to like me,” etc. — and set them to music, Hayes suggests. 

He recommends an app called Songify by Smule, or just sing it to the tune of “Happy Birthday.” Besides making you laugh, the effect will be to put those thoughts in perspective.

3. Say those thoughts out loud in the voice of your least favorite politician. 

Or say them quietly to yourself, or say them in a silly cartoon voice. “Not to ridicule it,” Hayes says. “Just to remind you, it’s just a voice inside you talking.”

4. Trust that the thought will pass.

It’s just a thought, and it’s just not that important — it’s irrational after all! Don’t waste energy fighting it or dwelling on it, Bonior says. 

“We don’t realize we’re empowering those thoughts, getting into a tug of war with them,” she says. “You can choose to accept its presence in the moment and trust that it will pass.”

5. Slow your breathing to calm your thoughts.

Negative thinking can do a number on your central nervous system, causing you to react physically. Have you ever started getting negative thoughts and suddenly felt physically bad too? Whatever your response — shaky hands, trembly voice, sweaty brow — a slow inhale and a slower exhale will help soothe the central nervous system.

And finding your composure will help you let the thoughts pass.

“You can’t have a calm mind if your body is in hyperdrive,” Bonior explains. “The opposite is true too — you can’t have a calm body if your mind is going in circles.”

6. Remember, you have a lot to give.

Along with taking slower breaths, remind yourself that you have just as much to offer to the conversation as the person you are speaking with. And you can always steer the conversation to topics that put you at ease. 

The people you encounter — whether it’s friends, colleagues or strangers — will like you more than you think, as Gillian Sandstrom, a psychologist and researcher at the University of Essex in the United Kingdom, told NPR’s Life Kit.

“When you talk to someone else, you’re actually going to brighten their day,” Sandstrom says.

Don’t let that voice in your head tell you otherwise.

To Heal from Trauma, You Have to Feel Your Feelings

At any age, in any life stage, you can change. Whether you’re 77 years old or 17, you can learn, grow, adopt new habits, and make new choices to create a life you truly love. It may not always feel that way, though. When childhood emotional wounds tether you to the past, it can feel like you’re being swept away by a fast-moving current; although there are branches on either side of the riverbank to grab onto, something is mentally blocking you from reaching out. That “something” is a tether point, an invisible string holding you back. 

Your tether points originated with emotional injuries or traumas in childhood—experiences that were hurtful and damaging to your sense of self. The same event or experience will affect people differently. School-yard teasing that stays with one person for decades may be brushed off easily by someone else. Genetics, previous events, mindset, and beliefs can all affect which childhood events stay with you and hold you back, and which you shrug off. The social support you received in the wake of the trauma, the trauma’s duration, and the type of injury it is also can affect the tether-creation process. 

Trauma generates emotions, and unless you process these emotions at the time they occur, they can become stuck in your system—negatively affecting you both psychologically and physically. The healthy flow and processing of distressing emotions like anger, sadness, grief, and fear are essential. You will never resolve underlying issues if you deny and run from your feelings. Suppressed emotions don’t just go away; instead, they become toxic. They will keep showing up in your life, in some form of dysfunction or unhappiness, until you resolve them. Throughout life, feeling your feelings is one of the healthiest and most productive things you can do. 

To reach out for that metaphorical branch and pull yourself from the current, you have to find what it is in your inner world that is tethering you to your traumas, restricting your movements and limiting your choices. You have to make conscious what is unconscious so that you can free yourself from your past and grab onto the life you want by making new, more empowering choices. 

To find your tether points, you don’t have to go through every experience you’ve ever had and dredge up old sorrows. Instead, look at what isn’t working well in your life right now. What situations make you feel extra emotional—hair-trigger anger, deep despair, shame? Are there times where you think you should have an emotional reaction, but you feel numb? What do these feelings or lack of feelings tell you about yourself? The act of self-exploration and understanding will help you get to know yourself on a deeper level. It will help you to process and let go of any beliefs, memories, judgments, and regrets that are keeping you bound to the past and unable to fully engage with life in the present. 

To free yourself from what is limiting you and unconsciously driving your actions, you need to observe yourself non-judgmentally. You need to bring your thoughts, feelings, and beliefs into conscious awareness. In doing so, you shift from using the fight-flight-or-freeze part of your brain to the less reactive and more analytical one, which can explore, discover, and create. 

The qualities you’ll need in your self-observation spell the acronym COAL

  • Curiosity
  • Openness
  • Acceptance
  • Love

By using COAL, you create a psychological safe-space where you can let your guard down to reveal the sensations, emotions, and thoughts trapped inside. When you focus on your inner world, you are practicing emotional mindfulness. Self-awareness is fundamental to understanding and being happy with yourself, forming close relationships, and recognizing your motivations so that you can build your life based on what is true for you now, and not a response to past trauma. 

You must feel your feelings; your emotions are helpful companions on the journey of life. You need to make friends with them, learn from them, and interact with them in a loving, not fearful, way.

4 Types of Powerful but Frequently Ignored Habits

When people think about habits, they often think about a narrow and stereotypical range of these, like going to the gym, food choices, teeth brushing, drinking more water, bedtimes, and technology use. To fully harness the power of habits, you need to think more broadly about which habits you could improve, and think about your cognitive-emotional habits as well as your behavior.

As a bonus, making tweaks in other categories of habits is often easier than consistently dragging your butt to the gym every day or passing up cookies.

1. How you habitually react to feeling overwhelmed or self-doubt

Cognitive habits (related to thinking) are just as important as behavioral habits. When people feel overwhelmed or self-doubt in response to a challenge, they either retreat or navigate a way forward. The strategies you habitually use in response to these feelings can have a huge impact on your success in life.

Here are a few examples of strategies I use: 

  • When I get an email that stresses me out, I re-read it with fresh eyes the following day. This helps me not overreact and see situations more clearly. 
  • If I feel overwhelmed, I break down the task into the parts I feel intimidated by and those I feel confident about. This helps me see that it’s not the whole task that’s difficult, just parts of it.
  • I often find that I can’t think clearly about an overwhelming task until I’ve taken a nap or gone for a walk, since those strategies calm me physiologically and allow my brain to think more clearly. 
  • If I’m procrastinating, I make a deal with myself that if I’m going to procrastinate I have to do something instead that’s objectively more important than whatever I’m dragging my heels on.

Challenge:

  • How can you improve the ways you habitually respond to anxiety-related emotions, like feeling overwhelmed and doubt?
  • What strategies help you see those situations as more manageable and navigate a path forward? 

2. How you react to envy and frustration

If you’re an ambitious person, you may find you get annoyed (envious, frustrated, resentful, etc) when you observe someone else who is having the success you would like to have yourself. Having these emotional experiences is no problem whatsoever if you use them correctly. You can use these feelings as a trigger for positive cognitive habits.

For instance, in response to envy, you might: 

  • Check for unhelpful thoughts. Thoughts like “It’s not fair, that person has so many advantages” might be true, but typically aren’t that helpful for moving forward. 
  • Ask yourself: Whatever superstar skills the other person has, have they put more effort and practice into them than you? Is it worth it for you to practice those skills in a more focused way? What’s your plan? What are the small, easy wins you have available to you in terms of improving how well you perform that skill?
  • Identify what that person has that you would like to have. Try answering the question—”That person has the freedom to….. and I would like that.” This question is a useful check against feeling envious about types of success you don’t actually want. For instance, I’d never want to have lots of employees.

Challenge: What are your current habitual ways of responding to envy? What cognitive habits would be more useful?

3. Habits that help maintain your close relationships

Others who write a lot about habits tend to focus on personal self-regulation, but many of the principles for improving self-orientated habits also apply to improving your social behaviors. Your relationship habits are incredibly important to your happiness in life. For instance, we know that how couples handle daily partings and reunions is closely tied to relationship health (typically involving how partners say goodbye on the way to work, and how they say hello again at the end of the day.)

Challenge: If you have a partner, identify what your current habits are when your partner:

  • Asks you to do something.
  • Expresses something they’re unhappy about.
  • Has a success they want to share with you.
  • Has a problem they need emotional support about.

What are your strengths, and where is your behavior ripe for improvement?

4. Whether you have a habit of doing things that are novel and challenging

Creativity often comes from novel experiences: e.g., working with a new collaborator rather than the person you always work with. People who habitually take on projects that are new and challenging are always adding to their skills, resilience, relationships, perspectives, etc. 

If you have this habit, you’ll cumulatively end up in a really good place. If your daily habits are too static (e.g., you’re rigid about always needing 90 minutes a day for the gym), you’ll have less room for novelty in your life.

Challenge: How is your balance between doing things that are familiar versus trying novel approaches and working with new people?

Wrapping Up

The idea that good habits are about being consistent with the same daily rituals and practices is a very limited perspective. Consistent practice at specific behavioral skills is only a small part of what it means to have good habits. Your cognitive habits, your emotional habits (like being emotionally accessible and responsive to your loved ones), and having a habit of curiosity (including an interest in choosing the novel over the familiar) are equally important in terms of healthy habits.

7 Questions Your Therapist Will Probably Ask During Your First Session

So you just made your first therapy appointment. Maybe it’s your first session ever. Or maybe you’ve talked to someone in the past but now you’re about to meet with a new therapist. Even though you know you’re taking a positive step, you may still feel apprehensive.

“It’s OK to be nervous! You’re meeting someone for the first time who is likely going to ask you some very personal and emotionally sensitive questions and you’re expected to be very honest and forthcoming with them,” Gina Delucca, a clinical psychologist in San Francisco, told HuffPost. “It’s a very unnatural and nerve-inducing type of situation, and as therapists, we try to be sensitive to this.”

To ease your pre-appointment jitters, we asked therapists to reveal what they typically bring up with clients during the first session. Below, they share what you need to know to start (or re-start) therapy on the right foot.

Questions You’ll Probably Be Asked

Before your first session, your therapist will likely send over some intake paperwork to fill out. One of those documents will probably be a questionnaire that asks for your medical history (including any medications you’re taking), mental health services you’ve received in the past, current issues or stressors, and what you hope to get out of therapy. The therapist will review your responses and may want you to elaborate on them during your initial session together.

Here are some of the questions you may be asked and why:

1. What prompted you to seek therapy now?

The therapist wants to know if there’s something going on in your life that pushed you to make the appointment when you did. It could be anything from a messy breakup to a conflict with a family member, unmanageable levels of anxiety, a sexual assault or some big life change like becoming a parent or starting a new career.

“We are interested in knowing what event or experience preceded you deciding to get some help to help us understand the nature of the problem and what you are wanting to work on,” said Kate Stoddard, a marriage and family therapist in San Francisco.

2. How have you been coping with the problem(s) that brought you into therapy?

Delucca asks her new clients this question to learn how they handle stressful situations and difficult emotions. Do they turn to something productive like meditation or spending time outside? Or do they rely on unhealthy habits like excessive drinking or drug use?

“I find it helpful to get a sense of my client’s current coping skills and resources so that we can utilize or build upon them in treatment,” she said. “Second, this allows me to assess whether my client is engaging in any unhealthy coping mechanisms that could be exacerbating the problem and may potentially impact treatment, like avoidance, substance use or self-injury.”

3. Have you ever done therapy before?

If you’ve talked to a therapist in the past, it’s likely this person did some things you liked and others you didn’t. Your current therapist can use this information to help treat you in the most effective way, explained Los Angeles-based marriage and family therapist Danny Gibson.

“If the experience was positive, why was it positive? If not, why was it a negative experience? What would you like to do differently?” he said. “The client drives the therapy session ― I act as the useful guide.”

If you answer no to this question, “the therapist can spend more time orienting you around the structure and process of therapy and how it works,” Stoddard said.

4. What was it like growing up in your family?

Many people enter therapy to gain a better understanding of themselves and how they relate to others. Learning about a client’s childhood and their family dynamics can offer insight into the person they are today, said Zainab Delawalla, a clinical psychologist in Atlanta.

“Although it is not a given that people will repeat the same roles they adopted during childhood, often the pattern of relating that they develop is tied to how they have internalized certain role expectations in the past,” she said.

5. Have you ever thought of harming yourself or ending your life?

For those who have experienced suicidal thoughts or harmed themselves in the past, these types of questions may bring up difficult emotions. But it’s crucial for your therapist to know this information from the get-go.

“Most clinicians will want to know if you’re struggling with thoughts of self-harm from the very first session so they can be sure they are recommending the appropriate level of care,” Delawalla said.

If you answer yes, Delucca said you can expect follow-up questions like: “Are you having current thoughts of suicide?” “Do you have a suicide plan?” “Do you intend to act on these thoughts?” and “Do you have the means to carry out the plan?”

6. How connected do you feel to the people around you?

Loneliness can have serious mental and physical health implications. So your therapist wants to know if you already have a solid support system in place. If not, they can help you work on building one.

“There is lots of research that documents the importance of social support in maintaining psychological well-being,” Delawalla said. “Having a good understanding of your social network will help your therapist know how to best use your social support resources to augment treatment and whether bolstering social support should be part of your treatment goals.”

7. What do you hope to accomplish in therapy?

“It’s helpful to explore this question in more depth during the first session to hear the client’s expectations for therapy and also to help them manage their expectations about how the process of change works through therapy,” Stoddard said.

When setting your therapy goals, be as specific as possible about what these improvements in your life might look like. Instead of just saying you want to be “more self-confident,” think about what some concrete markers of that change would be.

“For example, how would you know if you were more self-confident? What would you be doing differently if you were more self-confident?” Delucca said. “By having more observable and measurable goals, we will be better able to track your progress and know whether therapy is effective.”

Getting goal-ready: how mindfulness can help you tackle anything

Whatever our pursuit of excellence, we each need to show up mentally, not just physically. That’s why this month’s featured collection of exercises has one overarching theme: being at the top of your game in your chosen field.

We can train the body day in, day out, but if we’re not also looking after the mind, then we are not maximizing our highest potential; if we’re not maximizing our highest potential, we’re not truly ready to pursue our goals.

Imagine if you could walk into a competitive arena or a boardroom or a crucial interview, with a mind at ease, in the present, fully focused, not rattled by thoughts, emotions, or surrounding circumstances. Imagine being that mentally strong.

We could all do with being better equipped to be more resilient, more focused, more confident, and more able to handle pressure. Those are just a few reasons why professional athletes are turning to Headspace. It’s also why the app was first utilized as a training tool by Team Great Britain ahead of the 2012 Olympics, and why Headspace now partners with the NBA, the MLS, the LPGA, and U.S. Soccer.

But whatever our skillset — inside or outside of sports — it’s an undeniable truth that a healthy mind is a core element of how we perform in life. And a healthy mind — calmer, clearer, and contented — is less prone to being emotionally reactive during the highs and lows, and the successes and setbacks.

The mind doesn’t respect whether we’re a pro or a first-timer; nor does it respect reputations, popularity, or prestige. At the end of the day, we’re all human. And because we’re all human, we’re all fallible, meaning we will all struggle with the mind at one time or another.

Sobering Truth About Addiction Treatment in America

The crisis is well documented and reported: More people are dying of drug overdose than any other non-natural cause—more than from guns, suicide, and car accidents. Politicians have held press conferences, formed commissions and task forces, and convened town-hall meetings. Vivek Murthy, the Surgeon General under President Obama (fired by Donald Trump), issued an historic report on America’s drug-use and addiction crises. Pharmaceutical companies have been blamed. Drug cartels. Physicians who hand out pain pills like Skittles.

In the meantime, the problem worsens. In 2015, 52,000 people died because of overdose, including 33,000 on OxyContin, heroin, and other opioids. Almost three times that number died of causes related to the most-used mood-altering addictive drug, alcohol. The 2016 and 2017 overdose numbers are predicted to be higher. Currently, fentanyl deaths are skyrocketing.

If not politicians, to whom can we turn to address the crisis? Since addiction is a health problem, the logical answer would be the addiction-treatment system, but it’s in disarray.

Currently most people who enter treatment are subjected to archaic care, some of which does more harm than good. Only about 10 percent of people who need treatment for drug-use disorders get any whatsoever. Of those who do, a majority enter programs with practices that would be considered barbaric if they were common in treatment systems for other diseases.

Many programs reject science and employ one-size-fits-all-addicts treatment. Patients are often subjected to a slipshod patchwork of unproven therapies. They pass talking sticks and bat horses with Nerf noodles. In some programs, patients are subjected to confrontational therapies, which may include the badgering of those who resist engaging in 12-Step programs, participation in which is required in almost every program. These support groups help some people, but alienate others. When compulsory, they can be detrimental.

Patients are routinely kicked out of programs for exhibiting symptoms of their disease (relapse or breaking rules), which is unconscionable. They are denied life-saving medications by practitioners who don’t believe in them—as Richard Rawson, PhD, research professor, UVM Center for Behavior and Health, says, “this is tantamount to a doctor not believing in Coumadin to prevent heart attacks or insulin for diabetes.”

Patients are put in programs for arbitrary periods of time. Three or five days of detox isn’t treatment. Many residential programs last for twenty-eight days, but research has shown that a month is rarely long enough to treat this disease. Some of those who enter residential treatment do get sober, but they relapse soon after they’re discharged, with, as addiction researcher Thomas McLellan, PhD, sums, “a hearty handshake and instructions to go off to a church basement someplace.” As he says, “It just won’t work.” Finally, people afflicted with this disease are almost never assessed and treated for co-occurring psychiatric disorders, in spite of the fact they almost always accompany and underlie life-threatening drug use. If both illnesses aren’t addressed, relapse is likely.

The disastrous state of the system suggests that addiction-medicine specialists don’t know how to treat substance-use disorders (or even if they can be treated). It’s not the case. The National Institute on Drug Abuse (NIDA) and organizations of addiction-care professionals like the American Society of Addiction Medicine (ASAM) and American Association of Addiction Psychiatry (AAAP) have identified effective treatments. There’s no easy cure for many complex diseases, including addiction. However, cognitive-behavior therapy, motivational interviewing, and addiction medications, often used in concert with one another and in concert with assessment and treatment dual diagnoses, are among many proven treatments. However, most patients are never offered these treatments because of a fatal chasm between addiction science and practitioners and programs. 

Fixing the system requires modeling it on the one in place for other serious illnesses. Most people enter the medical system in their primary-care doctors’ offices, health clinics, or emergency rooms. Currently, most doctors in these settings have had little or no education about addiction. A recent ASAM survey of two thirds of U.S. medical schools found that they require an average of less than an hourof training in addiction treatment.article continues after advertisement

Doctors must be taught to recognize substance-use disorders and treat them immediately—the archaic “let them hit bottom” paradigm has been discredited. They should offer or refer for brief interventions. A program called SBIRT (Screening, Brief Intervention and Referral to Treatment), which seeks to identify risky substance use and includes as few as three counseling sessions, has proven effective in many cases, and may be implemented in general healthcare settings.

Primary-care doctors should be trained and certified to prescribe buprenorphine, a medication that decreases craving and prevents overdose on opioids. Currently, there are limitations on the number of patients doctors can treat. Still, in Vermont, for example, almost 50 percent of opioid users in treatment receive care in their doctors’ offices- they don’t have to go to addiction specialists or intensive treatment programs to receive care.

When a patient requires a higher level of care, doctors must refer them to addiction specialists, which excludes many current practitioners whose only qualification to treat addiction is their own experience in recovery. Instead, patients must be seen by psychiatrists and psychologists trained to diagnose and treat the wide range of substance use disorders. There’s a shortage of these doctors; there needs to be a concerted effort to fill the void.

According to Larissa Mooney, MD, director of the UCLA Addiction Medicine Clinic, “Individuals entering treatment should be presented with an informed discussion about treatment options that include effective, research-based interventions.  In our current system, treatment recommendations vary widely and may come with bias; medication treatments are either not offered or may be presented as a less desirable option in the path to recovery. Treatment should be individualized, and if the same form of treatment has been repeated over and over with poor results (i.e. relapse), an alternative or more comprehensive approach should be suggested.”article continues after advertisement

When determining if a patient should be treated in physicians’ offices, intensive-outpatient, or residential setting, doctors should rely on ASAM guidelines, not guesses. The length of treatment must be determined by necessity, not insurance. If a patient relapses, is recalcitrant, or breaks rules, treatment should be reevaluated. They may need a higher level of care, but sick people should never be put out on the street. In addition, all practitioners must reject the archaic proscriptions against medication-assisted treatment; Rawson says that failing to prescribe addiction medications in the case of opioid addiction “should be considered malpractice.” 

Programs must also address the fact that a majority of people with substance-use disorders have interrelated psychiatric illnesses. Patients should undergo clinical evaluation, which may include psychological testing. Those with dual diagnoses must be treated for their co-occurring disorders. Finally, initial treatments must be followed by aftercare that’s monitored by an addiction psychiatrist, psychologist, or physician. In short, the field must adopt gold-standard, research-based best practices.

People blame politicians, drug dealers, and pharmaceutical companies for the overdose crisis. However, that won’t help the millions of addicted Americans who need treatment now. Even the most devoted and skilled addiction professionals must acknowledge that they’re part of a broken system that’s killing people. No one can repair it but them.    

Learn to Breathe

I’m not kidding. Sure, you knew how to breathe as soon as you were pushed out of the womb. But you didn’t learn to breathe right. If you were slapped on the butt by the doctor, you probably learned to breathe too shallow and too fast, maybe even hyperventilate. All that screaming and crying you did after leaving the comfort of the womb taught your brain that stress and anxiety go with rapid, shallow breathing. So when faced with adversity as you got older, your automatic reaction is to breathe too fast and too shallow. This is a case of classical conditioned learning. That kind of learning actually helps sustain stress, because your brain has learned that rapid, shallow, breathing is supposed to go with stress. The brain thinks this is normal.

About a month ago, I was having a large, benign growth on my neck removed by local surgeon. The area was locally anesthetized, but so much tissue was involved that as he had to cut deeper, I felt pain. The nurse said, huffing and puffing with staccato rhythm, “Breathe. Breath in, breath out.” After several such reminders, I blurted, “Is there any other way?” Then, I realized the risk I was taking if my surgeon started to laugh while holding a scalpel to my neck. But my doctor did a great job. And I was reminded that there is a right way and a wrong way to breathe under stressful conditions.

There are three principles to correct breathing for reducing stress:

  1. Breathe deeply. This means abdominally. As you inhale, the abdomen should protrude, filling the lungs better because the diaphragm contraction expands the chest cavity for more lung inflation.
  2. Breathe slowly. Common breathing rates are around 16-20 breaths per minute. This is fine when you are very active physically, but remember that the brain has through decades of conditioning learned to associate rapid breathing with distress. When you are trying to relax, you can shut down stress by slowing down to three to five breaths per minute.
  3. Exhale through the mouth. A good way to automate this method is to slightly open the mouth and move the tip of the tongue behind the front upper teeth during inhalation, then relax the tongue during exhalation.

You can use these principles in two well-known breathing techniques:

  1. The Navy Seal box technique. When they are not raiding a terrorist cell or on another similar stressful mission, Navy Seals train themselves to stay calm by taking a four-step breath cycle of inhale, hold breath, exhale, hold breath, and then repeating the cycle. Each step lasts 4 seconds. This would yield a total breathing rate of about four per minute. With practice, you can make each step last 5 or more seconds. Then you would be breathing like a yogi.
  2. The hum technique. Here, the idea is to make a soft, guttural humming sound throughout each exhalation. You can even do this during the exhale stages in the Navy technique. This may have a similar effect as using a mantra during meditation. Sometimes, people tell me I am humming when I had not been aware of it. I guess I have learned to associate humming with calming down and feeling good. Perhaps it is similar to why cats purr, which they do for two seemingly conflicting purposes: One is that the purring sound has a conditioned association with a calm state. When the cat is calm, it purrs. The other cause of purring is anxiety. In an anxious cat, anxiety acts as a cue that retrieves the memory of associated purring, which then helps to calm the cat.

If you are trying to train yourself to be calm, I recommend that you employ and combine the three principles and the two techniques during mindfulness meditation. All of these principles (deep and slow breathing, and exhaling via the mouth) and techniques (4-step and humming) can be synergistically combined during mindfulness meditation. In such meditation, the idea is to block out all thoughts in order to focus on breathing. You can achieve further synergy by mediating in certain yoga postures, which have their own relaxing effects. If you are like me, you are stiff and sore when you awake in the morning. I deal with this by combining yoga stretches with mindfulness meditation and stress-relieving breathing. It is a great way to start each day.

There is a biological explanation for why all these ideas work, but few scholars explain it. The whole constellation of beneficial effects is attributable to the vagus nerve. The vagus nerve is a huge nerve that supplies most of the visceral organs — lungs, heart, and the entire gastrointestinal tract. Usually, when biology or physiology teachers explain the vagus nerve, they focus on its “motor” effects — initiating secretions, slowing heart rate, lowering blood pressure, and promoting peristaltic movements in the GI tract. What usually gets left out is that the vagus is a mixed nerve; it contains sensory fibers. These sensory fibers are activated by all the breathing functions mentioned above. These impulses signal the part of the anterior hypothalamus that contains the neuronal cell bodies of the so-called parasympathetic nervous system (PNS). The PNS suppresses the “fight or flight” system of the sympathetic nervous system, which is triggered by certain neurons in the posterior hypothalamus. Thus, feedback signals from proper breathing serve to keep the PNS active and in control of a relaxed physical and mental state.

So, CALM DOWN. And TAKE A DEEP BREATH.

How Exercise Lowers the Risk of Alzheimer’s by Changing Your Brain

To find out, for nearly a decade, Ozioma Okonkwo, assistant professor of medicine at the University of Wisconsin School of Medicine and Public Health and his colleagues have studied a unique group of middle-aged people at higher risk of developing Alzheimer’s. Through a series of studies, the team has been building knowledge about which biological processes seem to change with exercise. Okonkwo’s latest findings show that improvements in aerobic fitness mitigated one of the physiological brain changes associated with Alzheimer’s: the slowing down of how neurons breakdown glucose. The research, which has not been published yet, was presented at the annual meeting of the American Psychological Association on Aug. 9.

Okonkwo works with the 1,500 people on the Wisconsin Registry for Alzheimer’s Prevention (WRAP)—all of whom are cognitively normal, but have genes that put them at higher risk of developing Alzheimer’s, or have one or two parents who have been diagnosed with the disease, or both. In the latest study, Okonkwo recruited 23 people from the WRAP population who were not physically active. Eleven were asked to participate in an exercise regimen to improve their aerobic fitness for six months, and 12 served as the control. All had their brains scanned to track Alzheimer’s-related brain changes including differences in how neurons metabolized glucose, since in people with Alzheimer’s glucose breakdown slows. At the end of the study period, the group that exercised more showed higher levels of glucose metabolism and performed better on cognitive-function tests compared to the controls.

“We are carrying our research full circle and beginning to demonstrate some causality,” says Okonkwo about the significance of his findings.

In their previous work, he and his team identified a series of Alzheimer’s-related biological changes that seemed to be affected by exercise by comparing, retrospectively, people who were more physically active to those who were not. In this study, they showed that intervening with an exercise regimen could actually affect these processes. Taken together, his body of research is establishing exactly how physical activity contributes to significant changes in the biological processes that drive Alzheimer’s, and may even reduce the effect of strong risk factors such as age and genes linked to higher risk of neurodegenerative disease.

For example, in their earlier work his group confirmed that as people age, the presence of Alzheimer’s-related brain changes increases—including the buildup of amyloid, slower breakdown of glucose by brain cells, shrinking of the volume of the hippocampus (central to memory), and declines in cognitive function measured in standard recall and recognition tests.

But they found that in people who reported exercising at moderate intensity at least 150 minutes a week, as public health experts recommend, brain scans showed that these changes were significantly reduced and in some cases non-existent compared to people who were not active. “The association between age and Alzheimer’s brain changes was blunted,” says Okonkwo, “Even if [Alzheimer’s] got worse, it didn’t get worse at the same speed or rate among those who are physically active as in those who are inactive.”

In another previous study, they found the benefits of exercise in controlling Alzheimer’s processes even among those with genetic predisposition for the disease. When they divided the participants by fitness levels, based on a treadmill test and their ability to efficiently take in oxygen, they found that being fit nearly negated the effect of the deleterious gene ApoE4. “It’s a remarkable finding because it’s not something that was predicted,” says Okonkwo.

In yet another previous study, Okonkwo and his team also found that people with higher aerobic fitness showed lower amounts of white matter hyperintensities, brain changes that are signs of neuron degeneration and show up as brighter spots on MRI images (hence the name). White matter hyperintensities tend to increase in the brain with age, and are more common in people with dementia or cognitive impairment. They form as neurons degrade and the myelin that surrounds their long-reaching arms—which helps nerves communicate with each other effectively—starts to deteriorate. In people with dementia, that process happens faster than normal, leading to an increase in white matter hyperintensities. Okonwko found that people who were more aerobically fit showed lower amounts of these hyperintensities than people who were less fit.

Given the encouraging results from his latest study of 23 people that showed intervening with exercise can change some of the Alzheimer’s-related brain changes of the disease, he plans to expand his small study to confirm the positive effect that exercise and better fitness can have in slowing the signs of Alzheimer’s. Already, his work has inspired a study launched earlier this year and funded by the National Institutes of Health that includes brain scans to track how physical activity affects biological factors like amyloid and glucose in people at higher risk of developing Alzheimer’s. The cumulative results show that “there may be certain things we are born with, and certain things that we can’t change ]when it comes to Alzheimer’s risk], but a behavior like physical exercise might help us to modify that,” says Heather Snyder, vice president of medical and scientific relations at the Alzheimer’s Association.

Instagram Is Not Therapy and I’m Not an Instagram Therapist

Instagram is not therapy. There is no such thing as an Instagram Therapist.

There are brave, generous, trailblazing therapists using social media as a platform to advocate for mental health reform, make information more accessible, and market their services.

Instagram, used by 1 billion people worldwide, was deemed the worst social media for your mental health in 2017. It reportedly leads to negative body image, increased depression and anxiety, and an increase in bullying. Therapists are acutely aware that the information we consume on this platform directly impacts our mental functioning and overall health. Social media’s psychological impact is something that clinicians around the globe contend with in their offices every day. So, it might seem odd that therapists around the world are embracing this controversial medium with open arms.

Is Instagram a viable platform for therapists?

Most mental health professionals are trained to think small and look out for risk everywhere. We are trained to look for symptoms, risk factors, and signs that things aren’t OK. Social media can be a very stressful place for an alert clinician. So, rather than creating more education and opportunities for growth in these realms, we are told to just avoid them all together. We are told it’s just not worth the risk. Many therapists, especially in the most recent cohort of graduates, are rejecting this notion and taking a different approach.

Instagram is being used to take mental health information off the couch and into the mainstream. Therapists with years of training are willingly sharing their knowledge and expertise for free with people who may not be able to access this information otherwise.

The best part? Most of the people sharing information are well informed and have great information. We need these people to keep sharing.

There are risks and benefits.

There have been several articles published about the rise of therapists on Instagram. Most have incorrectly labeled this new phenomenon as “Instagram Therapy,” falsely identifying what therapists are doing on this platform and misleading consumers.

Critiques of therapists using Instagram are also prevalent. Some are based in reality, others in fear. As we move into a new frontier of clinical practice that integrates the use of technology and other media, it’s important that we approach this with curiosity, compassion, and ethical standards.

We must weigh the recent critiques and old standards against the possible benefits, while considering potential pitfalls, solutions, and new ethical guidelines.

Instagram will not replace therapy, but it will help people.

Information presented on Instagram is often generalized and cannot be tailored to the individual. There is no way of knowing exactly how the other person is going to interpret our message. The same risk can be found for blog posts, self-help books, and other forms of media. It is crucial that we inform consumers that what they are reading is generalized advice and often cannot be applied to specific situations.

Research and mental health information are already being shared online, often by those with no credentials, experience, or license to practice. Therapists are a reliable, trained demographic who can provide quality information to the general public. Instagram allows us to share this information in a way that is easy to understand and digestible for the general public. We have to recognize that this is how media is being consumed in 2019, and mental health information needs to follow suit.

Many therapists, journalists, and laypeople have expressed concerns about emergency situations being handled via Instagram. They fear that a therapist will be contacted by someone in crisis. But if you have email, a website, or a phone line, this can also happen. Most therapists have those forms of contact, and clear policies around them. Instagram is not therapy and cannot be used as a substitute for crisis care. Steps have to be taken to ensure that this message is clear to followers. It is also important to have a policy in place about how you will handle potentially dangerous situations. Discouraging therapists from using social media does not solve this concern. It will only lead to people being unaware of their options in a crisis and likely contacting unreliable sources on the internet.

Social media isn’t inherently bad. But the type of information we consume via social media can lead to bad results.

It’s difficult to say that a social media platform is inherently “bad.” It’s often the type of content being consumed that leads to the ill effects described by many young adults who regularly use the app. Most reported that excessive use led to sleep disturbances, poor body image, bullying, and feelings of depression or anxiety.

As therapists, we have the ability to introduce important topics into the mainstream. We have the power to make mental health information more accessible. More information leads to increased awareness; awareness leads to change.

It’s important that we show up in the spaces where our clients live and inform them of their options for healing or treatment. We can do this ethically and with respect for our profession and the people we interact with.

Some guidelines for consuming information therapists share on Instagram or social media:

  • Always filter information through your own worldview. It is OK to question or investigate content. Not every post will be applicable to your life or current situation. It is OK to take what you need and leave the rest.
  • Follow credible accounts. Look for clinicians who are licensed and have a clear title.
  • Remember that this is not a substitute for therapy. Reading information online can help you further understand your situation or learn something new intellectually, but it is not a replacement for formal therapy.
  • Instagram is not a reliable platform to use in a crisis. Please contact the National Suicide Hotline or your local emergency room if you need immediate attention.
  • Therapists on Instagram are not there to provide therapy. Contact a clinician to schedule an appointment if you would like individualized feedback.
  • Remember that confidentiality is not ensured on Instagram. If you choose to leave a comment or share personal information, everything is public on the platform.

Some guidelines for therapists sharing information on Instagram or social media:

  • Develop clear policies for how you will handle comments and direct messages.
  • Create a social media policy for current and future clients that outlines your use of social media and guidelines if they choose to follow you.
  • Create a completely separate professional Instagram page and decide the level of information you will to share on it. Ask yourself every time you share something, “Am I OK with a client or stranger knowing this? Is there therapeutic value to this share?”
  • Clearly label your profession or license in your profile.
  • Tell potential clients how to contact you for appointments.
  • Create a disclaimer that informs clients that your posts are neither therapy nor a substitute for therapy.
  • Create a disclaimer that informs clients of their resources in an emergency.
  • Refrain from using this platform to provide personalized advice or therapy via comments or direct messages.

Physical fitness may help prevent depression, anxiety

Depression and anxiety reduce overall wellbeing and life satisfaction, but they may also increase the risk of cardiovascular disease and increase mortality risk.

Although talking therapies and medication can help in many instances, they do not help everyone.

An issue as substantial as mental health needs an effective public health strategy; stopping mental health issues before they begin would, of course, be ideal.

Researchers are focused on unraveling the myriad of factors that increase the risk of developing mental health conditions. Although it is not possible to alter some of these factors, such as genetics, it is possible to modify some lifestyle factors, including diet and physical activity.

Scientists are keen to identify which modifiable factors might have the most significant impact on mental health. Some researchers are looking to physical fitness.

Fitness and mental health

The authors of a recent study investigated whether cardiorespiratory fitness might be an effective intervention. Cardiorespiratory fitness is a measure of the cardiovascular and respiratory systems’ capacity to supply oxygen to the body during exercise.

They recently published the results of their analysis in the Journal of Affective Disorders.

The authors explain how previous studies “have found that low physical activity is associated with a greater incidence of common mental health disorders.” However, few studies have investigated whether cardiorespiratory fitness is directly related to mental health risk.

Medical News Today spoke with the lead author of the study Aaron Kandola, from University College London in the United Kingdom. We asked him why so few studies have looked at this question.

One reason, he said, is that cardiorespiratory fitness “can be expensive and impractical to measure, particularly in large groups of people.” He explains how it needs to be “measured with structured exercise tests that require the use of specialized equipment in a controlled environment.”

We found that low [cardiorespiratory fitness] and medium [cardiorespiratory fitness] are associated with a 47% and 23% greater risk of […] common mental health disorders, compared with high [cardiorespiratory fitness].”

They also found evidence of a dose-dependent relationship between fitness and common mental health conditions. The authors explain that “[i]ncremental increases in [the cardiorespiratory fitness] group were associated with proportional decreases in associated risk of new onset common mental health disorders.”

The results were in line with the researchers’ expectations. As Kandola told MNT, “exercise is the biggest determinant of cardiorespiratory fitness,” and scientists have already uncovered “the benefits of exercise for common mental health disorders.”

However, he explained that they “were surprised at the lack of research in this area.” He hopes that their study will “help to draw more attention to it.”

The Single Word That Stops Negative Self-Talk

Trying to deny or run away from negativity takes a lot of energy. You might even end up in a mental war with those thoughts, trying to rationalize them away, only to have them come back even stronger. If this has happened to you, here’s another strategy: Apply a good old-fashioned jujitsu move using your awareness. Apply this simple move, and flip negativity on its head.

This mental jujitsu practice, in a single word, is gratitude.

Before you start snoring and clicking away on your mouse, thinking, “Oh, yeah, that’s what my grandmother used to go on and on about and made me yawn,” let’s look at some research that might surprise you. 

One major research project on gratitude showed that a gratitude practice resulted in the following effects on well-being:

  • Higher levels of life satisfaction and more optimism and vitality about life.
  • Better progress toward personal goals and goal attainment.
  • Reduced levels of stress and depressed mood.
  • Greater alertness, enthusiasm, determination, attentiveness and energy in young adults.
  • More prosocial behavior, such as helping and providing emotional support to others.
  • Reduced focus on materialism as a definition of one’s success, as well as fewer feelings of envy toward others.
  • Greater “positive moods, a greater sense of feeling connected to others, more optimistic ratings of one’s life, and better sleep duration and sleep quality,” in adults with neuromuscular disease.

This is really just the tip of the iceberg when describing the benefits of gratitude. In my own practice as a psychotherapist, I’ve seen dramatic shifts in mood and narrative as the result of a simple gratitude intervention.

Let me share the experience of one patient, Jerry (all names are changed), who had a history of family depression that stretched back generations. His grandfather had been in and out of mental hospitals for years, and his mother was diagnosed with acute depression and had trouble functioning. In Jerry’s own words, “I have a genetic history of depression and there’s nothing I can do about it.”

But Jerry had not yet encountered the masterful mind-bending and life-bending power of gratitude. As he explored it, a major shift occurred in his life. He started asking people at work what they had gratitude for. It became a touchstone that transformed his understanding and perception of events—one that represented a very different way of thinking and being in the world. 

Over time, Jerry’s inner narrative changed. I still recall the day he said to me, “I have periods of depression, but I know how to effectively manage them using gratitude and other skills.” That is a much more empowering narrative, isn’t it? And it was made possible in part by gratitude. 

Gratitude Is an Intentional and Selective Attention Practice

Gratitude trains us to use attention in a very specific way. For example, you can focus on what is wrong or missing in your life, and endlessly compare yourself to others. Or, you can turn your awareness toward noticing the good, decent, and beautiful things around you in this moment.

Why does this matter?

By noticing what you could be grateful for, you cultivate a different attitude about your situation. This, in turn, changes not only how you think and behave in the moment, but helps to develop a supportive and life-affirming habit for the future. 

Gratitude Encourages Here and Now Participation

Gratitude is a proactive means of engaging in the here and now. We spend a lot of time as life spectators—watching things on our computer, watching sports and entertainment on TV, and so on. Gratitude catapults us into the present moment because it encourages participation. For example, in order to feel gratitude, you need to be present. You are encouraged to act on your gratitude because you feel more connected and optimistic as a result. Gratitude also helps build resilience, because it gets us looking at the positives, rather than focusing on what’s gone wrong. 

Here are some simple practices for getting started with gratitude. The next time you notice negativity, use the jujitsu gratitude intervention below to turn negativity on its head.

  • Jujitsu Gratitude Move 1: Notice and name one gratitude right now. Write this down, being sure to include WHY you are grateful or thankful. For example, this might look like: “I am grateful for ____ because _____.” Telling why you are grateful deepens the story. 
  • Jujitsu Gratitude Move 2: Keep track of your daily gratitudes. Get a teacup and tape the word “gratitude” on it. For each gratitude you find each day, put a penny in that cup, or write down on a small piece of paper two or three words about that gratitude. At the end of the week, review how many gratitudes you found and experienced. 
  • Jujitsu Gratitude Move 3: Share your daily gratitude with another. This is a wonderful way to make connections on a deeper level with others. Don’t underestimate the importance of this for relationship building, at home or the workplace. 

Do this for a week, and don’t settle for repeating the same gratitude each day. There are many kinds of gratitude to notice.

What is the link between sleep apnea and depression?

Around 20–30% of people with depression and other mood disorders do not get the help they need from existing therapies.

Depression is the “leading cause of disability worldwide.”

For this reason, coming up with effective therapies is paramount.

New research points to obstructive sleep apnea(OSA) as a potential culprit for treatment resistant depression and suggests that screening for and treating the sleep condition may alleviate symptoms of depression.

Dr. William V. McCall — chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Augusta University — is the first and corresponding author of the study.

He says, “No one is talking about evaluating for [OSA] as a potential cause of treatment resistant depression, which occurs in about 50% of [people] with major depressive disorder.”

He hopes that the team’s new paper — appearing in The Journal of Psychiatric Research — will remedy this.

14% of those with depression had OSA

Dr. McCall and team examined the rate of undiagnosed OSA in a randomized clinical trial of people with major depressive disorder and suicidal tendencies.

They recruited 125 people with depression, originally for the purpose of determining if treating their insomnia would improve their depression symptoms.

The original trial excluded people at risk of OSA, such as those taking sleeping pills, or people with obesity or restless legs syndrome.

The scientists tested the participants with a sleep study and found that 17 out of the 125 (nearly 14%) had OSA.

Dr. McCall and colleagues note that people who had OSA did not present with the usual indicators of OSA severity, such as daytime sleepiness. Also, 6 of the 17 people were non-obese women.

This is contrast with the demographic group usually at risk of OSA: overweight men.

“We were completely caught by surprise,” says Dr. McCall, “that people did not fit the picture of what [OSA] is supposed to look like.”

Also, 52 of the 125 participants had treatment resistant depression; 8 of those with treatment resistant depression also had OSA.

Future treatment options

The researchers point out that underlying conditions — such as hypothyroidism, cancer, and carotid artery disease — may often be the cause of treatment resistant depression.

Therefore, many people with depression undergo a series of invasive and costly tests in an attempt to figure out the cause of depression treatment failure.

Such tests may include an MRI scan or even a spinal tap — but Dr. McCall and team urge for sleep tests first. “I am thinking before we do a spinal tap for treatment resistant depression, we might need to do a sleep test first,” he says.

“We know that [people] with sleep apnea talk about depression symptoms,” he goes on. “We know that if you have [OSA], you are not going to respond well to an antidepressant.”

“We know that if you have sleep apnea and get [a CPAP machine], it gets better and now we know that there are hidden cases of sleep apnea in people who are depressed and [have] suicidal [tendencies].”

Dr. William V. McCall

However, the study authors also acknowledge that other factors — such as the side effects of other medications, including beta-blockers and corticosteroids — may cause treatment resistant depression.

They also point out that suicidal tendencies are also a key factor, and the researchers suggest that a further area of investigation should be the question of whether or not treating sleep apnea will also reduce suicide ideation.

In the United States, suicide is the 10th leading cause of death among people of all ages.

Lifestyle Changes Decrease Genetic Risks of Alzheimer’s

There hasn’t been much good news about Alzheimer’s lately, between the March announcement by Biogen and Esai that a promising trial of a potential drug treatment failed, and the July decision by Novartis and Amgen to stoptheir study of another class of therapies for the neurodegenerative disease.

But in a pair of studies presented at the annual Alzheimer’s Association International Conference on July 14, researchers reported encouraging results from studies of non-drug approaches.

In one, scientists led by Dr. Klodian Dhana at Rush University Medical Center in Chicago followed nearly 2,500 people for almost a decade while tracking several lifestyle factors: their diet, whether they smoked, the amount of leisure physical activity they completed each week, how much alcohol they drank and how much cognitive activity they engaged in. The researchers found that people who reported healthier lifestyles overall—those who stuck to a low-fat diet, did not smoke, exercised at least 150 minutes each week at moderate-to-vigorous levels, drank moderately and engaged in some late-life cognitive activities—had lower levels of Alzheimer’s dementia. In fact, the more healthy activities the people adhered to, the lower their risk. Compared to those who followed none or only one healthy lifestyle behavior, those following two or three of the healthy lifestyle factors reduced their risk of developing Alzheimer’s dementia by 39%, while those who followed four or five of the healthy behaviors reduced their risk by 59%.

Click Read More for the full article.

Don’t Pick up just Any Book this July or August

It’s not surprising that a well-chosen book would aid self-improvement in the general population. But metaanalyses also report bibliotherapy’s effectiveness in helping teens with mild depression or anxiety, as do individual studies of mild depression with young adults, and of mild to moderate depression in older adults.

So here are 12 books that my clients and I have found helpful in self-improvement. Because I’m a career and personal coach, not a psychotherapist, except for one book (The Noonday Demon), these books aim at self-improvement for the general public, not specifically for those with clinical anxiety or depression, although they could be helpful to them as well.

With the exception of the book that’s listed last, I’ve included only books that have stood the test of time both with the public and with me: Even though I read them years ago, they’re still helpful.

ChangePower by fellow Psychology Today blogger, Meg Selig. Despite being a self-help writer myself, I view askance much of such writing, but not this book. It favors the tried-and-true practical over pop-psych nostrums. For example, the book suggests rehearsing your upcoming day:

Conjure up any people or situations that might trigger a lapse and imagine yourself coping successfully. After you’ve made it through the day, have a talk with yourself: How did you do? Jog your thinking by filling in these blanks: “I liked that I _______.  I wish I had ____.  I could strengthen  my plan by ______.

The book’s subtitle, 37 Secrets to Habit Change Success, implies that those tips are atomistic, stand-alone suggestions. In fact, they’re presented in a sequence that could well comprise an overall step-by-step plan for improving your life.

The Seven Habits of Highly Effective People by Stephen Covey. The seven habits reduce to: 1) Have a personal vision that you’d be proud to aim for.  2) Seek first to understand, only then to be understood. 3) Keep learning. Those are obvious but too often not done, so they’re useful reminders, dispensed in plain English.

How to Win Friends and Influence People by Dale Carnegie. I chose not to look back at the book before writing this so that I could mention only what has stuck in my head all these years. In sum, it’s: To get what you want, you have to give people what they want, and what most people want is to feel good about themselves and to get their problem du jour solved. This book written in 1936, has sold more than 15 million copies and today, its Amazon sales rank is still, among self-help books, #13.

How to Stop Worrying and Start Living by Dale Carnegie.  My favorite page is “Part One in a Nutshell” Here’s its essence:

Rule 1: Live in day-tight compartments. Don’t stew about the future. Just live each day.

Rule 2: The next time Trouble with a Capital T backs you into a corner, ask yourself: a) What’s the worst that can happen if I can’t solve my problem. b) Prepare yourself to accept the worst if necessary. c) Calmly try to avoid the worst.

Rule 3: Remind yourself of the exorbitant price to your health that you can pay if you worry excessively.

Three-Minute Therapy by therapist and fellow Psychology Today blogger Michael Edelstein. The book helps readers create a customized three-minute exercise, which if repeated daily, within weeks, often significantly reduces mild to moderate anxiety, depression and substance abuse.

Click Read More for 5 other choices.

6-Plus Ways Heavy Drinking Harms Your Health

The statistics are alarming: More than 15 million Americans struggle with a diagnosable alcohol use disorder. Yet fewer than 8 percent of people who struggle with the disorder get treatment. 

Of drinkers in general, more than 65 million surveyed reported at least one episode of binge drinking (defined as five or more drinks on a single occasion for men, four or more for women) in the past month. One in every six American adults reportedly binge drinks approximately four times a month. Most bingers are not (yet) considered alcohol-dependent, but that may be because binge drinking is most common among young adults ages 18 to 34. Every year, more than 4,300 deaths among those under the age of 21 are attributed to excessive drinking.

Even if excessive alcohol doesn’t kill you on the spot, and even if you’re never diagnosed with an alcohol-related disorder, routine binge drinking has a profound effect over time on almost every part of your body. Some of the more devastating, long-term physical and mental health effects include:

  • Depression and anxiety
  • Learning, memory, and social problems
  • High blood pressure
  • Heart disease
  • Liver disease
  • Cancers of the digestive tract, including the mouth, throat, esophagus, and colon, as well as increased risk of breast cancer in women

Excessive use of alcohol also interferes with reproductive health and sexual functioning, affecting testicular activity and hormone production in men, disrupting the menstrual cycle and increasing the risk of infertility in women, as well as contributing to miscarriage, stillbirth, Fetal Alcohol Spectrum Disorders, and Sudden Infant Death Syndrome in pregnant women who drink alcohol and their babies. 

What can you do? Choose to drink moderately, if at all (no more than one drink a day for women, two for men), and help others around you do the same. Serve less alcohol at parties, and don’t serve alcoholic beverages to anyone who shouldn’t be drinking, such as minors and anyone who has already had too much to drink. And if you know your drinking isn’t reserved for special occasions, or if you just drink too much, too often, or your drinking behavior is risky (or if excessive drinking affects someone you know), speak with your doctor who can help you get over any shame you may feel and determine if further help is necessary from a support group, psychological counseling, medication, or other programs and steps that can lead to reduced cravings for alcohol and, perhaps, ultimately abstinence. 

Commonly prescribed drugs possibly tied to higher dementia risk

A study published in the journal JAMA Internal Medicine on Monday suggests that the link is strongest for certain classes of anticholinergic drugs — particularly antidepressants such as paroxetine or amitriptyline, bladder antimuscarinics such as oxybutynin or tolterodine, antipsychotics such as chlorpromazine or olanzapine and antiepileptic drugs such as oxcarbazepine or carbamazepine.

Researchers wrote in the study that “there was nearly a 50% increased odds of dementia” associated with a total anticholinergic exposure of more than 1,095 daily doses within a 10-year period, which is equivalent to an older adult taking a strong anticholinergic medication daily for at least three years, compared with no exposure.”The study is important because it strengthens a growing body of evidence showing that strong anticholinergic drugs have long term associations with dementia risk,” said Carol Coupland, professor of medical statistics in primary care at the University of Nottingham in the United Kingdom and first author of the study.”It also highlights which types of anticholinergic drugs have the strongest associations. This is important information for physicians to know when considering whether to prescribe these drugs,” she said, adding “this is an observational study so no firm conclusions can be drawn about whether these anticholinergic drugs cause dementia.”She said that people taking these medications are advised not to stop them without consulting with their doctor first, as that could be harmful.

Click Read More to learn about the findings of the study.

High Levels of Internet Use May Alter Brain Function

In a new review, an international team of researchers propose that internet use can produce both acute and prolonged changes in specific areas of cognition, affecting our attentional capacities, memory processes and social interactions.

“The key findings of this report are that high levels of internet use could indeed impact on many functions of the brain,” said study leader Dr. Joseph Firth, Senior Research Fellow at the National Institute of Complementary Medicine (NICM) Health Research Institute, Western Sydney University.

“For example, the limitless stream of prompts and notifications from the internet encourages us towards constantly holding a divided attention — which then in turn may decrease our capacity for maintaining concentration on a single task.”

“Additionally, the online world now presents us with a uniquely large and constantly-accessible resource for facts and information, which is never more than a few taps and swipes away.”

“Given we now have most of the world’s factual information literally at our fingertips, this appears to have the potential to begin changing the ways in which we store, and even value, facts and knowledge in society, and in the brain.”

For the review, the team of researchers from Western Sydney University, Harvard University, Kings College, Oxford University and the University of Manchester investigated the leading hypotheses on how internet use may alter cognitive processes, and further examined the extent to which these hypotheses were supported by recent findings from psychological, psychiatric and neuroimaging research.

The extensive report, published in the journal World Psychiatry, combined the evidence to produce revised models on how the internet could affect the brain’s structure, function and cognitive development.

“The bombardment of stimuli via the internet, and the resultant divided attention commonly experienced, presents a range of concerns,” said Professor Jerome Sarris, Deputy Director and Director of Research at NICM Health Research Institute, Western Sydney University and senior author on the report.

“I believe that this, along with the increasing #Instagramification of society, has the ability to alter both the structure and functioning of the brain, while potentially also altering our social fabric.”

“To minimise the potential adverse effects of high-intensity multi-tasking internet usage, I would suggest mindfulness and focus practice, along with use of ‘internet hygiene’ techniques (e.g., reducing online multitasking, ritualistic ‘checking’ behaviours, and evening online activity, while engaging in more in-person interactions).”

The recent introduction and widespread adoption of online technologies, along with social media, is also of concern to some teachers and parents. The World Health Organization’s 2018 guidelines recommended that young children (aged 2-5) should be exposed to only one hour per day, or less, of screen time.

However, the report also found that the vast majority of research examining the effects of the internet on the brain has been conducted in adults, so more studies are needed to determine the benefits and drawbacks of internet use in young people.

Firth says that avoiding the potential negative effects could be as simple as ensuring that children are not missing out on other crucial developmental activities, such as social interaction and exercise, by spending too much time on digital devices.

“To help with this, there are also now a multitude of apps and software programs available for restricting internet usage and access on smartphones and computers — which parents and carers can use to place some ‘family-friendly’ rules around both the time spent on personal devices, and also the types of content engaged with,” he said.

“Alongside this, speaking to children often about how their online lives affect them is also important — to hopefully identify children at risk of cyberbullying, addictive behaviours, or even exploitation — and so enabling timely intervention to avoid adverse outcomes.”

What is Nonattachment?

What is Nonattachment?

Have you ever spent time in anguish over not getting a job, fixated on an upcoming decision, avoided coming to terms with the fact you’re getting older, or worried that your not as successful as you should be.  In Buddhism, all of these things can be considered attachments.  Attachments are our fixated attempts to control our experience, usually through clinging to what we perceive as desirable or aversion to what we perceive as undesirable.  The problem is, life usually has its own way of unfolding, quite separate from our attempts to control it, no matter how intense or well-intentioned.  Nonattachment, therefore, is what occurs when we can let go of the need to be in dogged control of what is occurring and can reduce our demands on the present moment to be any way in particular.  

Far from being a detached state, nonattachment is something which arises when we are truly present and not caught up in the automatic process of fixating on things being better or worse than what they are at any given moment.  Nonattachment is aligned with psychological maturity and insight into the ever-changing nature of experience and the futility of trying to control it. Nonattachment is not a passive or apathetic quality, it does not require the renunciation of life or moving to a cave in the Himalayas.  Rather, nonattachment involves doing whatever would normally drive you, just without fixation and the accompanied rumination and worry about getting everything right, or adhering to the societal- or self-imposed expectations about what your life should be like.

Our attachments and our dis-ease with the present moment are so ubiquitous, that almost all self-focused thinking involves wanting things to be better, or worrying about things that have happened or will happen. Rarely are they focused on appreciation of the present moment.  For example, we might worry about what we may have said to someone and what they might think about us, thinking things like “what did I say” or “I hope they didn’t think…”  These thoughts are often automatic and can bring up feelings associated with the worst possible scenario e.g., “perhaps they thought I didn’t like them…” or “they must think I’m so boring.”  Although these thoughts and feelings naturally arise, it is our choice to engage with them that can be avoided. This propensity to ruminate and worry about something that has already happened, or when imagining something that may happen, can underlie poor mental health and prevent us from living with a lightness, and sense of ease and flow.  Imagine the freedom involved with letting go of your demands on needing your experience to be any way in particular. 

Research on nonattachment

In 2010, Sahdra, Shaver, & Brown (2010) created the nonattachment scale to capture the quality of nonattachment and investigate how it relates to other aspects of life.  Since then, there has been a growing amount of research in the field of nonattachment, which has found that reducing fixation on the need for experience to be one way or other is extremely healthy.  Not only is it related to reduced symptoms of depression, anxietyand stress (Sahdra et al., 2010), it has shown to relate to increased prosocial behaviours such as empathy and kindness (Sahdra et al., 2015) as well as advanced psychological development outcomes of wisdom and self-actualisation (Whitehead et al., 2018). Numerous studies have also shown it to be a more important quality than mindfulness when explaining positive psychological outcomes (e.g., Lamis & Dvorak, 2014).

This is an interesting question.  Within the Eastern contemplative traditions, the path to building nonattachment involves meditation or a monastic life, and research shows nonattachment is stronger in those that meditate. However, recently, I had the pleasure of interviewing individuals that scored very high (and very low) on nonattachment (see Whitehead et al., 2019) and asked them how they had developed and integrated nonattachment in their life.  Interestingly, the most common theme was the way they worked through their most difficult moments in life.  Almost all of these individuals had moments of intense suffering which had become a catalyst for them to live a different way.  They were able to draw strength from these experiences and realise the futility of living a life burdened by everything they could not change. Most were also able to integrate some form of self-reflective practice, such as psychotherapy or meditation that assisted them in their path towards letting go.

I know it is not the easiest thing to let go of your demands on experience.  Most of our attachments are automatic, have been around a long time and are there because we feel that letting go of them will result in some sort of apathetic quagmire or spiraling loss of control. However, when we can let go of our need for experience to be one way or other, we don ’t cease to make decisions. What occurs is a freedom and a lightness where life unfolds without obstruction, allowing us to be more present, be there for others, take opportunities when they arise and to move on from unhelpful experiences without getting unduly stuck.

Test it for yourself. Remember, life will unfold in its own way whether you try to control it or not.   

5 factors affecting happiness and wellbeing

Each one of us has experienced different levels of happiness based on varying life situations. The definition of happiness also varies from person to person. After a lot of study of the behavioral patterns of various individuals, our experts have made a list of things that affects the happiness of most people;

1. Sufficient Sleep

Many people do not realize but sleep is one of the major factors affecting the way you feel the entire day. If you sleep timely and peacefully for the required number of hours, your hormones are balanced and the body is rejuvenated to function perfectly the next day which makes you feel happy. If you do not sleep timely or do not take rest for the required number of hours, it will lead to the increase in the stress hormones named cortisol which is directly related to lowering your metabolism and you feeling heavy the next day. Get your 8 hours of sleep every day to enjoy a healthy life.

2. Family and Friends

Being surrounded by family and friends can change the quality of life which can lead to a much-fulfilled life. The ensured sense of comfort that you have a support system when needed can influence your level of happiness in a big way. Socially involved people are more satisfied in their lives than the ones who live detached from everyone

3. Money Doesn’t Buy Happiness

Many of us associate money with happiness A rich person can answer this concern better. Statistics suggest that rich people have more worries in their lives and find it more difficult to be happy. We are not discouraging you from earning money, work hard to be successful but do not assume you will be happy once you earn more money. It may feel good for some time but money doesn’t significantly make you happy, your mental peace and work-life balance can only help you feel satisfied.

4. Health Worries

A healthy body can lead to a healthy mind as well. If you are suffering from physical issues, you will never be mentally peaceful. Taking care of yourself by maintaining a healthy lifestyle is of utmost importance as you can eliminate any worries related to your health and feel good. Exercise three times a week to keep yourself fit; it will also help in raising the happy hormones hence you will feel good about yourself. Getting in touch with experts from integrativewellnessny.com can help you work towards better health holistically.

5. Stressed Minds

Many of us are so busy with our professional lives most of the day that the work stress haunts us even when we come back home. We need to learn to relax our minds and detach from all thoughts which makes us feel stressed. Practice meditation every day to bring a sense of peace and detachment every day, this will bring you closer to being happy.

Before You Dismiss Mindfulness…

What comes to mind when you think of mindfulness? For many it’s an image of a yogi, a Buddha, or a wellness influencer. Maybe it’s a phone app or a fitness outlet.

For me, it’s science.

Mindfulness has become a buzzword synonymous with self-care and meditation, promising wide-ranging benefits from reducing stress to increasing happiness. It’s now a multi-million-dollar business, with thousands of apps touting the benefits of mindfulness in one way or another. And among all this buzz, I’ve seen a few articles that push back on mindfulness. Often, they’re not wrong to question the claims some apps have made. But as a neuroscientist and physician, I’ve been impressed with the growing amount of evidence in support of the approach.

Like other “hot” topics, mindfulness has been hijacked by hype and misunderstanding. For example, many think that the goal of mindfulness is to clear your head of all thoughts. That’s a hard thing to do, and if you’ve tried mindfulness under that assumption, you’re destined for disappointment.  

Mindfulness is really about paying careful attention to our thoughts and behaviors, not trying to suppress them. When we do this, mindfulness helps us clearly see the cost and benefit of any given situation. It can, for instance, help us overcome cravings and addictions of all kinds. In one pilot study, we found that an evidence-based mindfulness training led to a 48% reduction in anxiety among participants after completing 28 core modules of the program. And we’ve seen this success not only with anxiety, but with overeating, smoking, social media use, and more.

Why might mindfulness be so effective? It starts with neuroscience. Our brains are wired based on the most evolutionarily conserved learning processes – the reward-based learning system. The system is based on a trigger, behavior and reward. Let’s take food as an example: When we get hungry (trigger), we look for food (behavior) and then we eat and feel satisfied (reward). After a while, however, the reward becomes so enticing that we no longer eat only when we’re hungry, but when we’re bored or stressed or tired. Before you know it, overeating becomes a habit that can be incredibly difficult to break.

Mindfulness is the tool we have been given to tap into this system to “hack” and rewire our brains so that we can address unwanted behaviors and overcome even the most difficult habits. When we pay attention to all aspects of our experience, we start to notice the push and pull of cravings in particular. Only then can we really see cravings for what they truly are: simple thoughts and feelings.

One of my favorite examples that shows just how powerful mindfulness can be is smoking cessation. In one study in my lab, smokers were given mindfulness training: They were taught breath awareness and how to pay attention to habit triggers and actions. In response, these smokers reported being more aware of why they smoked, what behaviors to substitute for smoking, and how disgusting cigarette smoke smelled and tasted when they just paid attention. We found that this mindfulness-based training was 5 times more effective than the gold standard treatment in helping people quit smoking. Mindfulness worked: The science speaks for itself.

Biggest risk factors for developing dementia

The 12 lifestyle choices and conditions which fuel dementia have been identified by the World Health Organisation (WHO) in the most definitive list ever of how to avoid mental decline in later life.

New guidelines based on analysis of decades of research found that physical inactivity, smoking, eating an unhealthy diet and drinking excessive alcohol significantly increased the threat of diseases like Alzheimer’s.

Medical conditions including diabetes, high blood pressure, high cholesterol and obesity also played a role in the development of cognitive decline and full-blown dementia.

WHO Director General, Dr. Tedros Adhanom Ghebreyesu, has warned that in the next 30 years, the number of people with dementia is expected to triple, and added that “we need to do everything we can to reduce our risk of dementia. “The scientific evidence gathered for these guidelines confirm what we have suspected for some time; that what is good for our heart is also good for our brain.” The possible risk factors identified by the WHO team are:

  • Low level of physical activity
  • smoking
  • poor diet
  • alcohol misuse
  • insufficient or impaired cognitive reserve (brain’s ability to compensate for neural problems)
  • lack of social activity
  • unhealthy weight gain
  • hypertension
  • diabetes
  • dyslipidemia (unhealthy cholesterol levels)
  • depression
  • hearing loss.

And health experts also warned of a link between hearing loss and depression.

How Kevin Love Takes Care of His Mental Health

Today, when Kevin Love feels a decline in his mental health, he’s able to deal with it in a number of ways. He goes to therapy and takes medication. He tries to meditate every day. He spends quiet time with his dog, Vestry.

To his opponents on the court, Love comes across as a fearless competitor, regularly sacrificing his body to make a play or change the outcome of a game. Standing 6’10” and 250 pounds, Love is an NBA star known for his physical strength. 

But it took a different type of strength—the courage to be vulnerable—to be able to bounce back after experiencing his first panic attack in front of thousands of people. 

It was just after halftime on November 5th, 2017, at Quicken Loans Arena in Cleveland, where the hometown Cavaliers were playing the Atlanta Hawks. Love had struggled through 18 minutes of playing time, posting a disappointing statline: four points, four rebounds, and four fouls on 1-of-6 shooting. He was pulled from the court with 8:29 left on the clock in the third quarter, leaving fans, teammates, and commentators to speculate on what exactly had knocked the star center out of the game.

“I couldn’t catch my breath,” Love says. “I was sticking my hand down my throat trying to clear my air passage. I thought I was having a heart attack and ended up unconscious on the floor of our head trainer’s office.”

Love remembered thinking that “this could be it”—that he would die at 29 years old at the peak of his professional career as an elite athlete. But what scared Love more than that feeling of helplessness was the idea that other people would find out about the episode. He didn’t want his teammates or coaches or fans to think he was “not reliable.” For months, Love closely guarded a secret that brought him deep shame: that he was struggling with his mental health. 

Despite all this, Love still managed to play well enough that season to land a spot on the All-Star team. And although a broken hand kept him from being able to play in that, Love made the trip to Los Angeles for the All-Star Break in February 2018. It was in L.A. that Love felt compelled to finally open up to the public about his mental health. 

“I didn’t want anyone to tell this story but me,” Love says.

On March 6th, The Players’ Tribune published an essay written by Love titled “Everyone Is Going Through Something.” The essay functioned not only as a confession, but also as a deep exploration of how notions of masculinity have stigmatized men talking openly about mental health and seeking treatment.

“Growing up, you figure out really quickly how a boy is supposed to act. You learn what it takes to be a man It’s like a playbook: Be strong. Don’t talk about your feelings. Get through it on your own. So for 29 years of my life, I followed that playbook. And look, I’m probably not telling you anything new here. These values about men and toughness are so ordinary that they’re everywhere … and invisible at the same time, surrounding us like air or water. They’re a lot like depression or anxiety in that way.”

Since going public with his mental health issues, Love has used his platform to try to lessen that stigma for young men, primarily through his charity The Kevin Love Fund. The charity has partnered with other mental health organizations like the Movember Foundation and Just Keep Livin’, as well as the meditation app Headspace, which provided 850 donation subscriptions to UCLA student athletes. 

“These superheroes that we look at, whether it be somebody in the entertainment industry or an athlete, we also have these layers that we deal with on a daily basis,” Love says. “Know that you’re not alone. You’re not different. You’re not weird. And we can do this stuff together.”

Click Read More to watch Kevin’s video.

Risk of Mental Disorders Higher for People Who Live Alone

That’s the conclusion of new research published this week in the journal PLOS ONE, which used data from three separate surveys in the United Kingdom over the course of nearly two decades.

“In our study, the prevalence of common mental disorders (CMDs) was higher in individuals living alone than in those not living alone in all survey years. Multivariable regression analyses corroborated this findings, as there was a positive and significant association between living alone and CMDs,” said Louis Jacob, first author of the study and member of the faculty of medicine at the University of Versailles Saint-Quentin-en-Yvelines, France.

Researchers looked at survey data from the United Kingdom conducted in 1993, 2000, and 2007, which included more than 20,000 adults.

Between 1993 and 2007, the incidence of adults living alone steadily increased from 8.8 to 10.7 percent, correspondingly, so did the rate of common mental disorders from 14.1 to 16.4 percent.

Regardless of age or sex, CMDs were invariably more prevalent in individuals who lived alone. 

In some cases, those living alone were more than twice as likely as cohabiting individuals to have a mental disorder.

Expanding evidence 

Other studies have associated living alone with CMDs, but this research builds on that work in several ways.

Prior studies have primarily been interested in the effects of living alone on the elderly, but this research helps to expand findings on the relationship between living alone, loneliness, and mental disorders to the adult population in general. The authors also expanded their research to include other disorders like anxiety rather than depression alone.

The findings are consistent with other work on the subject. For example, a study of nearly 5,000 adults living in Finland found a twofold increase of anxiety and depression in people living alone compared with people who were married.

A 2011 study from Singapore of nearly 3,000 adults age 55 and older found that living alone was a contributor to poorer psychological well-being, with loneliness being the cause.

Loneliness is a complex issue, and its association with living alone and mental disorders has become a topic of increasing interest for public health officials and urban planners.

Some researchers have pointed at cities in general as drivers for loneliness and social isolation. While others have noted our increasingly digital world and the influence of social media on feelings of isolation, depression, and anxiety.

Many are also taking note of the effects of loneliness as a legitimate public health concern. Beyond mental health and well-being, the effects can also take a physical toll.

Physical health risks

A 2015 study in the British Medical Journal found that loneliness and isolation were risk factors for both coronary heart disease and stroke.

Jacob said he hopes giving loneliness and social isolation more visibility will ultimately help to bring relief.

“This is important for the identification of vulnerable populations and the establishment of effective strategies to improve population mental health,” said Jacob.

“Based on the findings of the present study, health professionals should be aware that living alone is a risk factor for CMDs, and that this association is largely mediated by loneliness. We believe that reducing levels of loneliness in people living alone is important,” he said.

Indeed, the most important findings from the research may have more to do with how loneliness can be treated.

What you can do

According to Jessy Warner-Cohen, PhD, MPH, a health psychologist at Long Island Jewish Medical Center, “The most robust finding of this study is the effect of social support on those living alone.”

“The takeaway message for me from this study is that those not in cohabiting relationships, whether living with a partner or marriage, need to more actively seeks means of developing social support,” said Warner-Cohen, who wasn’t affiliated with the research.

Social support can take on many different forms and affect people from all walks of life.

It can mean joining clubs related to personal interests, like book clubs or athletic organizations, walking dogs with others in the neighborhood, or cooking together. Involving friends and family more frequently is a great resource for social support.

“Look for meet-up groups related to something you enjoy. This will help with meeting other people with similar interests and provide a natural means of developing social support. Fill your life with fun and exciting things,” said Warner-Cohen.

Mindfulness Meditation Helps with Stress and Therefore Your Love Life

Both sex and meditation involve taking breaks from daily routines and responsibilities. Both include deep diaphragmatic breathing. Both encourage emptying the mind of extraneous thoughts, and focusing attention on the present moment. And both help free the mind from daily hassles.

Meditators accomplish this by sitting quietly and focusing intently on their breath, or on a word or phrase (manta), or on a simple activity (walking, slowly chewing one bite of food). Lovers free their minds by engaging in mutual erotic touch while focusing intently on one another (though they may fantasize about other partners). Both expand spiritual connections—meditators to the world around them, lovers to their partners. And after both, meditators and lovers emerge feeling calm and refreshed, better able to cope with life’s challenges. 

But emptying the mind isn’t easy. During both meditation and lovemaking, random thoughts—some possibly disturbing—inevitably dart in and out of consciousness. Meditation teachers urge students to accept their thoughts without judging them, no matter what the content. They say: “Your thoughts are not you. They’re like dreams. You can’t control them and are not responsible for them. Don’t judge your thoughts. Simply observe them, then let them go as you return to your breath, mantra, or mindfulness activity.” 

Sex therapists concur, encouraging lovers to observe their erotic thoughts and fantasies nonjudgmentally no matter what their content, and then gently let go of them as lovers return to focusing on giving and receiving pleasure. Just as random thoughts during meditation don’t mean anything, neither do the vast majority of thoughts and fantasies during sex.

A Head Full of Ideas 

In Bob Dylan’s song “Maggie’s Farm,” one line goes: “I got a head full of ideas that are driving me insane.” Many people can identify. They have heads full of sexual beliefs that may not exactly drive them crazy, but produce sufficient stress to cause problems. Stress/anxiety/worry trigger the fight-or-flight reflex that constricts the arteries in the central body, limiting blood flow to the gut and genitals and sending it out to the limbs for self-defense or escape. Reduced blood flow through the genitals compromises sexual responsiveness, function, and satisfaction. But deep relaxation, the kind produced by meditation, opens the arteries that supply blood to the genitals and enhances sexual function and pleasure.        

In recent years, several sex researchers, notably Lori Brotto at the University of British Columbia, have harnessed the power of meditation to treat a broad range of sex problems:         

• Child sex abuse. A team led by Brotto enrolled twenty adult survivors of childhood sex trauma in a program shown to aid recovery, cognitive behavioral therapy. CBT helped them reframe their stories away from the horror of abuse toward self-forgiveness and personal empowerment. Half the group also learned mindfulness meditation and practiced it daily. After one month, both groups reported less sexual distress, but the mindfulness group reported greater relief and better sexual functioning.

• Low libido. Another Brotto team recruited 117 low-desire women. Forty-nine were placed on a wait list. The rest participated in three 90-minute classes over six weeks that discussed the causes of low libido and offered instruction in mindfulness meditation. Between classes, the women practiced mindfulness daily at home. After six months, the treatment group reported significantly greater desire, arousal, and lubrication, easier orgasms, and greater satisfaction.        

Investigators at Willamette University in Oregon analyzed eleven studies of mindfulness involving 449 women who complained of low libido and arousal and orgasm difficulties. “All aspects of sexual function and well-being—exhibited significant improvement.”         

• Erectile dysfunction (ED). A third Brotto team enrolled ten men suffering erection difficulties in a four-week mindfulness-based treatment program that included information about ED, counseling, and mindfulness meditation practiced in therapy sessions and daily at home. Most of the men reported significant improvement.         

• Men in distress because of their porn consumption. Creighton University investigators took thirty-eight men convinced they were porn addicts to a rustic retreat center for eight-days. They spent thirty-two hours in cognitive-behavioral therapy. During CBT sessions, the researchers endeavored to correct participants’ sexual misconceptions, such as:

         • Sexual thoughts and fantasies are wrong, harmful, and sinful. 

         • Only bad people masturbate.

         • My porn watching proves I’m evil.

The therapists endeavored to correct those mistaken beliefs:

         • There’s nothing wrong with sexual thoughts and fantasies. Everyone has them. They’re perfectly normal and a key element of great sex.

         • Almost everyone masturbates, particularly men who feel stressed. Unless it interferes with life responsibilities or partner lovemaking, there’s nothing wrong with it, even frequently, even daily. 

         • Virtually every Internet-connected man on Earth has seen porn, many frequently, some daily. Viewing it doesn’t make you evil. Porn is a cartoon version of men’s fantasies of effortless sexual abundance.

The researchers also taught participants mindfulness meditation, which they practiced several times a day. After the retreat, their sexual anxiety and porn viewing decreased significantly.

Breaking Vicious Cycles

Anxiety contributes to many sex problems. That’s why “Am I normal?” is one of the most common questions sex experts get. It’s a leading query on the site I publish, GreatSexGuidance dot com. Many people feel nervous about their fantasies, bodies, libidos, sexual repertoire, and ability to negotiate functional sexual relationships. That nervousness causes stress, which, as mentioned, impairs sexual desire and function. 

When sex experts correct people’s misconceptions, sometimes that’s all that’s necessary to resolve their issues. But quite often, sexual issues cause chronic stress not relieved just by learning the truth. Sometimes, people need the truth plus tools to relieve their sexual stress. That’s where mindfulness and other relaxing activities help: deep breathing, hot baths, massage, yoga, tai chi, dance, hiking, and other exercise. They break the vicious cycle of stress-dysfunction-more-stress-worse dysfunction, and replace it with refreshing calmness.

Sex unfolds most pleasurably when people feel calm, centered, and focused on pleasure—their own and their partners’. Even those free of sex problems can benefit from deep relaxation. For more, search: mindfulness, meditation, or the relaxation response.

What does depression feel like?

It can also cause physical symptoms of pain, appetite changes, and sleep problems.

The Centers for Disease Control and Prevention (CDC) found that nearly 10 percent of adults aged 40 to 59 years had depression between 2009 and 2012. However, despite its prevalence, depression isn’t always easy to identify.

Symptoms and causes of depression can vary widely from person to person. Gender may also play an important role in why a person is affected by depression, and what it feels like to them.

How depression feels

One of the common misunderstandings about depression is that it’s similar to feeling sad or down.

Although many people with depression feel sadness, it feels much more severe than emotions that come and go in response to life events.

The symptoms of depression can last for months or years and can make it difficult or impossible to carry on with daily life.

It can disrupt careers, relationships, and daily tasks such as self-care and housework.

Doctors will usually look for symptoms that have lasted at least 2 weeks as possible signs of depression.

Depression may feel like:

  • There’s no pleasure or joy in life. A person with depression may not enjoy things they once loved and may feel like nothing can make them happy.
  • Concentration or focus becomes harder. Making any kind of decisions, reading, or watching television can seem taxing with depression because people can’t think clearly or follow what’s happening.
  • Everything feels hopeless, and there’s no way to feel better. Depression may make a person feel that there’s no way ever to feel good again.
  • Self-esteem is often absent. People with depression may feel like they are worthless or a failure at everything. They may dwell on negative events and experiences and be unable to see positive qualities in themselves.
  • Sleeping may be problematic. Falling asleep at night or staying asleep all night can feel nearly impossible for some people with depression. A person may wake up early and not be able to go back to sleep. Others may sleep excessvely, but still wake up feeling tired or unrefreshed, despite the extra hours of sleep.
  • Energy levels are low to nonexistent. Some people feel like they can’t get out of bed, or feel exhausted all the time even when getting enough sleep. They may feel that they are too tired to do simple daily tasks.
  • Food may not seem appetizing. Some people with depression feel like they don’t want to eat anything, and have to force themselves to eat. This can result in weight loss.
  • Food may be used as a comfort or coping tool. Although some people with depression don’t want to eat, others can overeat and crave unhealthy or comfort foods. This can lead to weight gain.
  • Aches and pains may be present. Some people experience headaches, nausea, body aches, and other pains with depression.

Many people mistakenly believe that being depressed is a choice, or that they need to have a positive attitude. Friends and loved ones often get frustrated or don’t understand why a person can’t “snap out of it.” They may even say that the person has nothing to be depressed about.

Common causes and risk factors

Depression can be caused by a number of factors. Though a single cause cannot always be found, experts recognize the following as possible causes:

  • Genetics: Depression and other mood disorders can run in families, though family history alone does not mean a person will get depression.
  • Life events: Major life changes and stressful events may trigger depression. These events include divorce, the death of a loved one, job loss, or financial problems.
  • Hormonal changes: Depression and low mood are often associated with menopause, pregnancy, and premenstrual disorders.
  • Certain illnesses: Anxiety, long-term pain, diabetes, and heart disease may make someone more likely to develop depression. Depression is a symptom of bipolar disorder.
  • Drug and alcohol abuse: In some cases, drug and alcohol abuse may cause depression. Other times, depression may cause a person to start abusing drugs or alcohol.
  • Some medications: Certain prescription medicines may increase the risk of depression. These include some high blood pressure medications, steroids, and some cancer drugs.

Click “Read More” for the full article.

Self-Evaluation and “The Four B’s”

Do you feel that you are a truly worthwhile person?

What do you see when you are genuinely trying to evaluate yourself and you look in the metaphoric mirror of life? That is, when you are wholly truthful with yourself, no masks, no games, no pretense, defensiveness or guile, do you really like (respect, admire, appreciate) that person you see? 

Who are we, really? 

We all experience successes and pleasures in our lives, just as we do disappointment and setbacks. Life can be complicated and pressured. In these circumstances we sometimes question wonder about our personal qualities or worthiness as human beings. We might behave differently in diverse circumstances (work, school, family, recreation), and when we’re with different people and settings. There may be times we worry about how we’re being perceived by others, but we ultimately have to answer to ourselves.

I’ve learned through research studies, clinical work and social relations with people of diverse ages and backgrounds that we all want to be “comfortable in our own skin.” We know that if people have enough to live on and are properly clothed, sheltered and safe (admittedly a big IF), it is not the amount of accumulated material wealth which leads to self-appreciation and ease ‘inside’ their beings. Most people are looking for more substance and meaning in life, and in fact have similar views about what makes them appreciative of their own worthiness.

So, what is it they (we) are all looking for?

The genuine appreciation of our worthiness and our quality depends on whether we achieve four core inner senses, which I call “The Four B’s”—the personal senses of Being, Belonging, Believing and Benevolence.

BEING (Personal): People who have achieved a sense of Being feel grounded and at ease with themselves. They have the sensation of inner peace and self-acceptance. They have insight into themselves and they have a realistic self-image, neither boastful or demeaning of themselves. They are grateful for whom they have become and how they’ve acted with others. They are aware of their strengths and potential, and similarly, of their faults and limitations. They appreciate themselves in spite of mistakes they have made and their emotional scars. They have worked at overcoming their frailties and redeeming themselves for transgressions.

They are empathic and caring, kind and generous to family, friends and strangers, and they’re respectful and tolerant of others. They are responsible and trustworthy, and feel comfortable with who they have become.

BELONGING (Social): People with a sense of Belonging know they are integral members of at least one group or community of people that is very important to them, where they feel comfortable, liked and appreciated, and where they genuinely reciprocate those feelings. These groups could compose a family or close friends, a congregation, a club, gang, team, cast, platoon or a wide range of other possible communities.

Members of these communal groups feel an organic affiliation and comfort with others who share their values and traditions. The members provide support, respect and friendship. These kinds of relationships bestow pleasure and fulfillment. They diminish anxieties and help prevent depression associated with loneliness. The warm glow of belonging contributes to their physical and emotional health, and enhances the quality of their lives.

BELIEVING (Ethical/Spiritual): A sense of Believing refers to having guiding values and principles of one’s behavior. Millions of people around the world venerate (their perception of) a God(s) who gives them comfort and hope, and provides moral rules for their ethical conduct. But one need not believe in a Supreme Being to be an ethical individual, and by the same token, religious followers are not inherently more principled or compassionate than agnostics and atheists. We human beings need to believe in a system of moral principles and civil behavior.  Ideally, we adhere to these overriding tenets in our daily functioning and relationships and we wish to pass these down to our children. When we act according to principles based on religion or other humane social philosophies, our lives become more meaningful during times of both joy and pain. 

Our lives can be at different times and circumstances rewarding, mundane or challenging: We are concerned about ourselves and perhaps even more about our families, wanting to protect and facilitate their navigation through life’s challenges. We are also at times beset with the pressures of finances, responsibilities, health, obligations, social demands, political issues and other aspects of life’s travails. The details and decisions of life can get to us.

Yet when we wonder about issues beyond everyday practicalities and materialism, we can be awed by just how minuscule we are. We are microscopic in our own world, but especially infinitesimal when we consider our own infinite universe and countless other universes. Looking at the photographs taken from the Hubble telescope can be riveting and awe-inspiring. They can transport our thoughts into cosmic or spiritual realms, and help us realize we have but one life to live, and making it fulfilling and meaningful becomes of even more consequence.

BENEVOLENCE (Altruism): A sense of Benevolence refers to the extent to which we have bestowed a caring effect on others. It encompasses how we have positively affected and contributed to people in our lives. This can be in our everyday lives, when we demonstrate seemingly small but important acts of kindness and generosity. The positive effects we have on others linger on in the ‘social atmosphere.’

Benevolence is in a way a culmination of the other B’s. Our personal legacies are best represented by our acts of decency and respect for each other. Notwithstanding humanity’s history of aggression and violence, we humans are also genetically predisposed to be helpful to others. Studies have shown that we can in fact learn to behave with more tolerance and generosity and with less aggression and animosity. The kindness and goodness we bestow on others throughout our lives is the essence of a sense of benevolence.

Nobody is perfect. I know many wonderful people but have yet to meet a veritable saint or tzaddik who is the epitome of perfection in all of his/her personal thoughts and behaviors. While a purely noble existence may be beyond us mere mortals, most of us endeavor to be intrinsically worthwhile: Decent, honest and caring—in other words, a “Mensch.”

When we are evaluating the worthiness of our lives, we aspire to the goals of the Four B’s. These are the foundations for our important core legacies, “Our Emotional Footprint.”

A Sleepless Brain Leads to Emotional Negativity

A sleepless night not only leaves us fatigued and distracted, it also makes us interpret things more negatively and makes us more likely to lose our temper. Moreover, people suffering from a pollen allergy are at a high risk of some form of sleep disruption from the outset. This is the conclusion of a new doctoral thesis from Karolinska Institutet that takes a neuroimaging approach to sleep loss.

“Ultimately, the results can help us understand how chronic sleep problems, sleepiness and tiredness contribute to psychiatric conditions, such as by increasing the risk of depression,” says Sandra Tamm, who has recently defended her doctoral thesis at the Department of Clinical Neuroscience.

Sleep deprivation is already known to potentially affect the way we react to emotional impressions. For her thesis, Sandra Tamm and her colleagues used functional MRI and PET techniques to examine under experimental conditions three emotional functions: emotional contagion (i.e. our natural tendency to mimic other people’s emotions in our facial expressions); empathy for pain (i.e. how we react to other people’s pain); and emotional regulation (i.e. how good we are at consciously controlling our emotional reaction to emotional images).

One study also examined low-grade inflammatory activity in the brain as a possible mechanism for non-specific symptoms such as sleepiness, fatigue and depression in people with severe seasonal allergy. A total of 117 participants were involved in the thesis’s constituent papers.

A negativity bias

The results of these various studies show that experimentally induced sleep loss leads to what the researchers call a negativity bias, which is to say a more negative interpretation of emotional stimuli, negative mood along with impaired emotional regulation. The ability to empathise with other people’s pain, however, was found to be less affected. So, while we might be grumpy in the morning, we still care if our partner happens to scold themselves when making the tea.

Researchers also found that the participants with a pollen allergy had disrupted sleep both during and outside the pollen season, and that the amount of deep sleep they had was higher during the pollen season than at other times of the year.

“Regrettably, we were unable to trace the underlying change mechanisms behind sleep deprivation-induced negativity bias by showing differences in the brain’s emotional system as measured by functional MRI,” says Sandra Tamm. “For people with a pollen allergy, we found signs of inflammation in their blood readings, but not in the brain.”

Mental health can impact memory decades later

Scientists have already shown that depression and other mental health problems can affect a person’s memory in the short term.

For instance, a study that the journal Cognition and Emotion published in 2016 found that individuals with dysphoria — a persistent sense of unhappiness or dissatisfaction that is often a symptom of depression — had poorer working memory than people without any mental health problems.

Now, however, researchers from the University of Sussex in Brighton, U.K. have found evidence that links experiencing mental health problems throughout adulthood to memory problems at the age of 50 years.

The implications, says study author Darya Gaysina, are that “the more episodes of depression people experience in their adulthood, the higher risk of cognitive impairment they have later in life.”

“This finding highlights the importance of effective management of depression to prevent the development of recurrent mental health problems with long-term negative outcomes.”

Darya Gaysina

In the new longitudinal study, the findings of which appear in the British Journal of Psychiatry, researchers analyzed the data of 9,385 people born in the U.K. in 1958, which the National Child Development Study (NCDS) has been collecting.

This new study is the first to look at the long-term relationship between mental and cognitive health.

Mental health problems and memory

To date, the NCDS has followed this cohort for more than 60 years, collecting information about each participant’s health at the ages of 7, 11, 16, 23, 33, 42, 44, 46, 50, and 55 years.

In addition, these participants reported their affective symptoms at the ages of 23, 33, 42, and 50 years and agreed to take memory and other cognitive function tests when they reached 50 years of age.

Gaysina and colleagues looked at how often the participants experienced mental health symptoms throughout the study period and assessed their performance in terms of memory function at age 50.

The researchers used a word-recall test to assess the participants’ memory, and they also evaluated each person’s verbal memory, verbal fluency, information-processing speed, and information-processing accuracy.

The investigators report their findings in the study paper, writing that the “accumulation of affective symptoms across three decades of adulthood (from age 23 to age 50) was associated with poorer cognitive function in midlife,” and, specifically, with poorer memory.

Although experiencing a single episode of depression or another mood disorder did not seem to affect a person’s memory in midlife, the researchers explain that going through depression and anxiety repeatedly throughout adulthood was a good predictor of poorer cognitive function at age 50.

“We knew from previous research that depressive symptoms experienced in mid-adulthood to late-adulthood can predict a decline in brain function in later life, but we were surprised to see just how clearly persistent depressive symptoms across three decades of adulthood are an important predictor of poorer memory function in midlife,” says the study’s first author Amber John.

Why Is It So Hard to Change Bad Habits?

I’ve managed to turn around a lot of my bad habits over the years, like reducing my fast food consumption, spending less time glued to screens, and finding an exercise regimen that I like and works for my life.

But my healthy habit journey isn’t anywhere near completion yet. I’m constantly looking for ways to optimize my energy and improve my life. If you’re reading this article, chances are you too have a few habits you’d like to change. So why is the process of adopting new habits usually so difficult? Because there is not a system in place to help you get the job done (unless you’ve reached the problematic tipping point of developing an addiction or diagnosable disorder.) Even then, the systems that are in place just want to help you stop the bad habit, not give you the tools needed to adopt new, healthier ones.

Why does this happen? Partially because, as a society, we still hold onto a false notion that those struggling with addiction or mental health issues are somehow different than the rest of us “normal” folks. This is not only false, but it’s also extremely dangerous because it ends up exacerbating the shame and stigma for those who are struggling, thus preventing them from seeking help.

The good news is that we do know a lot about how to change people’s behavior before things escalate to a problematic tipping point. Today I’ll be sharing with you four different approaches to change bad habits and the scientifically proven tools that will help you adopt new habits.

1. Behavioral Psychology

When we think, feel, and act in a particular way over a period of time, habits form, not only in our behavior but in our memory systems too.

There are different types of memory classification including semantic memory (knowledge), episodic memory (remembering events), and procedural memory (knowing how to do things) which is considered an implicit form of memory and therefore operating mostly below conscious awareness. It’s this last memory type, procedural memory, that is most important in the formation of habits. Over many decades of research, three primary types of learning emerged in the behavioral psychology domain.

Classical Conditioning

Classical conditioning (also known as Pavlovian conditioning) is learning through association. It was discovered by Russian physiologist Ivan Pavlov, which he discovered in his infamous study of dogs. In simple terms, classical conditioning refers to two stimuli which are linked together to produce a new learned response. 

Operant Conditioning

Operant conditioning refers to behavior that is shaped by either positive or negative reinforcement. It was developed by American Psychologist B.F. Skinner who studied the behavior of rats. He found that he could encourage or discourage behaviors based on a reward or punishment system. 

Observational Learning

Albert Bandura, an American psychologist, believed that people learn behaviors by observing and modelling other people’s behavior, attitudes, or emotions. In particular, he studied babies and young children and found that they imitated the behavior of those around them. This became the foundation of his social learning theory in which he highlighted that any form of learning requires the individual’s attention, retention, reproduction and motivation to imitate the modelled behavior.

2. Neuroscience

Researchers from MIT have identified that if neurons fire at the start and end of a specific behavior, then it becomes a habit. Neurons located in the habit formation region fire at the beginning of a new behavior, subside while the behavior occurs, and then fire again once the behavior is finished. Over time, patterns form, both in behavior and in the brain. This can make it extremely difficult to break a habit. 

In the forebrain, the basal ganglia is known to control voluntary movements and it may also play a crucial role in habit formation (both good and bad) as well as emotional expression. This system is not just concerned with motor (body) movements, but it has a strong effect on the emotional part of the brain. Investigator and Professor at MIT, Ann Graybiel, believes that at its core, the basal ganglia works to help people develop habits, so that they become automatic. This frees up space in your brain and memory to take in all the other things we encounter on a day to day basis. Automatic habits may include riding a bicycle, driving a car or brushing your teeth.

However, it’s the same region that helps people develop unwanted, or unhealthy, habits like eating disorders, anxiety, depressed mood, and addictions.

Research in this field, that focuses on the neurons in the basal ganglia, may lead to new psychological and drug treatments in mental health disorders and addiction.

3. Self-help Tools

The self-help industry claims to want to help you develop better habits. Before newer technologies, self-help mainly came in the form of physical books, but these days you can access information from home through eBooks, online courses, apps, and podcasts.

What Else Is Important?

Two factors that effectively help people achieve the behavior change they desire are incentives and accountability.

The American Society of Training and Development (ASTD) have released data from their study on accountability and the results were very interesting! What did they find? If you are held accountable to someone else, by committing to someone that you will achieve a goal, then your chance of success is up to 95 percent.

Accountability is the most important factor in habit formation or habit changing. This means that the likelihood that you will reduce your alcohol or lose weight will go up if you share your goal with friends, family or your community, either in person or online.

Though the above-mentioned tools are proven to work, physicians and therapists typically don’t employ them that often because they don’t think they are relevant to mental health issues and compulsive behaviors.

So, when people become “addicted” or “depressed” we just tell them they should stop without rerouting those “bad habits” and then wonder why it doesn’t work. Why? Because we are bad at stopping ourselves from doing something, especially if it’s already a habit.

Click Read More for the rest of the article.

Take Control Of Your Happiness

If you are relying on anyone or anything else for your happiness, stop that right now. If you feel like you’re not quite doing what you want to be doing and you’re not quite the person you want to be, let reading this be the sign that you have a change to make.

There are those who take control of their life and there are those who are life’s victims. Which do you want to be? The type who confidently assesses their own worth or the type that complains about feeling undervalued? No one can ‘make’ you feel anything. Happy or sad. every emotion you feel you can be in charge of. Giving away control of your feelings? Sort it out.

Here are 6 ways to create and control your own happiness:

Make a change

If you always do what you’ve always done, you’ll always get what you’ve always got. If you always avoid difficult conversations, you’ll always work with a team that isn’t up to scratch. If you always blame others, you’ll never take ownership and you’ll never be the best you can be.

Everything that happens is a cyclical process that will continue until you make an intervention – a change that puts you on a new course. Happy where every part of your life is going? Great! Go you! More of the same. Feel like you’re missing something? Make a change – somewhere. If what you’re putting out there isn’t working, or isn’t manifesting the results you want, it’s only you that can get you back on the way to happy.

Evaluate yourself

Be prepared to give yourself honest and ruthless feedback and don’t forget to learn each time you mess up. If you’ve already assessed and addressed your own weaknesses, what can anyone else’s opinion matter?! Get comfortable with your strengths – look for opportunities to use them. Nothing you hear in a formal appraisal or passing comment should surprise you. Don’t rely on others to point out your shortcomings.

Stop comparing

It happens all the time. You’re happy with your job until you hear about someone else’s and it sounds much better. You’re happy with the growth of your business until you hear of someone else’s growing faster. You feel like things are going pretty well until a peer does something you’d love to do. If you compare your life to anything other than a former version of itself, you’re asking for unhappiness. Even some of the most successful and inspiring people I know have moments where they want to swap places with someone else. It’s madness. Sure, there are other things you could be doing, but choosing to do them would mean forgoing your current path. Keep forgoing your current path and you’ll end up flitting around with no agenda, copying the last success story you read on the internet. Make comparisons with no one but your former self.

Define happiness

Ever seen the BBC show Saturday Kitchen? In each episode, James Martin, the presenter, cooks one of two dishes for the special guest – their food heaven or their food hell. My food hell is a seafood linguine with some kind of pea, mint and fennel sauce. Every part of that dish absolutely disgusts me. Yuck. I know, however, that the dish I’ve described will be someone else’s food heaven. Life and work are the same. The choices you make and the reality you live will be someone else’s version of hell, and vice versa. The happiness you seek has to be based on your version of happiness and not someone else’s. Definitely not based on TV adverts, celebrity Instagram pictures or the lives of friends and relatives.

Keep your lips sealed

Work out your own plan before you ask for comment. Be sure of your next move before you open up to receive advice. Recognise that every time you share your intentions you leave yourself susceptible to be influenced. Get clear on your plan, put the work in, then share the results, not the journey.

Design your life

In the 4 Hour Work Week, by Tim Ferriss, he advises an exercise where you take a piece of paper and write down: every day, every other day, every week, every month, every quarter, every year. You then write down the things you’d like to do in those frequencies. They could be ‘go for a walk’ every day. ‘Have a meal with friends’ every week, ‘go to Disneyland’ every year. Anything you like! Try it out – write them all down and use that piece of paper as a blueprint for living a life full of your favourite things.

5 Steps to Reduce Stigma About Mental Illness

If you tune into any conversation about mental illness and addiction, it won’t be long until the term “stigma” comes up. Stigma has various definitions, but they all refer to negative attitudes, beliefs, descriptions, language or behavior. In other words, stigma can translate into disrespectful, unfair, or discriminatory patterns in how we think, feel, talk and behave towards individuals experiencing a mental illness.

Where stigma comes from is a complicated question. It’s almost like asking where differences in racial prejudice, political views, religious preference, or sports team allegiances come from. Turns out we are influenced (all too easily) by family, friends, the media, our culture and environment, inaccurate stereotypes, and a host of factors. It’s really difficult to tease all this apart.

Rather than figure out where stigma begins, it’s easier to become more aware of what it isand when it occurs. Then we can do our best to educate others about how to reduce stigma and work toward ultimately eliminating it.

How do we become more aware of stigma? It’s usually easier to take a look at ourselves first before we try to change the rest of the world. 

Here are 5 simple steps you can do as a new stigma fighter:

1. Don’t label people who have a mental illness.

Don’t say, “He’s bipolar” or “She’s schizophrenic.” People are people, not diagnoses. Instead, say, “He has a bipolar disorder” or “She has schizophrenia.” And say “has a mental illness” instead of “is mentally ill.” This is known as “person-first” language, and it’s far more respectful, for it recognizes that the illness doesn’t define the person.

2. Don’t be afraid of people with mental illness.

Yes, they may sometimes display unusual behaviors when their illness is more severe, but people with mental illness aren’t more likely to be violent than the general population. In fact, they are more likely to be victims of violence. Don’t fall prey to other inaccurate stereotypes from movies, such as that of the disturbed killer or the weird co-worker.

3. Don’t use disrespectful terms for people with mental illness.

In a research study with British 14-year-olds, teens came up with over 250 terms to describe mental illness, and the majority were negative. These terms are far too common in our everyday conversations. Also, be careful about casually using “diagnostic” terms to describe everyday behavior, like “That’s my OCD,” or, “She’s so borderline.” Given that 1 in 4 adults experience a mental illness, you quite likely may be offending someone and not be aware of it.

4. Don’t be insensitive or blame people with mental illness.

It would be silly to tell someone to just “buckle down” and “get over” cancer. The same applies to mental illness. Also, don’t assume that someone is okay just because they look or act okay or sometimes smile or laugh. Depression, anxiety, and other mental illnesses can often be hidden, but the person can still be in considerable internal distress. Provide support and reassurance when you know someone is having difficulty managing their illness.

5. Be a role model.

Stigma is often fueled by lack of awareness and inaccurate information. Model these stigma-reducing strategies through your own comments and behavior and politely teach them to your friends, family, co-workers and others in your sphere of influence. Spread the word that treatment works and recovery is possible. Changing attitudes takes time, but repetition is the key, so keep getting the word out to bring about a positive shift in how we treat others.

Former President Bill Clinton said it very well: “Mental illness is nothing to be ashamed of, but stigma and bias shame us all.” Take the next step. Adopt these simple tools and you can help move the needle in the direction of getting rid of stigma once and for all.

The Healing Power of Telling Your Trauma Story

However, our trauma memoriescan continue to haunt us, even—or especially—if we try to avoid them. The more we push away the memory, the more the thoughts tend to intrude on our minds, as many research studies have shown.  

If and how we decide to share our trauma memories is a very personal choice, and we have to choose carefully those we entrust with this part of ourselves. When we do choose to tell our story to someone we trust, the following benefits may await. (Please note that additional considerations are often necessary for those with severe and prolonged experiences of trauma or abuse, as noted below.)

Feelings of shame subside. 

Keeping trauma a secret can reinforce the feeling that there’s something shameful about what happened—or even about oneself on a more fundamental level. We might believe that others will think less of us if we tell them about our traumatic experience.

When we tell our story and find support instead of shame or criticism, we discover we having nothing to hide. You might even notice a shift in your posture over time—that thinking about or describing your trauma no longer makes you feel like cowering physically and emotionally. Instead, you can hold your head high, both literally and figuratively. 

Unhelpful beliefs about the event are corrected.

Many people experience shifts in their beliefs about themselves, other people, and the world following a traumatic event. For example, a person might think they’re weak because of what happened, or that other people can never be trusted. When we keep the story inside, we tend to focus on the parts that are most frightening or that make us feel self-critical. 

I’ve often been struck during my work with trauma survivors by the power of simply telling one’s story to shift these unhelpful beliefs. These shifts typically don’t require heavy lifting by the therapist to help the trauma survivor recognize the distorted beliefs. Instead, there’s something about opening the book of one’s trauma memory and reading it aloud, “from cover to cover,” that exposes false beliefs.

For example, a person who was assaulted might believe they were targeted because they look like easy prey; through recounting what actually happened, they may come to see that it was due to situational factors (“wrong place, wrong time”) rather than something personal and enduring about themselves. 

Telling the trauma story to a supportive therapist is one of the key components of Cognitive Behavioral Therapy (CBT), which is one of the most effective treatments for posttraumatic stress disorder (PTSD). I recently explored the latest findings on PTSD treatment research with psychologist Dr. Mark Powers, Director of Trauma Research at Baylor Scott and White Health. As we discussed, effective CBT typically doesn’t require an intensive examination of the survivor’s beliefs and evidence for those beliefs, as is often done in CBT for other conditions. Instead, insights about the truth of what happened emerge just through talking about what happened and what it means. 

The memory becomes less triggering. 

Revisiting a trauma memory can be very upsetting, triggering strong emotional and physical reactions and even flashbacks to the event. Those reactions can stay in place for years if we have unprocessed trauma memories, especially when we’re trying to avoid thinking about the trauma.

Through retelling the story of what happened, we find that our distress about it goes down. The first time it’s likely to be very upsetting, even overwhelming, and we might think we’ll never be able to tolerate the memory. With repeated retelling to people who love and care about us, though, we find the opposite—that the memory no longer grips us. As Dr. Powers noted, we find that the memory no longer controls us. It will never be a pleasant memory, of course, but it won’t have the same raw intensity that it once had. 

You find a sense of mastery.

As we talk about our trauma, we find that we’re not broken. In fact, as Dr. Powers pointed out, we can come to see that our reactions to trauma actually make sense. For example, it’s understandable that our nervous systems are on high alert, since they’re working to protect us from similar danger in the future. 

Many trauma survivors I’ve worked with described the strength they found as they faced their trauma and told their story. They said they felt like they could face anything as they saw their fear lessen and found greater freedom in their lives. It takes courage to tell your story, and witnessing your own courage shows you that you’re not only strong but whole.

How chronic stress fuels cancer

Scientists say they now have a better understanding of how chronic (long-term, sustained) stress can accelerate the growth of cancer cells, and how this damage could be avoided.

While the correlation between stress and health issues – such as gut health, heart problems and cognitive impairment – is well-established, researchers have now located a key mechanism, which chronic stress triggers, that fuels the growth of cancer stem cells that tumours originate from.

The report, published in The Journal of Clinical Investigation, is one of the first to link chronic stress specifically with the growth of breast cancer stem cells in mice.

Principal investigator Quentin Liu, from the Institute of Cancer Stem Cell at Dalian Medical University told Medical News Today that while the direct signalling network between stress pathways and a cancer propagating system still remains “almost completely unknown”, a better understanding of the biochemistry that causes stress to increase the growth of cancer cells “could lead us toward targeted drug interventions”.

In these findings, researchers found the hormone epinephrine was responsible for the tumour growth, not cortisol. This hormone, when binding with ADRB2 cells, boosted levels of lactate dehydrogenase, an enzyme that normally gives muscles an “injection” of energy in a danger situation as part of a fight or flight mechanism. As a result, this led to an energy boost in the production of lactate, which feeds the harmful cancer cells and allows them to acquire more energy.

This means a person with chronic stress will have too much lactate dehydrogenase in the system which in turn will activate genes related to cancer growth and allow those cancer cells to thrive.

“When most people think of stress they think it’s cortisol that’s suppressing the immune system,” says Keith kelley, the co-author of the report. However cortisol was actually lower after a month of stress, while epinephrine was much higher, he notes.

Researchers confirmed these results by studying the blood epinephrine levels in 83 people with breast cancer, and found people with higher levels of the stress hormone also had higher levels of lactate dehydrogenase in cancer tumours and were more likely to have poorer outcomes following treatment.

Researchers also considered how they could block epinephrine’s effect on the system and found vitamin C to be the most promising substance. When tested on mice, scientists found stressed mice injected with vitamin C experienced tumour shrinkage.

Meditation can help treat PTSD

Studies have shown that meditation practices can have a significant, positive effect on mental health and how well our bodies respond to stress.

Existing research has also found that different types of meditation can even help boost a person’s emotional intelligence.

Interest in meditation’s potential as a tool for coping with various mental health symptoms has risen in recent years, and now, a new study suggests that one type of meditation — called transcendental meditation — can successfully counteract PTSD and lower depression.

The researchers, who hail from various academic institutions across the world, including Norwich University in Northfield, VT and the Maharishi Institute in Johannesburg, South Africa, have worked with students from the Maharishi Institute and the University of Johannesburg who had all received diagnoses of PTSD and depression.

The investigators’ findings, which appear in the journal Psychological Reports, indicate that participants who started practicing transcendental meditation saw notable improvements in their symptoms.

Symptoms recede after 3.5 months

The researchers worked with 34 students at the Maharishi Institute who had PTSD and depression. These students agreed to practice transcendental meditation, a type of meditation that involves chanting and focusing on mantras to achieve serenity.

Additionally, the team recruited a further 34 University of Johannesburg students with the same diagnoses who neither received any treatments nor took part in meditation for the duration of the study. These students acted as the control group.

At the beginning of the study period, which lasted 3.5 months, all of the participants scored 44 or over on the PCL-C test, which assesses PTSD symptoms. These scores signify that PTSD is very likely. Moreover, mental health professionals had also diagnosed PTSD in each of the participants.

At the end of the study, most of the participants from the transcendental meditation group had PCL-C scores below 34, which is the threshold for a PTSD diagnosis, indicating that their symptoms had altogether receded.

These participants also reported improvements in their depression symptoms.

In contrast, the participants in the control group, who did not take part in the meditation sessions and did not receive any other treatment, did not see any improvements.

‘A way to effectively deal with this problem’

Some of the PTSD symptoms that the participants reported at the beginning of the study included nightmares, flashbacks to traumatic events, a sense of anxiety or fear, and a state of hypervigilance.

At that point in time, many of these students were also experiencing emotional numbness, states of anger, violent outbursts, and misuse of alcohol and drugs.

“A high percentage of young people in South Africa, especially those living in the townships, suffer from PTSD,” explains study author Michael Dillbeck, from the Institute for Science, Technology, and Public Policy at the Maharishi University of Management in Fairfield, IA.

This issue extends beyond South Africa, however. In recent worldwide survey data that the World Health Organization (WHO) collected, 70.4 percent of the respondents reported experiencing trauma, and many of these individuals may have PTSD as a result.

“To become successful students and productive members of society, they absolutely need help dealing with the symptoms of post-traumatic stress disorder,” Dillbeck points out, noting that a tool as simple as meditation could make an important difference to people’s lives.

“Our study shows that after 3 months of meditation, [the meditation] group, on average, was out of PTSD. It offers a way for others to effectively deal with this problem.”

Michael Dillbeck

Can social media really cause depression?

The supposed effects of social media on young people sound drastic enough to make anyone switch off their cell phone.

Some studies have indicated that young people can develop an addiction to social media.

Meanwhile, other studies have linked this with poor sleep, poor self-esteem, and potentially poor mental health.

However, new research has now dispelled the belief that social media use can bring about depression.

Previous studies have made this claim based on measurements from a single point in time, but this new study took a long-term approach.

“You have to follow the same people over time in order to draw the conclusion that social media use predicts greater depressive symptoms,” says lead study author Taylor Heffer, of Brock University in St. Catharine’s, Canada.

“By using two large longitudinal samples, we were able to empirically test that assumption.”

The real effect on mental health

The study focused on two separate groups of participants. One was made up of 594 adolescents in the sixth, seventh, or eighth grade in Ontario, Canada. The other comprised 1,132 undergraduate students.

The team surveyed the younger group once per year for 2 years. They surveyed the older students annually for a total of 6 years, starting in their first year of university.

The questions focused on how much time they spent on social media on weekdays and weekends, as well as how much time they spent on activities such as watching TV, exercising, and doing homework.

They also looked at symptoms of depression. For the undergraduate students, they measured such symptoms using the Center for Epidemiological Studies Depression Scale. They used a similar but more age-appropriate version for the younger participants.

Next, the researchers analyzed the data, separating it into age and sex. The findings — which now appear in the journal Clinical Psychological Science — revealed that social media use did not lead to depressive symptoms later on. This held true in both groups of participants.

The scientists also found that in adolescent females, higher depression symptoms predicted later social media use. Heffer points out that females of this age “who are feeling down may turn to social media to try and make themselves feel better.”

Reducing social media fear

These findings suggest that overuse of social media does not lead to depression. More importantly, this may go some way toward dissuading public fear over the impacts of the technology.

As Heffer explains, “When parents read media headlines such as ‘Facebook Depression,’ there is an inherent assumption that social media use leads to depression. Policymakers also have recently been debating ways to tackle the effects of social media use on mental health.”

It is likely that differences in factors such as personality play a part in how social media can impact mental well-being. For example, some young people might choose to use social media negatively as a comparison tool, while others may simply use it to stay in touch with friends.

Scientists will now need to further examine motivations such as these to help authorities, medical experts, and parents figure out the best path forward.

Decision-Making for Sound Mental Health: 3 Useful Principles

A useful distinction to consider when thinking about decision-making in the mental health space is between principles and rules. A principle is a fundamental proposition that guides a system of belief or behavior. A rule, on the other hand, is a prescribed dictate for action within a particular activity or sphere. Parental authority is a principle; bedtime at 8:00 is a rule.

Principles tend to be broad and more abstract, and they may apply across contexts. Rules tend to be narrow and context-specific. Principles tend to regard general processes, and often represent internal convictions. Rules tend to regard specific content, and are often imposed on us externally. Principles invite contemplation, and need to be applied thoughtfully. Rules demand obedience and can be followed thoughtlessly. “Is it right?” is a question about principles. “Is it legal?” is a question about rules. Principles allow for flexibility and agency, but may generate confusion regarding how they should be applied. Rules are useful in that they clarify proper conduct, but they also limit flexibility and personal agency.

Principles and rules are not unrelated, of course. In fact, a system’s rules are often derived from—and function to uphold—its principles. If “customer service above all” is a company principle, then the company may devise a rule that, “all customers must be greeted within 5 seconds of walking into the store.” Many rules may be subsumed under one principle, and so novel situations usually beget new rules, rather than new principles. For example, upholding the ‘right to privacy’ principle in the new digital environment will require devising new privacy-related rules. This is one reason rules tend to multiply over time. Before long, they may begin to obscure, and even undermine, the principles they ostensibly serve. This is, in essence, the paradox of bureaucracies: designed to advance the worthy principles of organizational efficiency, rationality, and objectivity, their convoluted rules often end up undermining all three.

Our culture prizes both those who follow the rules and those who are principled. But in general, the latter is more highly regarded than the former. If you break a rule in the name of principle, you’ll be often regarded positively. If you obey a rule in betrayal of principles, you’d be perceived negatively. In Lawrence Kohlberg’s famous moral reasoning theory, a rule-based moralityis considered ‘conventional,’ and is located lower on the developmental ladder than a principle-based, ‘post conventional’ morality. Yet rules can be helpful in putting principles into practice. A transportation system that includes highways may be considered better developed that one that relies on country roads. But a truly developed system needs both.

Most of the systems that govern human conduct and decision makinginclude both principles and rules, yet systems may differ in which of these they lean more heavily on. For example, American football is a game of rules. Every nuance of the game is closely measured, officiated, prescribed, and addressed in preset ways. Soccer is a game of principles: Move the ball into the opponent’s net without using your hands or breaking other players’ shins. That’s more or less it. American football is heavy on equipment and technology; it involves many more referees than soccer, and many more stops, consultations, and rule-related controversies (Deflategate, etc.). Soccer flows. It is known as ‘the beautiful game.’

The work of psychotherapy concerns itself with principles and rules quite regularly. For therapy clients, I find, focusing on principles is often more productive than focusing on rules. Now granted, therapy is not a one-size-fits-all proposition. What works for one client may not work for another. At the same time, people are people, and commonalities exist. For example, when it comes to parenting, clients often find that they do well to behave in ways that satisfy the principles of generosity, fairness, and responsibility. Giving your kids no treats ever may be fair and responsible, but ungenerous. Giving one child more treats than the other may be generous and responsible, but unfair. Giving each child fifty treats to eat at once may be fair and generous, but not responsible. You get the idea.

Clients often benefit from figuring out general principles of thinking and decision making that work well across content areas in the mental health space. Here are three useful go-to principles of sound mental process:

Flexibility over Rigidity

This principle is based on the fact that cognitive flexibility is a hallmark of cognitive health. Cognitive flexibility refers to our ability to adapt our cognitive processing strategies to novel or unexpected environmental conditions. As such, cognitive flexibility implies a capacity for learning from experience. It also involves the ability to apply and adjust problem-solving strategies by exploring potential solutions inside a given problem space. It therefore is best thought of as a facility with complexity.

Life, as you may have noticed, is, if nothing else, complex. In such an environment, rigid, narrow, and simplistic thinking will not suffice. All-or-nothing perfectionism, for example, is rigid thinking. It is ill fitted to handle real life, which is much more likely to involve more-or-less propositions. Perfectionism distorts our analysis by turning life’s nuanced continua into crude dichotomies. Striving for excellence, on the other hand, affords the requisite flexibility. For the difference to become clear, think about someone in your life whom you love and admire: are they perfect or excellent?

One obstacle to the development of cognitive flexibility is the cache our culture attaches to dogged determination. Many successful people attribute their success to ‘not giving up,’ and to their stubborn insistence on pursuing a dream against the odds. Narratives of success against the odds are heralded and often compelling, but they are also misleading. In principle, it is better to go with the odds rather than against them (see under: Las Vegas). For example, if you want to become financially secure, you can play the lottery doggedly every day, or you can get an education and a good job. Some of those who choose the former strategy may be successful. And they will attribute their success to their stubbornness. But their good fortune doesn’t validate the strategy, because most of those who choose it will fail. Put differently: the fact that Steve Jobs succeeded after dropping out of college and starting a business doesn’t mean that dropping out of college to start a business is a sound strategy for success. The error illustrated by these examples is known in the literature as survivor bias. Those who succeed by beating the odds succeed despite, not because of, their strategy.

This is why much received wisdom, such as “Follow your dream and never give up,” constitutes poor life advice. Better to follow only those dreams for which you have aptitude and good success odds, and give up on the rest. Most successful people have given up on many dreams and goals along the way. Adaptive flexibility predicts success better than rigid stubbornness.

Compassion over Cruelty

This principle appears self-evident: Of course it is better to treat others with kindness rather than cruelty. Yet somehow this self-evident truth becomes less so when applied inward. Somehow, treating yourself with cruelty and lack of kindness doesn’t evoke the same moral outrage as seeing someone else treated this way, or experiencing yourself treated this way by someone else. Yet a fair evaluative system cannot accept an arbitrary double standard. If we accept and respect others who are imperfect, but fail to accept and respect ourselves on account of our imperfections, then we are creating a unique, and uniquely harsh, measurement system just for us, an unjustified double standard.

Click Read More to Continue

Hearing loss and cognitive decline: Study probes link

After analyzing 8 years of data from a health study of more than 10,000 men, scientists at Brigham and Women’s Hospital and Harvard Medical School, both in Boston, MA, found that hearing loss is tied to an appreciably higher risk of subjective cognitive decline.

In addition, the analysis revealed that the size of the risk went up in line with the severity of hearing loss.

The risk of subjective cognitive decline was 30 percent higher among men with mild hearing loss, compared with those with no hearing loss.

For men with moderate or severe hearing loss, the risk of subjective cognitive decline was between 42 and 54 percent higher.

Subjective cognitive decline refers to changes in memory and thinking that people notice in themselves. Such changes can be an early indication of cognitive decline that objective performance tests do not pick up on.

“Our findings,” says lead study author Dr. Sharon Curhan, who works as a physician and epidemiologist, “show that hearing loss is associated with new onset of subjective cognitive concerns which may be indicative of early-stage changes in cognition.”

They could also “help identify individuals at greater risk of cognitive decline,” she adds.

Dementia and early diagnosis

The World Health Organization (WHO) have identified dementia as a public health priority that requires more research, especially into causes and modifiable risk factors.

Today, there are around 50 million people living with dementia worldwide, and this figure is set to rise to 75 million by 2030.

There are currently no effective treatments that prevent or reverse the course of the disease.

However, early diagnosis can do much to improve the quality of life for people with dementia and those who care for them.

Identifying early decline in memory and thinking capacity could also help develop treatments that are more effective than those that target later stages of dementia, note the authors.

They go on to explain that subjective cognitive decline, that is, the changes in memory and thinking skills that people notice in themselves, can indicate “subtle features” of cognitive decline that do not show up in objective tests of performance.

This is borne out by imaging studies that have linked subjective cognitive function to brain changes that precede dementia.

Such findings support the notion that subjective cognitive function lies on a spectrum that includes mild cognitive impairment and predementia.

Hearing loss and cognitive decline

In the United States, a national survey has estimated that around 23 percent of those aged 12 or older have some level of hearing loss.

The majority of individuals affected have mild hearing loss. However, in those aged 80 or older, moderate loss is more common than mild loss.

Hearing loss and cognitive decline have some features in common. Their causes involve several factors and, in many cases, both get worse over time.

Dr. Curhan and colleagues remark that these common features likely point to a buildup of “auditory and neurodegenerative damage” over the lifespan.

For their investigation, they analyzed data from the Health Professionals Follow-Up Study (HPFS).

The HPFS recruited 51,529 men from health professions who were aged between 40 and 75 years when the study began in 1986. Their professions ranged from podiatry and dentistry to veterinary medicine and optometry.

Following enrolment, the men completed questionnaires about lifestyle, medication use, diet, and medical history every 2 years.

Click Read More for the results of the analysis.

Learn As You Go

I was recently asked about my top five inner practices for 2019, and here they are:

  • Drop the stone
  • Let it flow
  • Learn as you go
  • “Us” all “thems”
  • Open into awe

You can click the links above to see the first two. By “learn as you go,” I mean that each day is an opportunity to take in the good: to help useful or enjoyable experiences sink in and become a part of you. Then when you go to sleep, you’ll be a little stronger, a little more resilient, a little wiser, a little more loving, a little happier than you were when you woke up in the morning.

This kind of learning is not memorizing a multiplication table. It’s emotional learning, somatic learning. It’s becoming more skillful with the world around you and the world inside you. It’s social learning, motivational learning, even spiritual learning. It’s healing from the past and growing strengths for the future. It’s becoming more compassionate, confident, patient, capable, and joyful. This is the learning that matters most. If things fall apart, what’s already inside you is what you can really count on.

I grew up in a stable and loving home, but for a variety of reasons I was still very unhappy, awkward, and messed up inside. I didn’t know what to do and it seemed hopeless. Then about age 15, there was a big turning point when I realized that no matter what things were like at the present time, I could always look for ways to learn and grow from there – to get more skillful, to heal, to grow. I didn’t need to despair because it was in my power to develop myself in some way each day. To learn how to talk with other kids or not be so irritated by my parents or deal with my crazy thoughts. To learn how to make my way in the world. And that was full of hope.

We can’t do anything about the past but – to quote Captain Kirk in Star Trek – the future is an undiscovered country. It’s full of possibility, including the possibilities in who you are becoming. No one can stop you from learning. And no one can do it for you – which makes the results authentic, and yours to own.

How?

We’re having experiences all day long, but what actually sinks in? Usually it’s the moments of stress and sorrow, anxiety and anger, hurt and resentment. Meanwhile, all the many experiences of gratitude, accomplishment, friendliness, feeling cared about, wholesome pleasure, insight, and commitment pass through us like water through a sieve. This is due to the brain’s evolved negativity bias, which makes it like Velcro for bad experiences but Teflon for good ones.

To beat the negativity bias and grow more of the good inside yourself, there are just two steps – but you have to do both of them.

Two Steps
First, you need to experience whatever you want to grow. Such as an insight, intention, skill, satisfaction, calming, easing, soothing, or vitalizing. Second, that experience must leave a lasting physical trace behind in neural structure or function. Otherwise there is no lasting value, no healing, no growth, no learning.

The first step is usually easy. Most people are having many mildly pleasant or useful experiences each day and just have to notice them. And we can also create beneficial experiences, such as calling up the feeling of compassion or determination, or remembering what it feels like to be with someone who cares about you.

Second, once the “song” of that experience is playing in your inner iPod, turn on the recorder. This is the step that people routinely skip in everyday life, and that therapists and coaches and teachers (including myself) can fail to do when working with others. But if we miss this step, we’ve wasted the experience on the brain.

There are lots of ways to use the power of “experience-dependent neuroplasticity” (that’s a mouthful) to turn passing experiences into grit and gratitude and other inner strengths hardwired into your nervous system. (For a summary, check out my book Resilient.) Try one of these, or all three of them:

  • Stay with the experience for a breath or two or longer. There’s a famous saying: “Neurons that fire together, wire together.” The longer you keep them firing, the more they will tend to connect together.
  • Feel it in your body as much as possible. This is not about remembering specific events in your life, but about receiving the residues of lived experience into yourself.
  • Focus on what is enjoyable or meaningful about it. As the sense of reward in an experience increases, dopamine and norepinephrine activity in the brain tends to increase as well. This flags experiences as “keepers” and prioritizes them for long-term storage.

You might take these two steps only a few times a day, usually less than a minute at a time. But bit by bit, synapse by synapse, you’ll be growing happiness, love, and wisdom inside yourself.

Some Profound Implications
This practice is simple, down-to-earth, and natural. It’s also profound in a couple of ways.

First, experiences are continually changing; as Francis Bacon wrote: “We have only this moment, sparkling like a star in our hand – and melting like a snowflake.” Yet you can help them leave enduring tracks behind as they pass through consciousness. Remarkably, you can get lasting value from the melting moment even as you let go of it.

Second, as you take in the good over time, you feel increasingly filled up from the inside out. Then it feels like there is an enoughness of needs met already, even as you cope with challenges. This reduces our biologically rooted tendencies toward “craving” based on a sense of something missing, something wrong. As we grow an unshakable core of resilient well-being, there is less push inside to fight pain or chase pleasure or cling to other people.

Then our footprint on the world and others becomes lighter, and we also become harder to manipulate with fear or greed or “us against them” grievances and rivalries. We should certainly act to improve conditions in the world. But that is not sufficient – as we can see in the example of many privileged and affluent people who still see threats around every corner, can’t stop piling up more wealth no matter the cost, and dehumanize and bully others. The sense of enoughness must land in the heart and take root – and if it does in the hearts of enough people, that will change the course of human history.

6 Strategies to Overcome Insomnia

Do you occasionally find yourself up in the middle of the night, ruminating and unable to go back to sleep? Or do you sometimes have a hard time falling sleep because you have too much on your mind?

Part of the problem may be related to natural sleep patterns and waking/sleeping behavior, and another part of the problem may be how we deal with wakefulness. Here are strategies to address those problems and overcome insomnia.

1.     Understanding Sleep Patterns. A great deal of the worry associated with insomnia may be related to our misconceptions about sleep timing. Many of us adhere to the 8-hours-of-uninterrupted-sleep notion. This is the belief that sleeping straight through for 8 hours is “normal.” However, sleep research suggests that the normal pattern may be what is called “segmented sleep.” This is the idea that our natural rhythm is to sleep for 3-4 hours, followed by a 1-2 hour awake period, and a second 2-4 hour sleep. Historical evidence suggests that segmented sleep was once common, and our ancestors used the mid-night waking period to visit with neighbors, have a snack, or have sex.

2.     Cognitive Reframing. Occasional insomnia may occur because of our belief system about sleep. We may worry about our lack of uninterrupted sleep, or too few hours of sleep per night, and this anxiety often keeps us awake. By cognitive reframing—thinking differently about our sleep patterns—we may alleviate some of our insomnia. An obvious strategy is to assure ourselves that segmented sleep is ok, and a few nights of poor sleep will not lead to lasting damage.

3.     Benign Reflection. Wakefulness, right after we hit the sack or in the middle of the night, offers an opportunity to put negative thinking on hold, count our blessings, and reflect on the many positive things in our lives. By moving our thought patterns from negative to positive, it may become easier to fall asleep.

4.     The To-Do List. Sometimes insomnia is caused by the many things that we have to do the next morning, and we ruminate about them and can’t get back to sleep. This is the time to make a mental to-do list or have a pen and paper next to your bed and write it all down. Very often, once we make the list, we realize that there wasn’t all that much to do in the first place.

5.     Wrestle Your Demons. Perhaps wakefulness is not a bad thing, but an opportunity to reflect and solve problems. We can often cognitively put our demons to rest by thinking through problems and issues. And, coupled with benign reflection, we might satisfy our cognitive musings and return to peaceful sleep.

6.     Be Productive. Take advantage of wakeful time and get something done. It was mid-night insomnia, and the reflection it provided, that led to this blog post. (In fact, I got up way too early in the morning to write it down). Taking advantage of segmented sleep might lead you to accomplish tasks, and it may even tire you out so that you can get a restful, “second” sleep.

Why Exercise Is Good for Your Brain

As JPM Healthcare week kicks off in San Francisco, the conversation around healthcare turns clairvoyant as experts weigh in on their predictions for the big trends in the coming year. One of the main topics: Will this be the year we finally see a successful drug for Alzheimer’s disease?

But rather than play a guessing game, why don’t we look at what we know actually prevents dementia—improving your lifestyle. This article is the first in a five-part series focused on evidence-based methods to prevent dementia through lifestyle. Let’s begin with exercise.

Healthy Body, Healthy Mind

The Federal Government first published the Physical Activity Guidelines for Americans1 in 2008. Using science-based advice, these guidelines provide an overview of how much exercise Americans should perform each week (i.e., at least two days of muscle strengthening activity combined with at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise). These guidelines address both healthy individuals and those at increased risk of chronic disease, stressing how exercise can prevent the effects of certain chronic diseases, including dementia.

An updated edition of the Physical Activity Guidelines was released in late-2018. The primary update was a section dedicated to the relationship between physical activity and brain health. This section explains the benefits of exercise for cognition, sleep, depression, anxiety, and overall quality of life. The government’s recognition of brain health finally publicizes its integral role in overall health and highlights how exercise benefits not just your body, but also your mind.

How Exercise Improves Brain Health

There are many ways exercise improves cognitive health. Aerobic exercise (also known as cardio) raises your heart rate and increases blood flow to your brain. Your increased heart rate is accompanied by harder and faster breathing depending on the intensity of your workout. As your increased breathing pumps more oxygen into your bloodstream, more oxygen is delivered to your brain. This leads to neurogenesis—or the production of neurons—in certain parts of your brain that control memory and thinking.  Neurogenesis increases brain volume, and this cognitive reserve is believed to help buffer against the effects of dementia.

Another factor mediating the link between cognition and exercise is neurotrophins, which are proteins that aid neuron survival and function. It has been noted that exercise promotes the production of neurotrophins, leading to greater brain plasticity, and therefore, better memory and learning. In addition to neurotrophins, exercise also results in an increase in neurotransmitters in the brain, specifically serotonin and norepinephrine, which boost information processing and mood.

Exercise’s Lasting Effects on Cognition

In 2017, the Lancet released its landmark research commission on dementia prevention, intervention, and care that demonstrated that 35 percent of risk factors for developing dementia can be attributed to modifiable lifestyle traits. A significant component: exercise.

In a longitudinal study conducted by Dr. Zhu from the University of Minnesota, exercise tests were administered to a group of participants to determine their fitness levels. Those who were the most active in 1985 tended to still be on the fit side of the spectrum decades later. That same “fit” cohort also performed better on cognitive tests decades later.

Furthermore, exercise gives hope to people with a rare genetic mutation that programs them for early-onset Alzheimer’s disease. Although exercise cannot completely counteract their genetic predisposition, people who exercised for at least 150 minutes per week had better cognitive outcomes compared to those who did not.

Incredibly, exercise could potentially delay their dementia onset by up to 15 years.

Does Workout Type Matter?

Both the type of workout and method of staying fit are important to whether or not you experience cognitive benefits. It’s not enough to just count calories to stay thin, you still need to exercise. In fact, there is a term in medicine for people who are not healthy overall but manage to stay thin: TOFI (Thin Outside Fat Inside). Rather than exhibiting fat externally and appearing overweight, these individuals carry weight viscerally, around their internal organs. This is harmful to overall health—including brain health.

Between three sets of people—individuals who lost weight through restrictive eating, people who lost weight through exercise, and a group that used a combination of the two—only the groups who had exercise as part of their weight loss regimen noted an improvement in cognition.

It’s most important to concentrate on the type of exercise you perform if your goal is to maximize your cognitive health. A multi-component routine focused on balance, flexibility, and aerobic fitness is better than focusing on just one type of exercise. For example, tai chi has been heralded as an example of an all-encompassing exercise routine that significantly enhances cognition. A meta-analysis of research on tai chi and cognition found tai chi exhibited a greater effect on cognitive function than other types of exercise.

However, any exercise is better for your brain than none at all.

So, pick your exercise of choice! Go walking, running, swimming, hiking, or biking. Enjoy the fresh air. Get in touch with nature. And reap the many health benefits of exercise—both physical and mental.

The Science of Creating New Year’s Resolutions That Work

Research shows that people tend to make big life decisions at the first of the year, which gives us New Year Resolutions. This is the right time for changes both large and small.

Instead of following some of the usual folksy advice about how to make and keep New Year’s resolutions, you could, instead, use brain and behavioral science to craft New Year’s resolutions that will actually work.

Here are some ideas on how to do that.

1. Pick small, concrete actions. “Get more exercise” is not small. “Eat healthier” is not small. This is one reason New Year’s resolutions don’t work.

A lot of New Year’s resolutions are about habits — eating healthier, exercising more, drinking less, quitting smoking, texting less, spending more time “unplugged” or any number of other “automatic” behaviors. Habits are automatic, “conditioned” responses.

If it’s a habit, and you want a new one, it must be something really small and specific. For example, instead of “Get more exercise,” choose “Walk for at least 20 minutes at least four times a week” or “Have a smoothie every morning with kale or spinach in it.”

2. Use visual and/or auditory cues. Want to go for that walk everyday? Set up a place in your home where your walking shoes are. Don’t put them away in a closet. Put them in a place where you will see them when you get home from work or first thing in the morning. The shoes will act as a visual cue. And/or set an alarm on your phone called “Go for a walk” and have the alarm go off every morning at 7:30 a.m. People become conditioned to auditory and visual cues and that makes it easier for an action to become a habit.

3. Decide what you want, not what you DON’T want. Instead of setting a resolution of “I’m not going to check my email 10 times a day,” set it for what you ARE going to do: “I’m going to use “batching and check my email only twice a day.” Instead of “I’m going to drink less soda,” set the resolution as “I’m going to replace drinking a soda with drinking water.” Although this may seem not that different, it’s important. It’s easier for your brain networks to work on an intention stated in the “affirmative” than it is stated in the “negative.”

4. Write a new self-story. The best (and some would say the only) way to get large and long-term behavior change, is by changing your self-story.

Everyone has stories about themselves that drive their behavior. You have an idea of who you are and what’s important to you. Essentially you have a “story” operating about yourself at all times. These self-stories have a powerful influence on decisions and actions.

Whether you realize it or not, you make decisions based on staying true to your self-stories. Most of this decision-making based on self-stories happens unconsciously. You strive to be consistent. You want to make decisions that match your idea of who you are. When you make a decision or act in a way that fits your self-story, the decision or action will feel right. When you make a decision or act in a way that doesn’t fit your self-story you feel uncomfortable.

If you want to change your behavior and make the change stick, then you need to first change the underlying self-story that is operating. Do you want to be more optimistic? Then you’d better have an operating self-story that says you are an optimistic person. Want to join your local community band? Then you’ll need a self-story where you are outgoing and musical.

New Study Looks into Concussions and Suicide Risk

An assessment of cohort, cross-sectional, and case-control studies involving more than 7 million individuals has found an association between concussions, mild traumatic brain injury (TBI), and risk of suicide.

The analysis, led by Michael Fralick, MD, SM, of the Department of Epidemiology at Harvard TH Chan School of Public Health, reiterates a clinical trend reported as recently as this summer. In August, a Denmark-based study of a similar patient population size reported that those who suffer from concussions and/or TBI face a nearly two-fold greater risk of suicide.

This newest assessment involved a systematic search of studies reported from 1963 to May 1, 2017. Investigators included 17 analyses which featured 718,572 patients diagnosed with concussion and/or mild TBI, and 6,974,124 individuals not diagnosed with either neurological condition.

Among the 17 studies, 14 included patients in North America, 2 included patients in Scandinavian countries, and 1 was conducted in Australia. Military personnel—a subpopulation popularly associated with both TBI and suicide risk—were included in 7 studies, while children from the general population were included in 3 studies.

Investigators found there to be a more than two-fold greater risk of suicide in people to be diagnosed with at least 1 concussion and/or mild TBI compared to those not diagnosed with either (RR= 2.03 [95% CI: 1.47 – 2.80] P < .001). A majority of studies also reported a heightened risk of suicide attempt following a concussion and/or mild TBI. Additionally, all 8 studies to assess risk of suicidal ideation had reported a heightened risk following concussion and/or mild TBI diagnosis.

In separate, stratified analyses comparing military personnel to civilian populations, investigators reported a higher combined estimate for studies of nonmilitary populations (RR 2.36 [95% CI: 1.64 – 3.40] P < .01) than the combined estimate for studies of military populations (RR 1.46 [95% CI: 0.80 – 2.58] P < .01).

Despite there being a heightened risk of suicide in this patient population, investigators observed that “nearly all patients diagnosed with concussion and/or mild TBI did not die by suicide.” They theorized that abnormal activity on functional magnetic resonance imaging (MRI) as well as abnormal structural connectivity in the brain regions necessary for cognitive and emotional processing—trends noted in recent meta-analyses of mild TBI neuroimaging studies—could explain this trend of depression in individuals exposed to more TBI.

“In addition, multiple neuropathological models have been proposed for how neurobehavioral impairment may occur in the short term and long term after concussion and/or mild TBI,” investigators noted.

The most notable of these—chronic traumatic encephalopathy (CTE)—has been associated with contact sports, concussions and/or mild TBI, and symptoms of depression, anxiety and impulsivity. That said, it’s also been reported in athletes without any history of concussion or mild TBI.

“The lack of a prior documented concussion and/or mild TBI might be because of underreporting of these conditions, but this also raises the possibility that subconcussive events could be sufficient to cause (CTE),” Fralick and colleagues explained.

Making reference to notable former National Football League (NFL) players Junior Seau and Mike Webster—both of whom had previously suffered from concussions in their playing days and subsequently died from suicide years after—as well as to the prevalence of concussions and/or TBI and suicide in military personnel, investigators stressed the significance of their assessment.

“Although there has been anecdotal evidence reported in newspaper reports, movies, and documentaries suggesting a link between concussion and/or mild TBI and subsequent suicide, past studies on the topic have been limited by small sample sizes and conflicting results,” investigators noted.

They also emphasized the high prevalence of both concussions, which occur approximately 4 million times in the US annually—with up to 25% of patients experiencing chronic neuropsychiatric symptoms including anxiety and depression for years after injury.

“Evaluating the potential association between concussion and/or mild TBI and suicide is important, because concussion and mild TBI are common, affect individuals of every age, and are often preventable,” Fralick and colleagues wrote. “Furthermore, even if the absolute risk of suicide is low, evidence of an association between concussion and mild TBI and suicide across a range of populations is important because of the seriousness of the outcome.”

In an essay accompanying the meta-analysis, Donald A. Redelmeier, MD, MSHR, and Junaid A. Bhatti, MBBS, MSc, PhD, of the Departments of Medicine and of Surgery at the University of Toronto, noted the accumulated findings do not prove causality over correlation.

“Patients who receive a diagnosis of a concussion might have already had a latent psychiatric illness that contributed to the incident and the outcome,” the pair argued. “For example, one shared factor could be alcohol use, which is often poorly identified in medical data. Disentangling such factors is difficult because it is unethical to randomize patients to receive a concussion.”

That said, they added that Fralick and colleagues’ greatest contribution is by creating a comprehensive review of medical science suggesting a significant association between TBI and subsequent suicide risk. Consequently, they advise clinicals use proper terminology and etiquette when diagnosing concussion-like symptoms, and neurologists should be keen to suicide risk and the additional factors involved in suicidality.

After all, they conclude, concussions can be lethal in their own way.

“The major implication of this meta-analysis is to highlight that an acute concussion might add to long-term neuropsychiatric illness,” Redelmeier and Bhatti prose. “Health care needs to focus on the prevention of concussions, although the cost-effectiveness of specific tactics that are based on engineering, education, equipment, or regulation is uncertain.”

The study, “Association of Concussion With the Risk of Suicide,” was published online in JAMA this week.

What Kind of Happiness Do People Value Most?

Sure, everyone wants to be happy. But what kind of happiness do people want? Is it happiness experienced moment-to-moment? Or is it being able to look back and remember a time as happy? Nobel Prize winner Daniel Kahneman described this distinction as “being happy in your life” versus “being happy about your life.”  Take a moment to ask yourself, which happiness are you seeking?

This might seem like a needless delineation; after all, a time experienced as happy is often also remembered as happy. An evening spent with good friends over good food and wine will be experienced and remembered happily. Similarly, an interesting project staffed with one’s favorite colleagues will be fun to work on and look back on.

But the two don’t always go hand in hand. A weekend spent relaxing in front of the TV will be experienced as happy in the moment, but that time won’t be memorable and may even usher feelings of guilt in hindsight. A day at the zoo with one’s young children may involve many frustrating moments, but a singular moment of delight will make that day a happy memory. A week of late nights stuck at the office, while not fun exactly, will make one feel satisfied in hindsight, if it results in a major achievement.

While happiness scholars have long grappled with which form of happiness should be measured and pursued, nobody has simply asked people which version of happiness they seek. But if we want to find ways to be happy, it may help to understand what type of happiness we truly want.

In a series of studies, recently published in The Journal of Positive Psychology, we directly asked thousands of people (ages 18 to 81) about their preference between experienced and remembered happiness. We found that people’s preferences differed according to the length of time they were considering — and according to their culture. For Westerners, the happiness most people said they wanted for the next day was different from the happiness they said they wanted for their lifetime, even though one’s days add up to one’s life. We found this interesting; if people make decisions by the hour, they may end up with a different version of happiness than what they say they want for their life.

In one study, we asked 1,145 Americans to choose between experienced happiness (“where you experience happiness on a moment-to-moment basis”) and remembered happiness (“where afterwards you will reflect back and feel happy”) for either a longer timeframe (i.e., their life overall or next year) or a shorter timeframe (i.e., their next day or hour). The majority of participants chose experienced happiness over remembered happiness when choosing for their life (79%) or their next year (65%). By contrast, there was a roughly even split of participants who chose experienced happiness and remembered happiness when choosing what they wanted for their next hour (49%) or day (48%).  This pattern of results was not affected by individuals’ overall happiness, impulsivity, age, household income, marital status, or parental status.

After participants made their choices, we asked them to write a short paragraph explaining why. We found that those who favored experienced happiness mostly expressed a belief in carpe diem: a philosophy that one should seize the present moment because the future is uncertain and life is short. On the other hand, participants’ explanations for choosing remembered happiness ranged from a desire for a longer lasting happiness, to a nostalgic treasuring of memories, to the motivation to achieve in order to feel productive and proud.

Social Media: Why Does it Make Us Feel More Lonely?

Findings from a recently released study[i] demonstrate that social media use can directly impact our mental health, causing increased levels of depressive symptoms and loneliness. In an experimental study, researchers at University of Pennsylvania followed college students over the course of three weeks, asking them to send nightly screen shots of their battery usage (which reveals how much time they spent on social media per day). The experimental group was asked to limit their social media usage of Facebook, Instagram, and Snapchat to 10 minutes per platform per day (no more than 30 minutes per day total). The control group was told to continue social media use as usual. Researchers found that all students in the study showed decreased anxiety and “fear of missing out” (FOMO) scores over baseline, presumably due to self-monitoring throughout the three weeks. It seems that just being aware of how much you are using social media each day helps you use less and actually feel better in terms of worries over missing out on what others are doing. But interestingly, the experimental group (students who limited their social media use to only 30 minutes per day) had significantly lower depressive symptoms and loneliness than did the control group by the end of the three weeks.

This finding is eye opening in that many studies have shown a correlation between social media use and negative mental health symptoms— including depression, anxiety, loneliness, and even suicide-related outcomes[ii]. The relationship between negative mental health and social media use is strongest for those whose people whose usage patterns are the heaviest. While researchers continue to amass data indicating this connection, the actual direction of the relationship remained unclear: Is it that depressed and lonely people are more likely to seek out social media and use it more often than others, or does social media use directly contribute to people’s experience of more negative mental health symptoms? This study gives us initial evidence about the direction of the relationship.

Why Would Social Media Make Us Lonely?

In exploring the somewhat puzzling finding that social media use leads to negative mental health outcomes, particularly depression and associated loneliness, the question becomes, “Why? Why would social media use lead to increased depressive symptoms? Isn’t the purpose of using social media to be social, to increase and enhance our connections with others?” Looking at the pervasive use of social media in our current culture, there is no doubt that we are definitely more “connected”, but these online connections just don’t seem to be emotionally satisfying. When using social media for multiple hours per day to the neglect of face-to-face interactions, people report feeling less fulfilled and even more isolated. As people mindlessly scroll through their feeds, they compare themselves to others, which can create envy, feelings of rejection, and contribute to a “fear of missing out” on the great time everyone else seems to be having. Even more concerning, for younger users who are in the process of developing an identity, their development of an authentic sense of self can be impaired when they “live for likes” and measure their worth by the number of friends and followers they can accumulate. Further, when they are heavily immersed in social media, they are also likely to be sacrificing active participation in non-screen activities that are known to boost mental health and well-being. Finally, many users report that social media use contributes to decreased hours of sleep, and sleep deprivation also contributes to poor mental health.

Strategies for Social Media Resilience

While these findings seem like bad news for parents of teens (the heaviest users of social media), young adults, and actually any individual who is a heavy user of social media, the results of this particular study can be seen as encouraging in some ways— you don’t need to go cold turkey and put down your phone forever in order to feel better. An abstinence approach is simply unrealistic in current culture, particularly for younger people. The study demonstrates that people should become more mindful of their usage patterns (and that this practice alone will help curb our usage) and that they should put limits in place if they don’t want their social media experience to lead to increased depression and loneliness. How to start? Here are eight ideas to promote your social media resilience:

  1. Be intentional about Social Media Visits. Instead of considering social media as a 24-hour, ever-present experience in which you remain immersed, think about your platforms as simply a place to “visit”. Intentionally decide when to open your social media apps, decide how long you intend to visit, and when you intend to leave. While the highlighted study suggests that people who reduced their use to 30 minutes per day had more positive benefits than those who used more than 30 minutes, this might not be the right number for everyone. The point is to pay attention to your urge to look at social media, be mindful of how long you want to spend there, enjoy your brief visit, and then move on to something else in your life.
  2. Turn off Notifications and Close the Apps. Once you have closed your social media app/site, try not to think about it again until the next time you decide to visit. This is almost impossible if you receive notifications every few seconds about what you are missing out on by not checking your app. One way to help you do this is to change your notification settings so that you do not receive notifications about new posts, etc. If you are on a computer, close the window so you will not continue to receive notifications and messages as you try to do something else on your device.  It is exceedingly difficult to fully concentrate on other tasks (or on face-to-face conversations with real people) if you are constantly interrupted by a series of pings that draw you back into your feed.
  3. Become an Active Participant rather than a Passive Scroller. There is some research evidence to suggest that people who passively scroll through their feeds are more negatively impacted by social media than those who actively participate on others’ posts as they scroll (e.g., making comments, clicking “likes”, sharing stories). Try to intentionally interact with others’ posts when you visit your social media pages.
  4. Limit Social Media Platforms. Some research suggests that the more social media platforms you use, the more likely you are to experience depression and anxiety. In fact, in one study, the total number of media platforms that participants used was more strongly associated with depression and anxiety than was the total amount of time they spent on social media[iii].
  5. Put the Device Away at Least an Hour Before Bedtime. Social media use is associated with sleep deprivation, which can contribute to poor mental health. This occurs for two reasons: one, because the light emitted from your phone (or device) tends to suppress the production of melatonin, a naturally occurring hormone that your body produces in order to induce sleep. So using your phone or device at bedtime makes it harder for you to fall asleep. Second, many people report using social media at bedtime and then using it far longer than they intended, losing valuable hours of sleep. This is particularly detrimental for teens who sleep with their phones at night and whose sleep is continually disrupted by notifications and checking social media throughout the night. It is far better for teens to turn their phones in at night to an agreed upon charging area (not in their bedrooms) so that they can actually obtain much needed quality sleep[iv].

Click “Read More” for additional tips.

Why You Can’t Think Straight When You’re Sleep Deprived

After a bad night of sleep, we all typically feel distracted and off our mental game. But do you really know all the ways a lack of sleep interferes with your cognitive performance? Most of my patients are surprised to learn just how broadly it affects their ability to think at their best.

It’s difficult to identify a cognitive skill that isn’t affected by sleep and compromised by sleep deprivation. That’s how pervasive the effects of insufficient sleep are on the brain.

Thanks to recent research, we know that sleep deprivation interferes with brain function at a cellular level. A study by scientists at UCLA found that sleep deprivation interferes with the ability of some brain cells to function and communicate with one another. We’ve got billions of neuralcells working on our behalf, enabling us to make decisions, process information, focus on important information—and remember it down the road. Sleep deprivation slows that work down, compromising our mental performance.

Less robust brain-cell activity isn’t the only way poor sleep hampers our ability to think. Other recent discoveries have told us more about how lack of sleep changes brain function and cognitive performance.

Sleep deprivation…

disrupts levels of chemicals, including serotonin, dopamine, and cortisol, that affect thought, mood, and energy.
leaves key areas of the brain in an “always on” state of activation.
activates genes that interfere with optimal brain activity.
Because genetic makeup is different from one person to the next, the effects of sleep deprivation on brain function can be, as well—so, some people will experience the negative cognitive and mood effects of sleep deprivation more than others.

We’ve still got much to learn about the full effects of poor and insufficient sleep on cognitive performance and health. But as you’re about to see, what we know already offers many compelling reasons to make getting plenty of sleep a top priority.

You can’t focus well.

Attention is especially sensitive to the effects of sleep deprivation. You know this through experience when you have trouble focusing on tasks after a night of poor sleep. Unfortunately, “a night of poor sleep” is often a series of nights of poor sleep, leading to chronic sleep debt and continually compromised attention.

New research suggests that as many as 75 percent of people with ADHDmay have a chronic, underlying sleep problem stemming from a disruption to their circadian rhythms.

Attention is about focus and concentration—your ability to stay with tasks long enough to make meaningful progress. For most of us, focus is key to both our performance and our sense of purpose, in and away from work. Sleep deprivation makes focus harder to achieve.

Your reaction time slows down.

Attention isn’t only about focusing on big, thought-intensive tasks. It’s also about focusing on—and making sense of—what’s important right now. Remember those sluggish brain cells that result from being sleep deprived? Scientists in that recent study found that sleep deprivation slowed down neural cells’ ability to absorb visual information and translate that visual data into conscious thought. Research shows reaction times are dulled as much by sleeplessness as they are by alcohol.

Reacting to changing circumstances around us is a critical skill that helps keep us—and others—safe. And it can be significantly compromised by sleep deprivation.

You have trouble making—and storing—memories.

Research shows just how important sleep during middle age can be to memory and cognitive health in later years. A new study found that disrupted sleep during middle age, including insomnia, is connected to cognitive decline a decade or more later. (It isn’t just sleeping too little during middle age that is linked to greater risk for cognitive decline later on—the study found sleeping 9 or more hours a night was also associated with later-in-life cognitive problems.)

We know sleep is deeply critical to memory in all its phases—from acquiring memories, to storing them, to recalling them. All phases of memory are complex and involve multiple areas of the brain that are affected by lack of sleep.

Alzheimer’s: Artificial intelligence predicts onset

The team responsible suggests that, after further validation, the tool could greatly assist the early detection of Alzheimer’s, giving treatments time to slow the disease more effectively.

The researchers, from the University of California in San Francisco, used positron-emission tomography (PET) images of 1,002 people’s brains to train the deep learning algorithm.

They used 90 percent of the images to teach the algorithm how to spot features of Alzheimer’s disease and the remaining 10 percent to verify its performance.

They then tested the algorithm on PET images of the brains of another 40 people. From these, the algorithm accurately predicted which individuals would receive a final diagnosis of Alzheimer’s. On average, the diagnosis came more than 6 years after the scans.

In a paper on the findings, which the Radiology journal has recently published, the team describes how the algorithm “achieved 82 percent specificity at 100 percent sensitivity, an average of 75.8 months prior to the final diagnosis.”

“We were very pleased,” says co-author Dr. Jae Ho Sohn, who works in the university’s radiology and biomedical imaging department, “with the algorithm’s performance.”

“It was able to predict every single case that advanced to Alzheimer’s disease,” he adds.

Alzheimer’s disease and PET imaging

The Alzheimer’s Association estimate that around 5.7 million people live with Alzheimer’s disease in the United States and that this figure is likely to rise to almost 14 million by 2050.

Earlier and more accurate diagnosis would not only benefit those affected, but it could also collectively save about $7.9 trillion in medical care and related costs over time.

As Alzheimer’s disease progresses, it changes how brain cells use glucose. This alteration in glucose metabolism shows up in a type of PET imaging that tracks the uptake of a radioactive form of glucose called 18F-fluorodeoxyglucose (FDG).

By giving instructions about what to look for, the scientists were able to train the deep learning algorithm to assess the FDG PET images for early signs of Alzheimer’s.

We Need to Talk More About Mental Health at Work

Alyssa Mastromonaco is no stranger to tough conversations: she served as White House deputy chief of staff for operations under President Obama, was an executive at Vice and A&E, and is Senior Advisor and spokesperson at NARAL Pro-Choice America. So when Mastromonaco switched to a new antidepressant, she decided to tell her boss.

“I told the CEO that I was on Zoloft and was transitioning to Wellbutrin,” Mastromonaco said. “I can react strongly to meds, so I was worried switching would shift my mood and wanted her to know why. I talked about it like it was the most normal thing in the world —it is!”

Her boss was supportive. “You got it,” she said.

When Mastromonaco goes to work, she and her mental health struggles do not part ways at the door. “You want me,” she said, “you get all of me.” Mastromonaco brings tremendous talent to her workplace — but she also brings her anxiety. The same is true for high-performing employees everywhere: one in fouradults experiences mental illness each year and an estimated 18% of the US adult population have an anxiety disorder. And yet we’re loath to talk about mental health at work. If we’re feeling emotional at work, our impulse is to conceal it — to hide in the bathroom when we’re upset, or book a fake meeting if we need alone time during the day. We’re hesitant to ask for what we need — flex time, or a day working from home — until we experience a major life event, like a new baby or the illness of a parent. We would more likely engage in a trust fall with our boss than admit that we have anxiety.

Mental illness is a challenge, but it is not a weakness. Understanding your psyche can be the key to unleashing your strengths — whether it’s using your sensitivity to empathize with clients, your anxiety to be a more thoughtful boss, or your need for space to forge new and interesting paths. When we acknowledge our mental health, we get to know ourselves better, and are more authentic people, employees, and leaders. Research has found that feeling authentic and open at work leads to better performance, engagement, employee retention, and overall wellbeing.

Still, less than one third of people with mental illness get the treatment they need, and this comes at a cost — to people and to companies. Failure to acknowledge an employee’s mental health can hurt productivity, professional relationships, and the bottom line: $17-$44 billion is lost to depression each year, whereas $4 is returned to the economy for every $1 spent caring for people with mental health issues.

So what needs to change? In the twenty-first century, human capital is the most valuable resource in our economy. And though much has been done (rightly) to promote diversity at work, there’s a giant hole when it comes to understanding how temperament and sentiment play into the trajectory of success. As we recognize neurological and emotional diversity in all of its forms, workplace cultures need to make room for the wide range of emotions we experience. Professional support needs to get better. We need to have the option to ask for help, and feel safe doing so (depression screenings are free under the Affordable Care Act, and some companies offer an Employee Assistance Program). In short, we need more flexibility, sensitivity, and open-mindedness from employers. The same treatment and attention they’d give to a broken bone or maternity leave. We’re not there yet, but some companies are trying to bring conversations about mental health to the forefront.

EY (formerly Ernst and Young) launched a We Care program two years ago to educate employees about mental health issues, encourage them to seek help if they need it, and be a support to colleagues who might be struggling with mental illness or addiction. They started the program out of a demonstrated need. “Our Employee Assistance Program was starting to hear more conversations about anxiety,” said Carolyn Slaski, EY Americas Vice Chair of Talent. “They told us that it was very taboo — something that people don’t normally talk about — but they were seeing more activity, so we decided to schedule a session to talk about anxiety. Just talk about it and see what would happen.”

Since the advent of the We Care program, 2000 EY employees have attended these sessions, which always have a senior-level sponsor and a mental health professional on hand. Someone in leadership kicks it off by sharing their story. This sends the message that anxiety is not toxic and attendance is not a career-dampener.

The company also has an employee assistance hotline that offers confidential support — calls related to anxiety have increased 30% over the last two years. “You have to notice first if someone is struggling,” said Slaski, “and ask them if they’re okay. Learn how to listen to their concerns, and then act. Our company has 47,000 US employees, and 250,000 globally. If I can get my team comfortable just noticing when someone has an issue, then there is so much more we can do for them. These are people reaching out for help. We want to help. We don’t want to have a stigma around it.”

Other companies, like Michigan-based furniture store, Herman Miller, offer free onsite counseling sessions to employees and their families, and courses on mental health first aid that teach them how to recognize signs of mental illness in others. The goal is to empower people to achieve their optimal state of well-being.

What organizations like EY and Herman Miller realize is that, given the right support, employees who struggle with their mental health can do great work. Most people who suffer from chronic anxiety or depression are excellent at faking wellness. We put on our makeup, get dressed, and show up on time. But we never know when an attack might be around the corner. This is why a work environment that is open and understanding is so important. Anxiety is a lingering expectation that something bad is going to happen, and if we don’t talk about it, it’s harder to recognize our triggers and learn healthy ways to cope. But when we do talk about it, we can actually teach ourselves to harness it in ways that play to our strengths.

What’s the Best Way to Treat a First Bout of Depression?

In the midst of these difficulties, a person faces an important decision: What is the best way to treat my depression? Options include talking with close friends and family members, self-help books and apps, over-the-counter remedies, psychotherapy, and prescription medication, among others. Many people find these choices overwhelming and are not sure where to begin, especially because it’s their first time dealing with depression.

Thankfully many people have thought really carefully about this decision, and none more than psychologist Robert J. DeRubeis of the University of Pennsylvania. I recently interviewed Rob to discuss the current state of the science in depression treatment research.

Do I Have a Chemical Imbalance?

First, let’s think about what causes depression, which may affect choice of treatment. An explanation that seems to have saturated popular culture is that depression is caused by a “chemical imbalance.” Most often the imbalance is said to involve too little serotonin—with the understanding that a drug is needed to fix it. I asked Rob for his perspective on this theory:

Seth J. Gillihan: What causes depression? Is it a chemical imbalance?

Robert J. DeRubeis: The chemical imbalance theories that came around in the 1950s were quite intriguing and they captured the imagination of the profession. There’s no doubt that whenever we are in a particular mood or when we come out of that mood, there are associated events in the brain. That’s a given and we all understand that.

But theories that led some to talk about a ‘chemical imbalance’ as a rather simple matter have really not panned out. There’s nothing simple about the neurotransmitters and their relation to depression. The brain’s a very complicated organ, and current thinking is more focused on the regulatory systems in the brain that are more active in some people than in others.

SJG: And yet that simple account of a chemical imbalance has been surprisingly persistent given how little data there have been to support it.

RJD: Yes, and of course it’s connected to the predominant treatments in the US and many other Western countries for people with mood difficulties—that is, the antidepressant medications. And so there are some kind of interesting links between what we think the antidepressant medications are doing and what we know about what happens at the synapses in certain areas of the brain, but the connections are not very tight, strong, or well understood. And indeed as I’ve read these literatures and contributed a bit to them, it’s common enough that what we find about a given neurotransmitter system is the opposite of what was first proposed.”

Can Psychotherapy Really Help with Severe Depression?

The lack of evidence for a chemical imbalance in depression might call into question whether the condition requires a chemical solution. I asked Rob about existing research comparing the effectiveness of meds and psychotherapy, particularly for severe cases of depression.

SJG: When I started in my doctoral program at Penn in 2001, the idea was that medication was like a key that fit in the lock of your chemical imbalance, which fed the idea that the real treatment for real depression was medication. Someone I interviewed with at Penn actually predicted that in a study you were doing at the time, ‘the meds were going to beat up on the therapy’ in the head-to-head comparison of CBT and an SSRI. So I wanted to get your perspective on why it was widely assumed that medication was better than the best therapy for treating severe depression.

RJD: In the 1970s and ’80s, the possibility that we could correct a simple imbalance was very exciting, and the medications that were being used were more effective than placebo pills, on average, for people with substantial depression. So the idea was that ‘Here we have a real and serious treatment for depression.’

Then along came a relatively small study—but an intriguing one—that found that cognitive therapy outperformed medication in that randomized trial. This was surprising to many who believed that ‘real’ depression needs a ‘real,’ physical treatment, and there were many skeptics, as there should have been. But then a couple of other studies showed very similar kinds of effects that were encouraging about the benefits of cognitive therapy in comparison to medication.

And then in what was thought to be a large study comparing medications with cognitive behavioral therapy, there were reports that medications outperformed CBT for those with the most severe symptoms [Elkin et al., 1989—a study that’s been cited over 3200 times]. This finding confirmed preexisting notions among the psychiatric community, and also spread to the public. The belief was that ‘now that we’ve done the real study and we’ve looked at more severe depression, we can see that we were too optimistic to think that CBT could work as well as meds.'”

This 1989 study did indeed seem to have a lot of sway over the depression treatment field; it was frequently cited as evidence for the superiority of medication over psychotherapy. But as Rob explains, the implications of that study’s findings appear to have been overblown.

RJD: It turns out that in that study, the comparison that everyone was excited about and took very seriously was a comparison of 27 patients in each group. Now, that’s not nothing, and it certainly is data that one needs to take into account. In the 1999 paper we wrote, those 27 patients who got medication in that trial did significantly better than those in cognitive therapy, but it turned out that study was unusual in that regard. Clinical science is a larger enterprise than one study, and when we were able to look across several studies, there was no advantage of the medications at all in the short run. Cognitive therapy and medications, on average, performed essentially exactly the same.

Does Medication Work Faster Than Psychotherapy?

While CBT and medication appear to be equivalent in their short-term effectiveness, some have suggested that medication works faster, and thus can lead to quicker relief.

SJG: One of the other common arguments for giving antidepressant medications right away is that they work faster than psychotherapy. Is that the case?

RJD: They don’t. And this belief again somehow meets up with preconceptions, but in the analyses we’ve done, there really isn’t a difference in speed of the effects, and if there are any, they’re really slight. Of course, it’s going to depend a bit on what the medication is and how active and directive and potent the psychotherapy is. But if you’re talking about an effective antidepressant and an effective cognitive behavioral therapy, the rates of change are pretty much on top of each other, on average.

What You Need To Know About Poor Sleep And Alzheimer’s Risks

I work every day at keeping my brain in good shape. I read, I play games with my kids (Words with Friends, anyone?), take supplements, you name it. I eat a diet that emphasizes brain food—including those omega 3s I wrote about recently. I also make sure to get plenty of sleep.

I’m working hard today so that my cognitive abilities stay strong decades down the road.

But living a healthful lifestyle doesn’t keep us free from worry about the long-term risks for cognitive decline and neurodegenerative diseases like dementia. Many of my patients who are moving through middle age talk with me about their fears of losing memory, mental clarity, and cognitive functions with age—and of their concerns about Alzheimer’s in particular.

There’s new research out about the link between sleep and Alzheimer’s I want to share with you, research that deepens our understanding of how poor sleep and Alzheimer’s disease are connected. Most of us probably know, or know of, someone who has been affected by Alzheimer’s. Unfortunately, the numbers bear that out. According to the Alzheimer’s Association, someone in the US develops Alzheimer’s disease every 65 seconds. Today, there are 5.7 million Americans living with this neurodegenerative disease—the most common form of dementia. By 2050, estimates predict that number will rise to 14 million.

What causes Alzheimer’s disease?

The tough answer is, we don’t yet know. Scientists are working hard to identify Alzheimer’s underlying causes. Though we don’t yet know why, what we do know is that the disease causes fundamental problems in the way brain cells operate.

Billions of neurons in our brains are constantly at work, keeping us alive and functioning. They enable us to think and make decisions, store and retrieve memory and learning, experience the world around us through our senses, feel our whole range of emotions, and express ourselves in language and behavior.

Scientists think there are several types of protein deposits that cause the degradation of brain cells, leading to the progressively more serious problems with memory, learning, mood and behavior– the hallmark symptoms of Alzheimer’s. Two of those proteins are:

Beta amyloid proteins, that build up to form plaques around brain cells.

Tau proteins, that develop into fiber-like knots—known as tangles—within brain cells.

Scientists are still working to understand how plaques and tangles contribute to Alzheimer’s disease and its symptoms. With age, it’s common for people to develop some of these build ups in the brain. But people with Alzheimer’s develop plaques and tangles in significantly greater amounts—especially in areas of the brain related to memory and other complex cognitive functions.

There’s a growing body of research that indicates poor quality sleep and not getting enough sleep are linked to greater amounts of beta amyloid and tau proteins in the brain. One study released in 2017 found that in healthy, middle-aged adults, disruptions to slow wave sleep were associated with increased levels of beta amyloid proteins.

Daytime sleepiness is linked to Alzheimer’s-related protein deposits in the brain

A just-released study shows that excessive daytime sleepiness is linked to higher amounts of beta amyloid protein brain deposits in otherwise healthy older adults. Scientists at the Mayo Clinic set out in their study to answer a big question about causality: does build-up of beta amyloid protein contribute to poor sleep, or does disrupted sleep lead to the accumulation of these proteins?

The Mayo Clinic already had in progress a long-term study about the cognitive changes associated with aging. From that already-running study, scientists selected 283 people, who were over age 70 and did not have dementia, to investigate the relationship between their sleep patterns and their beta amyloid protein activity.

At the beginning of the study, nearly one-quarter—a little more than 22 percent—of the adults in the group reported that they experienced excessive daytime sleepiness. Being excessively sleepy during the day is, of course, a prime indicator you’re not getting enough sleep at night—and it’s a symptom associated with common sleep disorders, including insomnia.

Over a seven-year period, scientists looked at patients’ beta amyloid activity using PET scans. They found:

People with excessive daytime sleepiness at the beginning of the study were more likely to have higher levels of beta amyloid over time

In these sleep-deprived people, a significant amount of beta amyloid build-up occurred in two particular areas of the brain: the anterior cingulate and the cingulate precuneus. In people with Alzheimer’s, these two areas of the brain tend to show high levels of beta amyloid build up.

This study doesn’t provide a definitive answer to the question of whether it is poor sleep that’s driving amyloid protein build up, or the amyloid deposits that are causing sleep problems—or some of both. But it does suggest that excessive sleepiness during the day may be one early warning sign of Alzheimer’s disease.

The Mayo Clinic study lines up with more recent research that looked at the relationship between poor sleep and Alzheimer’s risk. Scientists at the University of Wisconsin, Madison investigated the possible links between sleep quality and several important markers for Alzheimer’s, found in spinal fluid, including markers for beta amyloid proteins and the tau proteins that lead to nerve-cell strangling tangles.

In this study, the scientists tested people without Alzheimer’s or dementia—but they specifically chose individuals who were at higher risk for the disease, either because they had a parent with Alzheimer’s or because they carried a specific gene (the apolipoprotein E gene), which is linked to the disease.

Like their counterparts at Mayo, the Madison researchers found that people who experienced excessive daytime sleepiness showed more markers for beta amyloid protein. They also found daytime sleepiness linked to more markers for tau proteins. And people who reported sleeping poorly and who had greater numbers of sleep problems showed more of both the Alzheimer’s biomarkers than their sound-sleeping counterparts.

The brain cleans itself of Alzheimer’s-related proteins during sleep

It was just a few years ago that scientists discovered a previously un-identified system in the brain that clears waste, including the beta-amyloid proteins associated with Alzheimer’s. (The University of Rochester Medical Center scientists who made this discovery named it the “glymphatic system,” because it functions a lot like the body’s lymphatic system in removing waste from the body, and is operated by the brain’s glial cells.) Scientists didn’t just identify the glymphatic system—a groundbreaking discovery in and of itself. They also found that the glymphatic system goes into overdrive during sleep.

When we sleep, the scientists discovered, the glymphatic system becomes 10 times more active in clearing waste from the brain.

This is some of the most compelling research yet to show the importance of healthy sleep to long-term brain health. When you sleep, scientists now think, your glymphatic system steps up its activity to remove potentially harmful debris that has collected over your waking day. If you sleep poorly or go without sufficient sleep on a regular basis, you risk missing out on the full effects of this cleansing process.

Irregular sleep wake cycles linked to Alzheimer’s

Another possible sleep-related early warning sign of Alzheimer’s? Disrupted sleep patterns, according to new research. Scientists at Washington University School of Medicine tracked the circadian rhythms and sleep-wake cycles of nearly 200 older adults (average age, 66), and tested them all for very early, pre-clinical signs of Alzheimer’s.

In the 50 patients who showed pre-clinical signs of Alzheimer’s, all of them had disrupted sleep-wake cycles. That meant their bodies weren’t adhering to a reliable pattern of nighttime sleep and daytime activity. They were able to sleep less at night, and inclined to sleep more during the day.

One important thing to note here: The people in the study who had disrupted sleep-wake cycles weren’t all sleep deprived. They were getting enough sleep—but they were accumulating sleep in a more fragmented pattern over the 24-hour day.

This study suggests that disrupted circadian rhythms may be a very early biomarker for Alzheimer’s, even in the absence of sleep deprivation.

When my patients share with me their worry about their long-term cognitive health, and their fears of Alzheimer’s, I understand. I’ll tell you what I tell them: the best thing you can do is to translate your worry into preventative action, and take care of yourself today, with the goal of lowering your risk for cognitive decline and dementia in mind. Looking at all that we know, it’s clear that getting plentiful, high-quality sleep is an important part of that action plan.

Dementia – six diet and lifestyle changes to lower Alzheimer’s disease risk at home

Dementia affects about 850,000 people in the UK, according to the NHS.

It’s the name given to a group of symptoms linked to an ongoing decline in brain function.

Common dementia symptoms include memory loss, difficulty concentrating and mood changes.

But, you could lower your risk of dementia – including Alzheimer’s disease – by making these six lifestyle swaps.

Boost nutrition
Certain foods could help to lower your risk of dementia, according to Cytoplan’s nutritional therapist, Clare Daley.

Eat more foods that are low in sugar, but moderate in starchy carbohydrates, including sweet potato, carrots and leafy greens.

Be sure to eat plenty of vegetables, and foods that contain healthy fats, including avocados and nuts.

“Nutrition is essential for cognitive health,” said Daley. “Eating foods that are low in sugar can prevent the development of insulin resistance.

“The brain is very susceptible to damage by ‘free radicals’ and antioxidants provide protection from these.”

Improve gut health
Having bad gut health causes inflammation, which is one of the many chronic health conditions linked to cognitive decline, said the nutritional therapist.

Improve your gut health by eating more green leafy vegetables, chicory, apples, olive oil, and dark chocolate.

“To improve gut health, remove specific foods from your diet that may trigger gut symptoms,” she said.

“Add in nutrients and fibre to support gut health.”

Get rid of stress
Feeling persistently stressed can actually kill brain cells, and increase the risk of cognitive decline.

Some stress-relieving exercises could help you to feel more relaxed when at work or at home.

“In order to effectively manage stress, it is important to focus on stress reduction activities that work for you.

“These could include yoga, meditation, mindfulness, massage, breathing techniques, gardening, reading, listening to music or keeping a happiness and gratitude journal.

“When we learn to effectively manage our stress, we see an improvement in our sleep, energy, patience, resilience, focus and memory.”

Sleep well
The health of your brain relies on getting a good night’s sleep, warned Daley.

“Sleep is vital for optimal brain health as during sleep our brain cells detoxify and cleanse,” she said.

“Melatonin is the hormone responsible for restful sleep, however as we age we produce less, and therefore older individuals often experience more trouble sleeping.

“Whilst eight hours of uninterrupted sleep is possibly a dream for many of us, it’s important to find sleep strategies that work for you.”

Try sticking to a regular bedtime routine to boost your chances of falling asleep faster. Eating well, regular exercise and avoiding bright digital screens could also help you get a good night’s sleep.

13 Things Confident People Don’t Do

Self-confident people know what they value and what they want. They share common habits and thought patterns that help them achieve their goals. Here are 13 things self-confident people don’t do, so you can be one of them.

1.   They don’t believe they are worth less than others. One of the fundamental beliefs underlying confidence is, “My worth as a person is equal to everyone else’s.” That doesn’t mean you don’t have to work for what you want, and it certainly doesn’t mean life divides up its rewards evenly. But it does mean you have the same right as anyone else to stand up for yourself, pursue your dreams, enjoy your life, and make a difference in the way that’s most meaningful to you.

2.  They don’t fear self-doubt. Confident people realize that not all self-doubt is a bad thing. Sometimes fear is a signal that you haven’t prepared enough for the big presentation, the recital or the interview. Practicing what you plan to say and do will give your mind something to fall back on when the pressure is high. The voice of self-doubt may also be saying you need to get more information, move in a different direction, or take a break.

3.  They don’t hesitate too much. The flip side of #2 is that once you’ve put in the hours of practice, you should be able to take action without obsessing over what might go wrong.

4.   They don’t wait for the “big” move. When you envision a confident person, you might think of someone who takes big, bold actions, like running for office or making a marriage proposal on the Jumbotron. But there can be boldness and bravery in small steps. Those incremental changes build on themselves, both through your own feelings of accomplishment and reinforcement from others.

5.  They don’t confuse confidence with arrogance. Some people fear confidence because they don’t want to start stepping on other people’s toes, taking up too much space or just plain being a jerk. But confidence isn’t the same as arrogance or narcissism. In fact, when you feel confident in yourself, you often become less self-absorbed. When you stop worrying so much about how you’re coming across, you can pay more attention to those around you.

6.  They don’t fear feedback or conflict. A confident person can accept helpful feedback and act on it without getting defensive. When your sense of self-worth is no longer on the table, you can handle criticism or even outright rejection without allowing it to break you. By the same token, confidence doesn’t mean you mow other people down when a conflict arises. It’s possible to speak your mind with conviction and still make room to listen to someone else’s point of view and even reach a compromise.

7.   They don’t fear failure. Confidence doesn’t mean you won’t fail. It doesn’t mean you’re always smiling or that you never experience anxiety or self-doubt (see #2). Instead, it means you know you can handle those feelings and push through them to conquer the next challenge.

8.  They don’t have to make things perfect.  Perfectionism is a form of faulty thinking that contributes to low self-confidence. If you believe you have to have something all figured out before you take action, those thoughts can keep you from doing the things you value.

A Real Dietary Treatment for Depression

I’m often asked in my work with patients about various diets and supplements that get promoted in books and blogs as miracle cures for everything from anxiety to autism.  As someone who tries to be very careful about medications, I want to be encouraging about nonpharmacological treatments, but at the same time, it’s important to base medical advice on real science, rather than hype. After all, pharmaceutical companies aren’t the only ones prone to making grandiose and exaggerated claims about their products. Supplement makers and fad diet promoters do the same thing, but for some reason, there is less public outrage and skepticism about these “natural” interventions.

What often happens is that particular diets or supplements often sound scientific and even make physiological sense as to why they theoretically might be useful for certain mental health problems, but nobody seems to have the time (or maybe the guts) to put rubber to the road and actually rigorously test the product in a real human clinical trial.

This is why I was excited to read about an actual randomized trial in Australia from respected dietary researcher Felice Jacka and colleagues of a specific diet designed to help adults with major depressive disorder. The official name of the study was SMILES, which stands for Supporting the Modification of Lifestyle in Lowered Emotional States. (All clinical trials that want to be important and groundbreaking now need to come up with these rather forced acronyms.)

Perhaps not unexpectedly, the dietary treatment was not some flashy new supplement or bizarre new approach, but rather a general healthy Mediterranean-inspired diet that urged people to increase consumption of fruits, vegetables, lean protein, and whole grains while decreasing consumption of carbohydrates, sweets, and heavily processed foods. Importantly, participants were also allowed to continue the depression treatments that they were already doing, which was mainly psychotherapy, antidepressant medications, or some combination.  In this way, the study really was testing the added benefit of dietary modification rather than looking at what happens when diet is used as the primary intervention.

The 67 subjects in this study suffered from major depression that was rated as being in the moderate to severe range.  They also had baseline diets that were not particularly healthy in the first place.  Half of the sample was randomized to social support (basically friendly chats with a research assistant), while the other half received 7 sessions of personalized nutritional counseling and motivational support to a “ModiMedDiet” that emphasized more healthy food choices as described above.  The counselors also focused on curbing alcohol use beyond 2 glasses of wine per day.

The results were very encouraging. Subjects in the dietary modification group generally did improve their eating habits and this, in turn, appeared to reduce their depressive symptoms. On their main instrument that tracked depression severity, subjects in the dietary modification group improved significantly more than those in the control condition.  In terms of raw scores, the mean depression score for the dietary modification group dropped from 26 to 15 over 12 weeks, while for the control group it fell from 25 to about 20.  This would be considered to be a fairly large effect that is comparable to—and even surpasses—some studies of antidepressant “augmentation” with other medications, such as antipsychotic agents, which carry with them the potential of some serious side effects.  By the end of the study, about a third of the subjects in the dietary group were rated as being “in remission” from their depression compared to only 8% in the control group. Anxiety scores also improved with the dietary intervention.  Improvement in depression was found to be independent of changes in weight.

The authors acknowledge that they can’t be sure exactly how a better diet improves depression, but they do note other research that suggests pathways related to decreased inflammation, antioxidant effects, and changes in one’s gut bacteria can affect the brain. One aspect of the study that does muddy the waters a bit is their focus not only on diet but alcohol use as well, which can worsen depression.  I’d honestly be a little more confident in their conclusions had they demonstrated that the improvement occurred independently on any changes in alcohol consumption.

Also worth noting is that the subjects were obviously aware of what group they were in rather than being “blinded” as in the case of an active drug versus placebo trial.  Finally, the authors acknowledge that their sample size was relatively small and, indeed, smaller than they had hoped, perhaps reflecting how challenging it can be to get people to want to make substantive changes in how they eat.  Nevertheless, this is an important advance as the first (and long overdue) real randomized clinical trial that demonstrates how changing one’s diet and positively improve mental health.

Harvard Psychology Professor Discusses How Trauma Affects Memory

ARI SHAPIRO, HOST:

Soon after Christine Blasey Ford went public with her story about Brett Kavanaugh, critics began to question her memory. Ford says Kavanaugh and a friend assaulted her at a house party when they were teenagers. They are both in their 50s now. Ford has recalled the attack in gripping detail to The Washington Post. But she can’t say whose house they were in or exactly how they ended up there. To shed light on how trauma affects memory, let’s bring in Harvard psychology professor Richard McNally.

Welcome.

RICHARD MCNALLY: Thank you. Thank you for having me.

SHAPIRO: We know that memory in general is not entirely reliable and it can be difficult to precisely recall events from long ago. Does that change when we are talking about trauma and traumatic events?

MCNALLY: Yes. In fact, the stress hormones that are released during a terrifying experience tend to render the central features of that experience vivid and memorable. That said, the process does not operate like a videotape machine. So for example, it doesn’t infallibly encode every detail of the experience. Nevertheless, the central features are typically retained – often all too well, as the case of post-traumatic stress disorder exemplifies, and sometimes at the expense of the peripheral details.

SHAPIRO: Do you find that these kinds of memories change over time the farther people get from the event?

MCNALLY: No, not necessarily. With traumatic events, they’re fairly stable. I mean, memory is – it’s a dynamic process. That’s true. But to the extent that you’ve experienced the intense emotion at the encoding of the memories, it tends to render the central features of them quite stable. So you find this with war veterans, rape victims, victims of torture or natural disaster. They don’t forget these things. They tend to be recalled quite vividly.

SHAPIRO: So you say the central event may remain vivid while peripheral details may not. That seems to come to bear in the Ford case, where she is saying she remembers the alleged incident very clearly but can’t say for certain whose house she was at.

MCNALLY: Exactly. Right. Yeah, so the central features are those that the person’s attending to. They’re are often the most threatening, the most terrifying features of the experience; where the day in which it happened or the house or a dress or the day of the week it happened – these things may get scrambled up, forgotten because they’re not really the ones that you are attending to at the very moment of terror.

SHAPIRO: Brett Kavanaugh categorically denies that anything like this assault ever happened. And he has suggested to Senator Orrin Hatch, Republican of Utah, that maybe this is a case of mistaken identity. Does it seem plausible to you that Ford may be remembering this traumatic incident correctly but not the cast of characters?

MCNALLY: That’s possible. That’s certainly possible that there’s a mistaken identity. I really don’t know. I don’t know enough about the case, quite frankly. But eyewitness testimony is sometimes fallible. But the memory of the actual (inaudible) that a person might experience is unlikely to be garbled up to that extent.

SHAPIRO: Another variable here is alcohol. Ford told The Washington Post that Kavanaugh was stumbling drunk during this alleged incident. How does alcohol affect recall?

MCNALLY: Well, alcohol can sometimes impair the encoding and, therefore, the memory of experiences. The most dramatic examples are alcoholic blackouts, where the person is behaving and acting and so forth but has consumed so much alcohol that they have no memory of it at all. I’m not saying that’s necessarily the case here, but alcohol does not improve memory. If anything, it tends to impair it.

SHAPIRO: Richard McNally is a clinical psychologist who teaches at Harvard University.

Thanks for joining us today.

MCNALLY: Thank you for having me.

How to Take a Break From Your Phone — and Why You Should Do It More Often

It’s rare but it happens. You forget your phone — whether you’re engrossed in conversation with friends, fail to check notifications after a peaceful yoga class, or simply leave the device across the room for a few hours. Shockingly, for a brief period of time, it’s as if your phone didn’t exist.

Today, people constantly look at, think about, and remain physically close to their screens. To be so intensely focused on a task that text messages go unread for hours is unusual. To be so engrossed in a task or activity that all distraction evaporates seems inconceivable.

In fact, such freedom is attainable. A phenomenon called flow state constitutes total absorption in an experience, such as surfing, writing, dancing, playing jazz, or painting. Once a person has achieved immersive focus in one task, they describe flow as a sustained period of cognitive clarity, self-confidence, joy, ecstasy, and unobstructed consciousness. Psychologist Mihaly Csikszentmihalyi coined the phrase in 1990.

Since then, everyone from professional athletes to special ops military has studied flow. Being in “the zone” can lead to peak performance, for instance, 12 three-pointers in one basketball game. It has informed innovations in game learning, where immersive design and achievable goals teach players new skills. Flow can be therapeutic, productive, educational, and downright spiritual.

So why can’t we flow all the time? Like animals, the human brain is wired to perceive distractions.

“Our ancestors had to watch out for snakes, saber-toothed tigers, and enemy tribes all the time — and if they did not, they stopped surviving,” said Csikszentmihalyi.

Unfortunately, the brain that evolved to sense distractions (and keep early humans alive) can’t be turned off so easily. Enter the mobile alert, the Slack message, the Instagram like. Each tiny communication signals a dopamine hit to the brain, hence why our phones are so addictive. But over time, the constant competition for our attention from all these apps and pings become less gratifying and more overwhelming. For Csikszentmihalyi, consumer technology presents a sinister picture: the business of commodifying the human mind.

“If we are always open to interruptions from the outside through the use of mobile devices, we risk giving up control of our lives to external agents who don’t really care about our lives, but only for how to gain our support—financial, political, or whatever,” he said.

“Honestly, have we abdicated our purpose just because of these insistent micro asks?” Jamie Wheal, director of the Flow Genome Project, told The New York Times. “Have we just completely ceded our center, completely ceded clarity, and it was all just based on 20-something bro-grammers trying to crack our attention spans?”

The numbers aren’t great. The average human attention span now hovers around eight seconds, shorter than a goldfish and down from 12 seconds in the year 2000. Americans devote more than 10 hours per day to screens, according to a 2016 Nielsen report.

But that doesn’t mean people don’t or can’t achieve the bliss that comes with flow. Perhaps you’ve even experienced it a time or two, since flow feels different for everybody. Teammates of Kobe Bryant say he goes silent when he’s flowing, but after he scored 81 points in one game, Bryant remained perplexed. “It’s tough to explain … To sit here and say I grasp what happened, that would be lying.”

How to Break Free

Today, one clue you may have reached flow is forgetting your phone. It makes sense since, according to Csikszentmihalyi, it’s easier to flow away from devices. He suggests setting aside one hour of free time per day to allow screens to “shape our minds,” then turning them off.

Find a task or hobby that won’t challenge your skill level too highly but which demands close focus. Most importantly, you should love it. That way you’ll be inclined to sustain the activity, repeat it, and increase your skill level over time. (Many people don’t reach a “runner’s high” until several miles in, or don’t trance until the sixth or seventh EDM song.) Look for activities where you either can’t reach for your phone or aren’t inclined to, such as mountain biking or knitting. Finally, make conscious choices to keep technological distractions at bay even when your phone is handy; for example, don’t buy Wi-Fi on your next flight.

“The information we carry in our brains will determine the content and quality of our lives,” said Csikszentmihalyi.

If the information that’s arriving to us is not information we choose, but rather in the form of interruptions, we have little control over it. Make deliberate choices in how you spend your time and develop your skills. You’ll focus. You’ll drop in. You’ll flow. And you will, blissfully, forget your phone ever existed.

How to Get Bad Sleep Back on Track

If you’ve ever lain in bed staring at the ceiling for what feels like forever, you know the pain of insomnia. The missed opportunity for sleep is bad enough, not to mention the worry about what it will mean for your performance the next day.

I’ve written elsewhere about the best way to treat chronic insomnia, which involves cognitive behavioral therapy for insomnia (CBT-I). If you’ve battled insomnia for years and have tried everything else, give CBT-I a try; if you’ve never tried treatment for your insomnia, CBT-I is a great place to start.

But how can we prevent chronic insomnia in the first place? To answer this question I spoke with Dr. Michael Perlis, a psychologist and sleep specialist at the University of Pennsylvania. Dr. Perlis works at the frontier of sleep medicine, and has played a key role in developing CBT-I; he’s the first author on a therapist guide for CBT-I entitled Cognitive Behavioral Treatment of Insomnia: A Session-by-Session Guide.

Let’s start by distinguishing between two different types of insomnia.

What Is Acute Insomnia?
Insomnia means trouble sleeping, whether it happens at the beginning, middle, or end of the night. As Dr. Perlis explains, “Insomnia includes not being able to fall asleep or stay asleep, or waking up too early in the morning.” Those difficulties can last a short time (acute) or a long time (chronic), and the distinction matters. So what is acute insomnia?

Michael L. Perlis: Somewhere between a few days and two weeks of three or more days per week is often considered the threshold of acute insomnia. Some people go as much as a few days to three months before they call it “chronic,” so everything before three months is considered acute insomnia.

Acute Insomnia Is Very Common—and Most People Recover
Most of us have experienced acute episodes of insomnia, as you’ve probably heard the people you know describe from time to time. New research is confirming just how common acute insomnia is, and how likely it is that people recover before it becomes chronic.

MLP: We just finished a study of a national sample of about 1500 people who started as good sleepers. They completed questionnaires for us quite frequently: daily sleep diaries, weekly measures of insomnia. And we just watched. And it was astounding—in confirmed good sleepers, around thirty percent had acute insomnia in one year. In England the same study was done with a colleague of mine and he found fifty percent. That’s a lot of people. The interesting thing is, ninety percent of people who have acute insomnia recover.

Unlike Chronic Insomnia, Acute Insomnia Is Unrelated to Age
Acute insomnia is relatively “equal opportunity,” meaning it doesn’t discriminate by age—which raises important questions about its function.

MLP: There is a belief—and it’s true—that as we get older decade by decade, the rate of chronic insomnia goes up. One of the things I’m working on in the data set is to see if this humongous incidence of acute insomnia varies by age, but so far it doesn’t—which is really telling you something. If a humongous percentage of the population has acute insomnia now and again, like once every three or four years, and it doesn’t differ by age the way chronic insomnia does, which gets more and more prevalent with each passing decade—how “abnormal” is that? Popularity is not a great way to define normal, but it is a way, and if something is highly prevalent and doesn’t vary the way the chronic form of it does, you start to wonder if this is normal. And then you start to wonder, How could that be?

Acute Insomnia Is Usually Linked to Stress
So what causes acute insomnia? Many factors can be involved, and most of them involve stress. The stress may be related to physical pain, illness, worry, or that argument you had with your sibling earlier in the day. As Dr. Perlis points out, it makes sense that our bodies at times make sleep a lower priority. As the late Dr. Art Spielman, another major figure in the insomnia treatment, said, “Sleep is adaptively deferred when the lion is at the mouth of the cave.”

MLP: There has to be an override when there is perceived or real threat, to disable the normal governance of sleep, so that you can stay awake and run or fight. So acute insomnia is part of the fight-or-flight response, such that if you are under siege and at mortal threat, don’t sleep. And that’s a good thing.

But why would our brains override the sleep drive when stress is more psychological, like having big deadlines at work? Is that just a function of our stress response, which doesn’t distinguish between physical danger and psychological distress?

MLP: You can argue, “Maybe for the caveman living on the savannah, evolutionarily speaking, that was important….But now it’s not adaptive at all, it’s just bad. We’re responding with inappropriate levels of fight/flight response, of being adrenalized, because I’m worried about work? Because I’ve got some financial problems? Those are not life threatening. I shouldn’t lose sleep over that.” And I hear that, and maybe this is vestigial, or maybe it’s not. Maybe insomnia is what you’re begging for when you’re under stress. What is insomnia but the gift of more time? It’s what you’re begging God for—”If only I had a 40-hour day, I could get all this stuff done!” You asked, you got it. So maybe it’s still adaptive in its acute form

Why It’s Important to Get to the Root of Your Emotions

We are all born with needs that are felt and expressed as emotions. Although we all experience the feelings of desire, fear, attachment, and despair, new research shows how these feelings are connected to our basic needs.

  • We need to engage with the world. This is felt as curiosity.
  • We need sexual partners. This is felt as lust.
  • We need to escape dangerous situations. This is fear.
  • We need to destroy those people and things that come between us and satisfaction. This is rage.
  • We need to attach to those who look after us. Separation from those who look after us can feel like panic and despair.

Developing healthy ways to meet these needs results in a feeling of well-being.  When these are unmet it can result in attempts to meet them in out-moded ways that worked when we were children but are now faulty and unproductive as adults. This can lead to suffering in our current lives, relationships, and at work.

Research demonstrates that psychoanalytic psychotherapy can help achieve better control over our emotions, more successful relationships, and a more fruitful professional life. In other words, psychoanalytic psychotherapy allows us to unlearn reactions that negatively affect our lives and to learn productive ones.

Unbearable emotions are caused by unmet needs 

Imagine a baby. When his parents steps out of the room the baby doesn’t have the capacity to know that they will be back.  All he knows is that he needs them. This need is expressed through a feeling of love when they are present and through the feeling of despair when they are gone. He has not yet acquired the capacity to understand that they will be back or the ability to self-soothe. When all goes well developmentally, the baby eventually learns that when his parents leave the room they always come back. But if the parents remain unreliable or neglectful the fear that they won’t come back is reinforced.

As this boy becomes a toddler and a teenager his parents continues to be unreliable, and he copes with this rejection by distancing and convincing himself that he does not need them.

Now let’s fast-forward. The boy is 40-years-old and finds that he cannot sustain a romantic relationship which brings him into therapy. As the therapy progresses, it emerges that whenever he starts to feel dependent on a significant other, he experiences intense panic and distances himself. This distancing behavior, designed to protect him from the despair, eventually leads to a break-up.

The challenge is to unlearn that default reaction with the mind of an adult. The adult mind does have the capacity to understand things that a small child can’t grasp. This is where psychoanalytic psychotherapy comes in. It is designed to address and help patients learn to tolerate painful feelings as they arise. The therapist and patient follow these feelings to their beginnings, where they were originally learned.

In this example, the need to distance from an important person goes back to the need for and the fear of losing his parents. To avoid that happening, he leaves the relationship before any real dependency can take place.  Gradually, the patient unlearns the automatic response of flight from dependency. This is achieved through repetition.

How does psychoanalytic therapy work?

Research has established that psychoanalytic psychotherapy is just as effective as cognitive behavior therapy (CBT) in the short term. However, psychoanalytic psychotherapy shows an increase in its effects after termination of treatment. In other words, people who go through psychoanalytic psychotherapy continue to benefit and grow from the treatment long after it has ended.

In the above example, the therapist encourages the patient to share his pain and recognize its origins. He reviews with the therapist his usual coping mechanism of distancing and detachment. The therapist addresses both the underlying feelings and the patient’s attempts to avoid them.

Unlike other psychotherapeutic methods that seek to lessen the intensity of the feelings, the psychoanalytic therapist helps the patient to stay with and tolerate these feelings over and over again. Eventually this repetition allows the patient to let go of the original reaction and to practice new options of feeling and coping.

Psychoanalytic psychotherapy allows the patient to gain access to unmet needs which are experienced as painful emotions and to learn to regulate them and become increasingly liberated from their oppressive and demanding grasp on our lives. This leads to an increased capacity to live a richer, fuller life.

Building the Perfect Day

We start every day hoping it’ll be great, maybe even perfect. But then, after snoozing, commuting, sitting in meetings, and grabbing junk food, we realize that, once again, we haven’t exercised, engaged with family and friends, or knocked much of anything off our to-do list. Staying up late, hoping to be productive, we manage only to watch TV and check Facebook before collapsing—and then starting all over again.

We can do better.

Believe it or not, most of us have the opportunity to get more done. We actually spend more time on leisure than ever before, according to the federal Bureau of Labor Statistics, dedicating about five hours and 16 minutes a day to pursuits we perceive as pleasurable, like socializing and watching TV (although research finds no correlation between the latter and feelings of satisfaction).

But we increasingly experience our free time in small, scattered chunks, says Geoffrey Godbey, professor emeritus of leisure science at Pennsylvania State University—nibbled half-hours on Netflix vs. restorative weekends away.

The foundation of any perfect or even half-decent day is adequate rest. As you can imagine, most of us start out behind. Our bodies run on an internal 24-hour chronobiological clock; when the retina captures light, a message sent to the brain suggests to this clock what time of day the body should think it is. It’s a system that has served us well for most of human history. “But over the last couple of generations, these natural rhythms have been gravely disrupted,” says Michael Grandner, the assistant director of the Behavioral Sleep Medicine Program at the University of Pennsylvania. Our near-constant exposure to artificial light has made nighttime effectively optional, leaving our bodies and brains struggling to do tasks that feel off schedule.

Can we fix our day? Absolutely. When Ken Wright, the director of the Sleep and Chronobiology Laboratory at the University of Colorado, took eight people camping for a week in the Rockies with no electronic devices or man-made lights, the group was exposed to about four times more natural light than usual. “We were able to shift everyone’s internal clock two hours to become in sync with nature within a week,” Wright reports, and his campers began waking up less groggy.

So there’s hope. Researchers in sleep health, nutrition, cognition, fitness, and productivity are working to identify where our modern schedules have gone wrong and how to better set ourselves up for success. We now know that with a handful of hacks, both large and small, and some changes to preconceived notions—wake-up sex and bedtime baths?—we can reconstruct our 16 waking hours to maximize productivity, leisure, and connection, while restoring alignment with our core chronobiological instincts.

You don’t need to follow this suggested schedule to the minute, but its consistency and healthier routines can bring you a lot closer to a more perfect day:

6:00 a.m. WAKE UP
No universal wake-up time will fit everyone, Wright says, but it’s ideal to rise when your body is best prepared—at the conclusion of REM sleep. We experience our longest nightly period of REM right before we naturally wake up. When is that? It’s so rare to wake without an alarm that many of us don’t know, but the amount you sleep on vacation should give you a good idea. Then track backward: If you need 7.5 hours of sleep to feel your best; need to be at work by 8 a.m.; need an hour to get ready; and have a one-hour commute, then a bedtime of 10:30 p.m., with a wake-up time of 6 a.m. might be best. If you can rise without an alarm, all the better, because when you hit the snooze button, you coax your brain to rewind to the beginning of the sleep cycle, making it that much harder to wake feeling refreshed, according to research by Edward Stepanski of Chicago’s Rush-Presbyterian-St. Luke’s Medical Center.

6:10 a.m. SEX
Surprise: Our level of testosterone—the hormone that spurs desire, our energy to perform, and even our generation of fantasies—is highest in the morning, for both men and women, says clinical sexologist Kathleen Van Kirk of the Institute for the Advanced Study of Human Sexuality in San Francisco. We also get an immediate boost in circulation in the morning, further fostering energy and arousal. Sexual activity is a pleasurable way to launch the day, not least because it causes a release of mood-elevating, stress-reducing hormones. Research on oxytocin has demonstrated that the hormone surge we get from intimacy can significantly reduce our level of the stress hormone cortisol and markedly boost positive communication between partners.

7:00 a.m. BREAKFAST
Eat within one to two hours of waking, says psychologist and dietitian Ellen Albertson. It may be 10 to 12 hours since your last meal, and your brain needs fuel. “Your brain is only about 2 percent of your body weight, but it consumes up to one-fifth of your body’s energy intake,” she says. “When you raise blood-sugar levels with breakfast, you increase your energy and improve mood.” Bonus: Your metabolism is at its peak in the morning, so your body efficiently uses most of what you consume, depositing less in fat stores, says Matthew Edlund, M.D., the director of the Center for Circadian Medicine in Sarasota, Florida.

7:45 a.m.  GET OUTSIDE
The best time to go outdoors and get moving is within two hours of waking up, says Jacqueline Olds, an associate clinical professor of psychiatry at Harvard Medical School. “The UV component of sunlight is low,” she says, “but the bright light sets you on a good course of wakefulness.”

The morning is a great time for a workout at your gym as well. Brigham Young University researcher James LeCheminant found that 45 minutes of moderate-to-vigorous morning exercise reduces the urge to eat throughout the day, but if that’s not possible, he suggests that you fit it in whenever your daytime schedule allows, because it still provides cognitive benefits and fosters restful sleep. “Pick the time when there are the fewest barriers,” he says, noting that this is often in the morning because the day’s events haven’t interfered yet.

8:45 a.m.  SEND EMAILS
Messages sent between 6 and 10 a.m. are much more likely to be read promptly than those sent between 10 a.m.  and noon, when people are more focused on work, says Dan Zarrella, the author of The Science of Marketing.

The average person spends 28 percent of the work week managing email, one reason 26 percent of us label ourselves chronic procrastinators. Limiting temptation by quitting your email app when you’re not using it can be instrumental in reclaiming your day. Start establishing two times during the workday to review messages—one here, one later in the afternoon.

9:30 a.m.  COFFEE
You may be used to pouring your first cup much earlier, but it will do more for you if you wait until later in the morning. “Our circadian clock controls the release of cortisol, a hormone that makes us feel alert and awake,” Albertson says. “Production is usually highest between 8 and 9 a.m., when most of us drink coffee,” negating the usefulness of the caffeine. This may be why regular coffee drinkers have an average of 3.1 cups a day—the first doesn’t help much. “Drinking caffeine too early can lead to too much cortisol, which can disturb our natural circadian rhythms,” Albertson adds. “It’s much better to drink caffeine between 9:30 and 11:30 when you actually need it.”

Are You Having a Bad Day? Exactly What to Do and Not to Do

Have you had one of those days? A day when you felt small, or like a bad parent, like a bad wife, like a bad everything? Or perhaps you had a day where you were publicly humiliated? Or just in a bad mood for absolutely no reason? Chances are you did!

How do you typically deal with such days? Go ahead and check as many as applies!

1) You had an internal conversation full of negativity and self-hate. “I do suck”, “I am a loser”, “I am a complete failure”, “I am a …”

2) You rationalized how much you suck by giving yourself examples and finding evidence for why you are indeed a failure:

“How could I be so stupid to push reply all instead of just reply” “I deserve this because I do …” “I deserve this because I don’t…”

3) You projected this onto others

Told your husband “you suck”, told your child “you are a failure”, gave the finger to someone who did not even cut you off! Who do you usually project feelings of insecurity onto?

4) You stopped feeling, thinking, but completely withdrew. You went to sleepand hoped that it would all end by the time you woke up. Or, tried to self medicate by taking painkillers, drugs, or overeating. How do you self medicate?

5) You firmly believed that these ugly feelings are forever, and if anything things would get worse. “There is no hope, I am a stupid person”, “I will never get this”, “I will never …”

Here is what you should do instead when you feel vulnerable:

1) Honor any feeling you have, even if negative. But, be kind to yourself and show self-compassion.

2) Speak to yourself with dignity and respect. Don’t allow any thoughts of self-disrespect to invade your soul.

3) Do one kind act towards someone, anyone. This will demonstrate to your injured soul that you can help someone feel better, and therefore you can make yourself feel better. Doing a kind act gives immediate gratification and makes the world a better place. Imagine if that person is also having a bad day and you shocked them with your kindness? Chances are, someone might shock you with their kindness.

4) Connect, connect and connect. Connect with someone who is trustworthy and who loves you because of your vulnerabilities. Do not do it by texting them, pick up the phone and call them. Or, ask someone who is worthy of your love to meet for coffee and just talk and vent about your day. Chances are you will feel so much better after venting. We are social beings and most of our problems and their solutions require social bonding. Do NOT connect with negative people; your soul is too raw to handle their acidity on such days. Do not just connect with anyone.

5) Self-medicate with exercise and indulge in nature. Go for a walk on the beach. Have a conversation with the ocean; oceans are never judgmental! But, don’t listen to sad music while taking a walk, not on those days. Sad music will intensify your negative feelings. Walking and exercising in general release feel-good chemicals.

6) Tell yourself “Nothing is forever, this too will pass”. Some days are bad, really bad, just allow them to pass.

We all have unprovoked bad days, they are almost mandatory! Sometimes, it is completely out of our control, but what we do about them is completely within our control. Every time, a bad day does not destroy you, your brainkeeps track of this as a small victory. Then the next time you have a bad day, your brain reminds you that you survived the last ten times that happened. It then predicts that you will survive this one too.  As a result, your self-esteem, self-confidence and self-worth escape uninjured from such days.

Have a great day or a manageable so-so day!

Depression in the United States—an Update

How common is depression? This is one of the fundamental questions Deborah Hasin and colleagues addressed in a recent epidemiological studyabout Major Depressive Disorder (MDD) in the United States.

The study analyzed data collected in 2012 and 2013 to provide an update on similar research from over a decade ago. Over 36,000 individuals age 18 and older were interviewed by trained personnel as part of the National Epidemiologic Survey on Alcohol and Related Conditions III. The analysis utilized the most current diagnostic criteria found in DSM-5. Participants were evaluated for depressive episodes and other psychiatricconditions that occurred during the previous 12 months as well as over their lifetimes.

Over 10 percent of the individuals in this study experienced function-impairing depression during the previous 12 months, and about 20 percent had experienced depression during their lifetimes. The prevalence was almost twice as high in women compared to men. During the previous year, reported depression was less common in those 65 and older than in those younger than 65. In fact, the prevalence of depression was 5.4 percent in the older group, considerably lower than the average.

About 13 percent of depressive episodes occurred shortly after the death of a loved one and lasted less than two months. In previous years, these episodes would have been diagnosed as bereavement, but the new diagnostic manual has eliminated bereavement as a separate diagnosis.

An interesting subtype of depression, called depression with mixed features, accounted for about 15 percent of the depressive episodes experienced by participants during their lifetimes. Mixed features include symptoms that might be expected in persons with bipolar disorder but do not reach the diagnostic threshold for bipolar I or bipolar II disorders. Among those are expansive or elevated mood, inflated self-esteem, rapid speech, racing thoughts, and increased energy. Thus, some individuals with moderate to severe depression demonstrate brief periods of elevated mood; it is uncertain whether these individuals go on to exhibit a diagnosable form of bipolar disorder.

How many depressed individuals consider suicide? Suicidal thoughts and suicide attempts occur in depressed persons. In this study, 39 percent of people with a history of depression had “thought a lot about suicide” and more than 13 percent had attempted suicide.

On average, how long do depressive episodes last? It has become increasingly clear that depression can be a chronic illness for some people. Results from this study indicate that during their lifetimes, 44 percent of individuals experienced episodes that lasted a year or longer and 30 percent had episodes lasting two years or longer.

Are other psychiatric illnesses associated with depression? The investigators found that co-morbid substance use disorders, anxiety disorders, and borderline personality disorder were common in persons with depression. Fifty-eight percent of people with lifetime major depressive disorder had a substance abuse disorder during their lifetime (including alcohol and nicotine use disorders as well as other drug use disorders), 37 percent an anxiety disorder, and 27 percent borderline personality disorder.

How many depressed individuals receive treatment? Interestingly, almost 70 percent of those who had experienced depression at some point during their lifetimes had received treatment. More than 50 percent had received medications and more than 60 percent had received counseling from a professional therapist. The percentages were lower for those who had experienced depression during the previous 12 months: about 50 percent had received some sort of treatment, 37 percent with medications and 44 percent with professional talk therapy. The intensity of treatment was not defined, however, and other research suggests that many who receive treatment do not receive adequate amounts of it.

The rates of depression found in this recent study are at least 50 percent higher than rates from the study performed a decade earlier. Whether this increase is a result of methodological differences or reflects a true increase in the prevalence of the illness is unclear. However, the authors point out that an increase in prevalence is supported by other studies demonstrating increases in indicators of depression and suicidality. Even if some of the observed increase is related to differences in methodology, it appears that an increasing number of people are suffering from this disorder.

Depression is one of the most disabling of all illnesses. We must do more to understand its various causes in order to develop better strategies for prevention and treatment.

7 Habits That Can Drag Down Cognitive Performance

This month brought a few studies showing some interesting connections between our everyday habits and cognition—dehydration, digital devices, and (potentially) neckties may all apparently sap cognitive bandwidth. The good news is that these habits are easily fixable (although device use may be trickier), which points to how delicate, and how responsive to its surroundings, the human brain can be. The three new studies are outlined below, along with four longer-term habits that may also deplete or replenish brain power. Again, some are easier to address than others, but the ones that take a little more commitment are definitely worth it, considering what’s at stake.

Dehydration  

As mentioned, a study earlier this month found that being just a bit dehydrated can affect cognition. The researchers analyzed previous studies, arriving at a final pool of 33 that looked at how being dehydrated at various levels can affect cognitive performance. Generally, the team found that people started making some errors during attentional tasks earlier during dehydration, and the errors became more pronounced the more significant the dehydration. In addition to the more innocuous initial errors, higher-level capacities like math and logic also fell off with dehydration over 2% of one’s body mass (which could occur after working out for a few hours without drinking).

“The simplest reaction time tasks were least impacted, even as dehydration got worse, but tasks that require attention were quite impacted,” said study author Mindy Millard-Stafford in a statement. Being dehydrated could well affect the kinds of attention and executive functions that’s required in work, school, or leisure. “Maintaining focus in a long meeting, driving a car, a monotonous job in a hot factory that requires you to stay alert are some of them,” said Millard-Stafford.

People working in hot places who need to make technical decisions would probably by the most affected—but for people who are feeling a little groggy, thinking back on whether you’ve gone a big chunk of the day without hydrating may be wise.

Neckties

Another study this month found that wearing a necktie can cut off the circulation to your brain—not fully, of course, but by about 7%. The team, wishing to study “socially desirable strangulation,” had men don neckties or go without, and then undergo MRI scans to measure cerebral blood flow. Men whose ties were tightened had a significant loss of the blood flow to their brains compared to others.

Whether this loss of blood flow would be enough to affect cognition isn’t totally clear. But for men who are concerned about the possibility, it may not be the worst idea to wear your tie a bit looser.

Devices in the classroom

Cell phones are likely the bane of many teachers’ existence these days, and now they have a true scientific study to support banning them. Researchers at Rutgers University allowed half of the study’s participants—funnily enough, 118 Rutgers cognitive psychology students—to use cell phones, tablets, and laptops in the classroom, and banned their use for the other half. The team correlated the students’ grades throughout the semester with their use of devices, and found that the kids for whom devices were banned had final grades that were about half a grade (or 5%) higher than the kids who got to use them.

“These findings should alert the many dedicated students and instructors that dividing attention is having an insidious effect that is impairing their exam performance and final grade,” said Arnold Glass. “To help manage the use of devices in the classroom, teachers should explain to students the damaging effect of distractions on retention – not only for themselves, but for the whole class.”

Others have suggested that gadgets are “making us dumb” for a variety of reasons, but this is the first to show a causal connection between their use and academic performance. The same connection is very likely true for devices in the office—and at home, when you’re trying to have some quality time with your family.

Sleep

Another habit worth mentioning, given its potentially significant effects on cognition, is one that most people don’t get enough of, acutely or chronically: Sleep. Losing sleep on a chronic level can affect cognition, but so can just a night or two of poor sleep.

A study last year looked at brain cells and cognition in real time: It found that during a night of lost sleep, participants’ brain cells became slower to respond during a cognitive task, and when they did respond, their activity was sloppier than normal. And sleep loss over the long-term has been shown to affect our cognition and our ability to form memories.

Sleep isn’t just an indulgence, but a necessary habit during which the brain is doing a lot of heavy work—pruning unnecessary connections and strengthening the needed ones. Most people know from their own anecdotal evidence that lost sleep can seriously affect how well we think and make decisions, but the scientific evidence certainly backs that up as well.

Chronic Stress

Like sleep loss, stress affects just about every system in our bodies; and chronic stress is well-knownto affect our mental prowess. Likely due to the stress hormone cortisol and its inflammatory effects, stress has been shown to affect everything from memory formation to decision-making to hand-eye coordination to brain volume. While we may not be able to control every variable that presents stress in our lives, we can at least control our relationship to the stress and how we respond. Taking care of ourselves, using tools like meditation, yoga, and therapy are good ways to reduce the effects that stress is known to have.

Lack of Social Connection

Social connection—and its doppelganger, loneliness—has been shown again and again to have major impacts on our health and mental health. In fact, social connectivity keeps showing up in the research as perhaps the number one variable affecting long-term health. And loneliness has been linked to poorer cognition, especially in older people. A study a few years ago showed that loneliness and social isolation were linked to a greater risk of cognitive decline in the future. It’s not totally clear why this is, but it may be the intellectual and emotional stimulation, not to mention stress reduction, which social interaction provides.

Sugar

Finally, sugar is one “food” that’s been shown to have ill effects on our neurological and cognitive health (“sugar coma” is a pretty well-known phenomenon, and there’s some logic to it). Not only does sugar seem to function somewhat like a drug, but it’s been shown to sap mental resources: A study a few years ago found that rats who were given sugar-water instead of plain water performed more poorly on a memory task (interestingly, those who were given omega-3s in addition to sugar water performed fine, suggesting that omegas may counter the effects of sugar). And it’s not just rodents: A study earlier this year found that people who consumed either glucose or sucrose performed worse on cognitive tests than those who consumed fructose or placebo—which isn’t surprising given the known connection between sugar and Alzheimer’s disease.

Luxurious Lifestyles Are Hurting Us

Inequality and climate change go hand in hand. Most of us know that poor countries and poor people in rich countries suffer the most from extreme weather, rising sea levels, and pollution. However you may not be aware that the carbon footprint of the rich is enormous as the rich live luxurious lifestyles with homes around the world, private jets, large yachts, exotic vacations, and closets full of things they don’t use. America’s 1 Percent emits 15 times more greenhouse gas emissions per person than the average American and fifty times more than the average person worldwide (World Resources Institute). The rich pollute the most and suffer the least from pollution.

What do the rich achieve with their extravagant consumption? Not much from a happiness or social welfare viewpoint, as Buddhist economics explains. While a person shows off their self-importance, they are still wanting more because another rich person has an even longer yacht or bigger house. The valuation of consumption rests on comparing ourselves to one another. Thorstein Veblen, the 20th Century economist who coined the terms “conspicuous consumption” and “invidious comparisons,” pointed out how individuals use luxury goods to show off their status. Veblen observed that people were living on treadmills of wealth accumulation, competing incessantly with others but rarely increasing their own well-being. This means that when inequality increases, we all feel less well-off even if our income has not gone down. When the rich get even richer and the rest of us don’t get more, our stagnant income and lifestyles seem diminished. Over the past four decades, economic growth has mostly gone to the top 5% of households, and this growth begets more inequality, without increasing social welfare as it exacerbates invidious comparisons. Yet inequality continues to increase in the U.S., with the top 1% grabbing 95% of income growth and the bottom 90% experiencing declining incomes even  as the economy recovered (2009 to 2012) (Atkinson, Piketty, and Saez, JEL, 49 (1), 2011, 3-71).

Feelings of social discontent and anxiety rise with growing inequality. People struggle to maintain their social position even as those at the top aren’t feeling more satisfaction with their fancier lifestyles. With rising incomes comes frivolous spending, which itself drives ever more needless consumption, all so we can try to maintain our relative standing. This treadmill of wealth accumulation leads us to spend our incomes on status or luxury goods that tend to pollute the earth. Yet even though America’s top ten percenters emit six times the tCO2e of the bottom 50% of households (50 vs 8.5 tCO2e per person yearly; Oxfam), even the bottom 50% have an average carbon footprint that is four times the Paris Climate Accord goal of 2.1 tCO2e per person per year by 2050. The task to reduce CO2 for the United States with 16.4 tCO2 is much greater than for the European Union with 6.7 tCO2. India and Indonesia will increase their carbon emissions as their living standards improve. Their people have very low emissions, below the 2.1 benchmark (Girod, Env Research Letter, 2013). Though there are improvements to be made across income groups and countries, the global rich need to lead the way in reducing their carbon footprint.

Rich countries are not the only ones vulnerable to this destructive story. The developing world faces enormous environmental degradation as the standard of living increases, and the professional class imitates the lifestyle of the Western world based on subsidized fossil fuel energy. Countries such as China and India are already suffering the consequences of a burgeoning middle and upper class that consumes increasingly more. These populations are not only trying to keep up with the rich within their own countries but the global rich as well—this is evident when nearly all Chinese provinces and cities’ per capita carbon footprints increased  from 2007 to 2010 (Shao et al. 2018). In India, poor urban slums (poorer areas) have lower carbon footprints than the richer non-slum areas (Adnan et al. 2018).

How to Choose a Therapist

Psychology is a field made up of fragments. We are far from having a unified theory of the mind and, in my opinion, that will come only with advances in neuroscience and that will come only with advances in technology. Meanwhile there is a plethora of therapies from which to choose and they are based mostly in the experiences of their founders and practitioners.

Psychotherapy is still more of an art than a science. In fact, research has confirmed that it does not matter so much what brand of therapy one practices as does the relationship between client and therapist.1 These are known as often known as the common factors.2

That is, these are aspects of therapy that cut across professed schools and mostly have to do with the quality of the relationship. We all know that feeling when we meet someone and just “click” with them. It is that click that a prospective client should be looking for in choosing a therapist. Interviewing three potential therapists is often recommended before choosing one.

While the quality of the relationship, affect and empathy can override the specific technique, it does not cancel it out. For example, Freudianapproaches will want to treat the unconscious, while Cognitive Behavioralthe conscious ideas and behaviors. Gestalt therapy searches for unexpressed anger, while the humanists aim for growth. Freud was concerned with the psychology of the son that he was, feminists have focused more on growing up as a daughter.

These emphases are generally based on the experiences of those who developed them and those who adhere to them. Some are narrower; for example those who do only EMDR (Eye Movement Desensitization) to treat PTSD (Post Traumatic Stress Disorder) and others will examine early childhood through the present. Obviously the latter will become long term therapy. In general though, whatever issues emerge will emerge in various ways during various treatments

The most important issue in making a good decision is to choose a therapist that you feel understands you, respects you and can help you. It is the relationship that really matters.

Heat might really be getting to your brain

We might be able to blame the heat for our bad decisions: A small study published this week found that college students who lived in dorms without air conditioning during a heat wave did worse on cognitive assessments than students who had air conditioning.

“To us, this is a way of saying yes, some of the effects are common sense, but what do you do about them?” said Jose Guillermo Cedeño Laurent, associate director of the Healthy Buildings Program at Harvard T.H. Chan School of Public Health and lead author of the study, which was published Tuesday in the journal PLOS Medicine. “And this is giving more precision to the opportunity of better controlling thermal environments in our buildings.”

The researchers followed 44 university students in Boston between the ages of 18 to 29 for 12 days in the summer of 2016. The first five days were a seasonable average of 68.7 degrees Fahrenheit. The next five days saw a heat wave, which the National Oceanic and Atmospheric Administration considers a period of abnormally higher air temperature and humidity, and had an average of 92.1 degrees. The last two days were a “cool-down” period with an average of 82.6 degrees.

The students took tests right after waking in the morning that required them to identify colors on displayed words to appraise selective attention and processing speed and to complete basic arithmetic to evaluate cognitive speed and working memory.

During the heat wave, students without air conditioning had 13.4% longer reaction times and scored 13.3% lower on the tests than students in air-conditioned rooms, the study found.

Twenty-four of the students lived in six-story buildings built in the 1990s and had air conditioning. The other 20 students lived in low-rises built between 1930 and 1950 that were naturally ventilated.

“What this study adds to that conversation is that we start to see these subclinical effects. We see these impacts on cognitive performance, so it’s not just the young and the elderly, the stuff that makes the front page of the news,” said Joe Allen, an assistant professor and director of the Healthy Buildings Program and one of the study’s authors. “It’s the millions of people during these heat waves who are impacted maybe in ways that aren’t so obvious to them. Or obvious to all of us, even.”
The largest difference in cognitive function occurred during the “cool down” period after outdoor temperatures decreased but indoor temperatures stayed high in dorms without air conditioning, according to the report.

Researchers have previously suggested that higher temperatures may result in more aggressionin populations, though critics argue that attributing a form of behavior to one factor is overly simplistic.

The new findings make sense, but it may be difficult to generalize them to the population at large, said Dr. David Kaiser of Montreal’s Regional Public Health Department, who was involved in coordinating the response to last week’s heat wave that resulted in 70 deaths there. He was not associated with the new study.

Getting Fully Aquainted with Bipolar Disorder

Recently, we’ve been hearing more in the news about celebrities who have openly shared their bipolar stories and have encouraged others to recognize bipolar in their own lives. And tragically, we’ve also heard about individuals allegedly with bipolar disorder who have died by suicide or committed acts of violence against others. From a society perspective, bipolar disorder is slowly coming out of the woodwork, and people are starting to ask more questions about this often misunderstood mental illness. Heightened awareness is a good thing, of course. But a profound stigma against treatment still exists, along with a general lack of understanding about bipolar disorder and what can be done about it.

The gap in knowledge about bipolar is exceeded only by the length of time people with the illness begin showing symptoms and when they’re actually treated appropriately. Drancourt et. al (2012) showed that, on mean average, patients will have waited nearly 10 years from their first bipolar mood episode to the time they receive a mood stabilizing medication specifically for bipolar disorder. Another study showed about two-thirds of bipolar patients are misdiagnosed and treated as having other psychiatric disorders (mostly major depression), while those patients had consulted a mean average of nearly four clinicians before receiving appropriate care (Hirschfeld, Lewis, & Vornik, 2003). Because of this 10-year gap in treatment, we have a whole population of underlying bipolar disorder presenting as relational dysfunction, substance abuse, unipolar depression, attention deficits, self-harm, personality disorders, domestic violence, workplaceconflicts, and many other common presentations to outpatient therapy.

But the biggest problem with unidentified and untreated bipolar disorder is suicide, which is at least 20 times higher in bipolar patients compared to the general population (Berk, Scott, Macmillan, Callaly and Christensen, 2013).  Perhaps even more striking, The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association [APA], 2013) states that “bipolar disorder may account for one-quarter of all completed suicides” (p. 131). While many people with undetected bipolar matriculate—then languish—through an often cumbersome mental health system, their condition worsens, threatening their own life along with the well-being of every concerned person around them.

With a prevalence up to 5% of the population (Ketter, 2010), a unified method to effectively recognize and comprehensively treat this chronic and deadly mental illness is critical. It’s certainly time to fully understand what bipolar is, how to better recognize and openly discuss it, and treat it in a unified manner with active support around the person suffering from uncontrollable mood swings.

It’s time to get fully acquainted with bipolar disorder.

Bipolar disorder, sometimes referred to as manic-depression, is a genetically-based psychiatric disorder, which involves poorly regulated changes in brain chemistry that creates extreme mood swings. Episodes of mania or hypomania can include euphoric and expansive mood; or dysphoric mood, which is marked by high levels of irritability and agitation. These episodes can also include grandiose self-image, decreased need for sleep, rapid thoughts, pressured speech, distractability, increased energy and creative desires, and severe impulsivity that leads to high-risk behaviors. In depressive episodes, the mood becomes severely reduced, dark and demoralizing. Manic, hypomanic and depressive episodes can last from several days to several weeks. In the most severe instances of bipolar, psychotic features including hallucinations or delusions may be present during extreme mood events.

The causes of bipolar can be classified as either predispositional or catalytic. First, a person needs the predisposition to bipolar for the true pattern to eventually emerge during the lifespan, which means what is coded in the person’s DNA essentially sets the foundation for eventual symptoms. The strongest and most consistent causal factor for bipolar disorder is genetic (APA, 2013). Catalytic causes bring out those symptoms. Some common catalysts involve hormonal changes, such as in puberty, or in women during or after childbirth, known as peripartum bipolar onset. Drug and alcohol abuse can also trigger underlying bipolar symptoms. The average age of onset is late adolescence to early adulthood. Although as we’ve seen above, accurate recognition and diagnosis may not occur until several years into adult life.

Bipolar patients and their families often struggle to accept the disorder out of shame, which is born out of stigma. Knowing that bipolar is genetic in its foundations, with natural internal and external catalysts driving symptom emergence, people can appreciate that having bipolar is nobody’s fault. There really is no one to blame, and no reason to feel ashamed when bipolar becomes a part of a family’s life story.

Yet, many different fears can hold people back from seeking proper treatment. These include concerns about medications and difficulty accepting a lifelong mental illness. Many people with bipolar often feargiving up the great feelings that accompany a manic or hypomanic episode. Nobody wants to be told that what makes them feel terrific and supercharged is actually part of a disorder that should be taken away. As a result, the defense of denial is an expected aspect of bipolar disorder. It’s especially important for people with bipolar to feel in control of the energetic and hypercreative parts of mania as an offset to the desperate, hopeless feelings of their depressive episodes.

And family members can possess fears, and at times, denial of bipolar in their lives. For example, parents can worry more about their children being “labeled for life” than how the disorder can destroy their children’s life goals. Or spouses of people with bipolar may initially view it as simply an excuse for their “bad behavior,” as their relationships fall apart from the weight of every destructive behavior.

There are many roadblocks along the path to success with bipolar treatment. But a combination of thorough assessment, education, and treatment centered around the medical stabilization of bipolar swings is useful in addressing all pertinent fears for patients and families, while engaging these important members into a collaborative, lifelong care plan. Reducing fear in all participants is key to remaining connected to treatment while building hope that stabilization will ultimately improve the quality of life for bipolar patients and their families.

10 ways to improve your memory

Here are the 10 ways to improve your memory:

  1. Get enough sleep. If you read a book or article when very tired, you will forget most of what you have read. Sleep improves attention and concentration, and therefore the registration of information, or retention rate. Sleep is also required for memory consolidation.
  2. Pay attention. You cannot take in information unless you are paying attention, and you cannot memorize information unless you are taking it in. It helps if you are actually interested in the material, so try to develop an interest in everything! As Einstein said, ‘There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.’
  3. Involve as many senses as you can. For instance, if you are sitting in a lecture, jot down a few notes. If you are reading a chapter or article, read it aloud to yourself and maybe even inject some drama.
  4. Structure information. If, for example, you need to remember a list of ingredients, think of them under the subheadings of starter, main, and dessert, and visualize the number of ingredients under each subheading. If you need to remember a telephone number, think of it in terms of the first five digits, the middle three digits, and the last three digits—or whatever works best.
  5. Process information. If possible, summarize the material in your own words. Or reorganize it so that it is easier to learn. With more complex material, try to understand its meaning and import.
  6. Relate information to what you already know. New information is much easier to remember if it can be contextualized. In a recent study looking at the role of high-level processes, Lane and Chang found that chess knowledge predicts chess memory even after controlling for chess experience.
  7. Use mnemonics. Tie information to visual images, sentences, acronyms, or rhymes. For example, you might remember that your hairdresser is called Sharon by picturing a Rose of Sharon or a sharon fruit. Or you might remember the colours of the rainbow and their order by the sentence, ‘Richard Of York Gave Battle in Vain’. Medical students remember the symptoms of varicose veins by the acronym ‘AEIOU’: Aching, Eczema, Itching, Oedema, and Ulceration.
  8. Rehearse information. Sleep on the information and review it the following day. Then review it at growing intervals until you feel comfortable with it. Memories fade if not rehearsed, or are overlaid by other memories and can no longer be accessed.
  9. Pay attention to context. It is easier to retrieve a memory if you find yourself in a similar situation to the one in which the memory was formed, or if you are feeling the same way. People with low mood tend to remember their losses and failures while overlooking their strengths and achievements. If one day you pass the cheesemonger in the street, you may not, without her usual apron and array of cheeses, immediately recognize her as the cheesemonger, even though she is very familiar to you. If you are preparing for an exam, try to recreate the conditions of the exam: for example, sit at a similar desk, at a similar time of day, and write with ink on paper.
  10. Be creative. Bizarre or unusual experiences, facts, and associations are much easier to remember. Because unfamiliar experiences stick in the mind, trips and holidays give the impression of living, and of living longer. Our life is just as long or short as our remembering: as rich as our imagining, as vibrant as our feeling, and as profound as our thinking.

Memory refers to the system, or systems, by which the mind registers, stores, and retrieves information for the purpose of optimizing future action.

Memory can be divided into short-term and long-term memory. Long-term memory can be further divided into episodic and semantic memory. Episodic memory records sense experiences, while semantic memory records abstract facts and concepts. Interestingly, the distinction between episodic memory and semantic memory is already implicit in a number of languages in which the verb ‘to know’ takes on two forms, for example, in French, connaître and savoir, where connaître implies a direct, privileged kind of knowledge acquired through sense experience.

There is, naturally, a close connection between memory and knowledge. The connaître and savoir dichotomy is also pertinent to the theory of knowledge, which distinguishes between first-hand knowledge and testimonial knowledge, that is, knowledge gained through the say-so of others, often teachers, journalists, and writers. In the absence of first-hand knowledge, the accuracy of a piece of testimony can only be verified against other sources of testimony. Similarly, the accuracy of most memoriescan only be verified against other memories, not any independent standard.

Episodic and semantic memory are held to be explicit or ‘declarative’, but there is also a third kind of memory, procedural memory, which is implicit or unconscious, for knowing how to do things such as reading and cycling. Although held to be explicit, episodic and semantic memory can influence action without any need for conscious retrieval—which, of course, underlies practices such as advertising and brainwashing. In fact, it is probably fair to say that most of our memories lie beyond conscious retrieval, or are not consciously retrieved, and, therefore, that memory mostly operates unconsciously. ‘Education’, said BF Skinner, ‘is what survives when what has been learnt has been forgotten.’

A mysterious type of memory is prospective memory, or ‘remembering to remember’. To send my mother a birthday card, I must not only remember her birthday, but also remember to remember it. Whenever I forget to set my alarm clock, I usually find myself waking up just in time to make my first appointment, even when I have only slept three or four hours. This suggests that, even in sleep, the mind is able to remember to remember, while also keeping track of the time.

Memory is encoded across several brain areas, meaning that brain damage or disease can affect one type of memory more than others. For example, Korsakov syndrome, which results from severe thiamine deficiency and consequent damage to the mammillary bodies and dorsomedial nucleus of the thalamus, affects episodic memory more than semantic memory, and anterograde memory (ability to form new memories) more than retrograde memory (store of old memories), while sparing short-term and procedural memory. Alzheimer’s disease on the other hand affects short-term memory more than long-term memory, especially in its early stages.

As a psychiatrist, I am often asked to assess people with advanced Alzheimer’s Disease and other forms of dementia, and am all too aware of the importance of memory in our lives. Without any memory at all, it would be impossible to speak, to read, to learn, to find one’s way, to make decisions, to identify or use objects, to cook, to wash, to dress, to develop or maintain relationships, or to have any real sense of self. To live without memory is to live in a perpetual present, without past, and without future. It would be impossible to build upon anything, or even to engage in any kind of sustained, goal-directed activity. Although there is wisdom in being in the moment, one cannot always be in the moment. In Greek myth, the goddess of memory, Memosyne, slept with Zeus for nine consecutive nights, thereby begetting the nine Muses. Without memory, there would be no art or science, no craft or culture.

And no meaning either. Nostalgia is often prompted by feelings of loneliness, disconnectedness, or meaninglessness. Revisiting our past can lend us much-needed context, perspective, and direction, reminding and reassuring us that our life is not as banal as it may seem, that it is rooted in a narrative, and that there have been—and will once again be—meaningful moments and memories. And it seems, if weddings and wedding photographs are anything to go by, that we go to considerable lengths to manufacture memories for the purpose of nostalgizing. Tragically, people with severe memory loss cannot revisit the past, and, as a result, may confabulate (make up memories) to create the meaning that they yearn for. I once visited a nursing home in England to assess an 85-year-old lady with advanced Alzheimer’s disease. She maintained that we were in a hotel in Marbella, and that she was making plans for her wedding. When I asked her what she did yesterday, she replied, with a twinkle in her eye, that she hit the town for her bachelorette (hen night), and that her glamorous friends spoilt her rotten with champagne and fancy cocktails. The search for meaning is deeply ingrained in human nature, so much so that, when pressed to define man, Plato replied, ‘a being in search of meaning’. Like confabulation, it could be argued that nostalgia is a form of self-deception, in that it involves distortion and idealization of the past. The Romans had a tag for the phenomenon that psychologists have come to call ‘rosy retrospection’: memoria praeteritorum bonorum, ‘the past is always well remembered.’

And memory is unreliable in other ways as well. ‘Everyone’, said John Barth, ‘is necessarily the hero of his own life story’. We curate our memories by consolidating those that confirm or conform to our idea of ourselves, while discarding or distorting those that conflict with it. We are very likely to remember events of existential importance such as our first kiss, or our first day at school—and, of course, it helps that we often rehearse those memories. Even then, we remember just one or two scenes, and fill in the gaps with reconstructed or ‘averaged’ memories. Déjà-vu (French for ‘already seen’), the feeling that a situation that is currently being experienced has already been experienced, may arise from a very good match between the current situation and an averaged memory of that sort of situation. Our memories depend on our interests and emotions. Two people supporting opposing teams in a football match, or opposing political parties in an election, will register and recall very different things, and would likely disagree about ‘the facts’.

 

 

Hiding My Depression Almost Destroyed My Job

If you spent any time on social media this past weekend, you no doubt saw hundreds — nay, thousands — of people reflecting on the recent suicides of Kate Spade and Anthony Bourdain. Some wondered what could have motivated these two wildly successful people to take their own lives. Others noted that we can never know someone else’s pain — and that, in any case, just because someone leads a seemingly blessed life doesn’t mean she or he can’t suffer from depression.

The New York Times tweeted out helpful recommendations of books that explored depression, including Andrew Solomon’s classic, “The Noonday Demon.”

Lots of suggestions were offered to help people suffering from depression.

And then there was the category that hit me the hardest: people who had suffered from depression and decided that now was the right time to tell their own stories. Peter Sagal, the host of NPR’s comedy quiz show, “Wait, Wait, Don’t Tell Me,” was one such person; Kirsten Powers, a USA Today columnist, was another. Both hinted that in their darkest days, they had harbored thoughts of suicide.

Such stories — or rather the accumulation of such stories — convey a brutal truth: Depression is far more commonplace than you might think. And people you would never expect to suffer from depression — hey, doesn’t Sagal tell jokes for a living? — do.

These stories also speak to the stigma that still attaches to depression. Untreated depression can cost people their marriages, their jobs, their friends — and yes, their lives. Yet far too often, people who suffer from depression are afraid to acknowledge it, out of fear or shame.

The decision to come out of the depression closet usually comes after a great deal of hesitation — and as part of a conscious effort to say out loud that depression is a medical condition, not a character flaw. Stigmatizing it isn’t just counterproductive, it’s dangerous.

I know these feelings because I’ve had them myself over the last few years, as I’ve gone back and forth over whether to tell my own story of depression. Like those others who have come forth  after the deaths of Spade and Bourdain, my answer — finally — is yes. So here goes.

Twelve years ago, when I was 54 and living a seemingly blessed life, I decided to get divorced. That decision, though the right one for me, consumed me with guilt, and caused me to spiral into a paralyzing depression, something I had never experienced before. I lost all interest in everything; my brain became a never-ending loop of crazed and dark thoughts. I could barely get out of bed. My work, which had always been so central to my life, felt meaningless. At Thanksgiving that year, I was so paralyzed I could barely speak to my own children. It was the only time in my life that I had suicidal impulses.

I got through that first depression with the help of a new psychologist, some anxiety medication, and my soon-to-be ex-wife, who despite everything helped coaxed me back to health. Because depression had never been part of my makeup, my working assumption was that it was a one-off. It was the result, I assumed, of my being traumatized at the thought of divorcing a good person with whom I had raised three children and had shared a life for over 30 years.

But I was wrong. Somehow that episode triggered something, or changed something, in my brain. Three years later, I had a second bout of depression. And then a third a few years after that. And a fourth. In between I would have long stretches of normalcy, as well as shorter stretches of what I now realize was mild mania — hypomania, it’s called — during which I would feel invincible. Deep into middle age, I had become bipolar.

Except that I resisted that diagnosis with every fiber of my being. Partly it was because I was terrified at the idea of having to take lithium, the drug of choice for people with bipolar disorder. (Didn’t it have side effects that caused patients to stop taking it?) But it was also because I was ashamed. Why? I can’t really say. But that feeling was real, and it was powerful.

Because these subsequent depressions were not as severe as the first, I decided to push through them. I went to work as if nothing were wrong, and managed, somehow, to write two op-ed columns a week for the New York Times, where I was employed at the time. But my thinking was impaired, and I sometimes blurted out non sequiturs during interviews, which did not enhance my ability to get the information I was seeking. I would spin my wheels for days at time, unable to come up with a column idea until the last possible second, which put me under the kind of deadline pressure that does not make for good writing or good thinking.

Worst of all, as a direct consequence of being depressed, I made several major factual errors that required substantial corrections in the paper and apologies from me. These mistakes didn’t just discredit me, they also, painfully, embarrassed the Times editorial page. In no small part because of those errors, my boss — who had no idea I suffered from depression — eventually had me shipped off to the sports section.

My most recent bout of depression came two years ago. This time I decided to acknowledge to the sports editor that I was depressed, though I assumed I would try to push through it once again. But I was acting erratically in the office, and to his everlasting credit, he wasn’t willing to look the other way. He insisted that I go on sick leave so that I could get better at home, with the help of my family and without the pressures of work.

Click Read More for the full story.

Being Kind to Others Benefits You

John Bunyan, author of The Pilgrim’s Progress, wrote that “you have not lived today until you have done something for someone who can never repay you.”(link is external) But research shows that when we do things for others, we do get repaid. Not just through reciprocation, but as a result of the psychological benefits acts of benevolence produce in the giver.

In one study researchers asked people to either perform acts of kindness for other people for four weeks, such as allowing a stranger to share their umbrella in the rain, or to perform kind acts for themselves for four weeks, such as going shopping and buying themselves a little gift. At the start and end of the study the researchers measured the participants’ level of psychological flourishing, made up of emotional, psychological, and social well-being. By the end of the study the people who had performed kind acts for others had higher levels of psychological flourishing compared to those who acted kindly towards themselves. Benevolent acts also led to higher levels of positive emotions. In short, demonstrating altruism not only benefits others, but makes us feel better ourselves.

In another study researchers measured how happy people were in the morning and then gave them $5 or $20 which they had to spend either on themselves or others before 5 p.m. that day. Then, in the evening the researchers phoned the participants to re-assess how happy they felt. The results showed that participants who had spent the money on other people by buying them a little gift or making a donation to charity, were happier than those who used the money to pay one of their own bills or buy themselves a gift. Again, generosity had a boomerang effect and benefited the “giver”.

Bigheartedness may even affect our perceptions of physical burdens. For example, researchers in China asked study participants to wait in the lobby of a university building because they hadn’t yet determined which room they’d be using for the study (This wasn’t true. Researchers are sneaky). When each participant arrived in the lobby, a female research assistant greeted them standing beside two cartons at the bottom of a flight of stairs. In one condition, the assistant pretended to have trouble carrying the cartons up the stairs, dropped one, and asked the participant if they’d be willing to help her. In the other condition, the assistant simply said that the first part of the study involved having participants carry a carton up the stairs. Afterwards, participants in both conditions were asked to estimate the weight of the carton. Incredibly, the participants who acted altruistically by helping the assistant carry the box up the stairs estimated its weight as lighter than those who simply carried the carton because they thought it was part of the study.

In fact, altruism can sometimes benefit givers even more than the receivers. In a recent study employees at company in Spain were asked to either perform acts of kindness for colleagues, or asked to simply count the number of kind acts they received from coworkers. It turned out that the people who received acts of kindness became happier, demonstrating the value of benevolence for the receiver, however those who delivered the acts of kindness not only showed a similar trend towards increased happiness, but also had an increase in life satisfaction and job satisfaction, and a decrease in depression. The givers benefited even more than the receivers did! Not only that, but the effects of altruism were contagious. The beneficiaries of the acts of kindness ended up spontaneously paying it forward and doing extra nice things for other colleagues. When we give kindness to one, we spread kindness to many.

Performing acts of charity, altruism, and benevolence has been advocated for by the world’s wisdom traditions for millennia. And although we likely benefit more when our motivations for kindness are other-oriented as opposed to self-oriented, it remains the case that when we give, we receive. And we get to live today.

The Curative Qualities of World Dance

The healing power of dance is recognized across the globe. Common evidence-based benefits of world dance include, but are not limited to, improvements in muscular strength, endurance, balance, flexibility, agility heart rate, and memory. Although predominantly viewed as a physical form, dance can also incorporate intrapersonal and interpersonal elements. The advantages within mental, social, and emotional aspects of dance are gaining attention. One domain that I find particularly incredible is that beyond the body, dance has the curative power to heal our mind, heart, and soul and ultimately enhance mental health overall.

Acceptance

The journey towards self-acceptance is often a long and difficult one. With contributing factors such as body image and self-esteem, individuals may waiver in their self-love. Many global styles of dance do not assert a typical body type, hence, supporting the beauty in diversity. Regardless of style, main prop for dancing is your own body. With time, individuals report an acceptance an appreciation for their bodies and true selves.

Achievement

Regardless of your ability level or learning style, dance gives you the opportunity to work on goals, experience a healthy challenge, and reap the rewards of accomplishment. It can be as simple as mastering a new movement or if you choose the achievement can be a complex combination of various elements of artistry including rhythm, technique, and athleticism.

Creativity

Dance provides the opportunity to embrace individuality through artistry. If you are experiencing the humdrum lull of your daily routine filled with work obligations and personal responsibilities, you may be in need for a creative release. It could be as simple as the freedom of expressing their body as they let loose on a dance floor. Or dance could serve as a conduit of creative expression through choreography. Moreover, when considering fusion dance, individuals are provided a smorgasbord of global elements to be artfully combined in a unique, creative expression.

Culture

Partaking in world dance provides two distinct yet curative benefits within the realm of culture. Involvement in a style that connects to one’s lineage provides an opportunity to embrace one’s heritage. World dance can serve as a link to family, childhood memories, and values, which can provide cathartic value. Particularly in the America, world dance may be the conduit to connect to cultural elements that may otherwise be dormant. Involvement in a world dance style from another culture promotes awareness, understanding, and sensitivity. While beyond respectful, dance can be a fun way expand your knowledge about cultures worldwide.

Expression

When words fail us, dance may still be an option. World dance can be a safe way to express pent up emotions. Particularly when experiencing complex feelings, dance can be used as a method of both exploration and expression.  In certain theatrical styles dancers have the opportunity to take on a persona which permits them to explore feelings they would not otherwise be comfortable confronting. For others, embodying a particular character is not required. Instead, they may create confident, exuberant dance persona of their own. Embracing this altered and empowered sense of self helps individuals to express themselves through movement over words.

Happiness

Dancers often remark on the pure joy attained from this healing artxii. Dance can help to improve sentiments of hope and happiness. Further, in addition to the perks of smiling and laughter, dance can be a powerful tool in combatting depression and anxiety as well.

Why You Need to be Good at Reading Your Emotions

As you look to the day ahead, are you anticipating it with joy or do you dread the daily grind you’re about to face? While with the people you care about the most, is it easy for you to laughand chat pleasantly, or do you tend to hold back, for reasons you don’t completely understand? According to new research by University of Pittsburgh’s Vera Vine and Loyola Marymount’s (Los Angeles) Brett Marroquin (2018), these are situations reflecting “emotional clarity,” an ability that plays a key role in mental health.

As the term implies, your emotional clarity involves your ability to identify the way you’re feeling. More formally, the Pittsburgh-LA researchers define this quality as “subjective perception of being able to identify which emotions one feels with relative ease” (p. 1). This is, it’s true, a “subjective” ability, meaning that there is no objective reference point for naming your emotions. Because there can be no accurate outside indicator, then, it’s important to focus on the idea that you can identify your emotional state without undue difficulty. Emotions are also relative qualities, meaning that happiness to you might mean something different than happiness does to someone else. The question is whether you know without having to think too hard that, at least for you, the primary emotion you’re feeling is a positive one.

Vine and Marroquin propose that the way emotional clarity affects mental health is through its role in predisposing people to depression. One possible pathway for this relationship involves emotional regulation, which is your ability to modulate or control the type of emotion you’re feeling, how long you feel that emotion, how strong it is, and whether you can turn it from negative to positive. If you’re good at emotional regulation, in other words, you’ll readily turn a bad mood to a good mood in reasonably short order by changing your perspective on the situation. You might be sad because your partner forgot to run an important errand for you, believing that this reflects lack of true caring. However, if you’re good at emotion regulation, you’ll get over those feelings relatively quickly, and you won’t let them overwhelm you in the first place.

People who are prone to depression not only are poorer at emotion regulation, according to Vine and Marroquin, but also tend to ruminate over situations that bother them. Your partner’s oversight in running that errand for you becomes, in rumination, a thought that you go over and over in your head as you ponder its meaning and importance. Being unable to identify clearly the emotion you’re feeling could contribute, the authors suggest, to the tendency to ruminate. In this situation, you’re not sure whether you’re sad or just plain angry. Perhaps because you’re not sure how you feel, you invest undue energy in trying to sort out your emotions. Furthermore, as the authors suggest, the more intensely you feel your negative emotions yet are unable to identify them clearly, the more likely you will experience depressive symptoms.

To test their proposals regarding the role of emotional clarity and intensity of negative affect in depression, Vine and Marroquin first asked an undergraduate sample of participants to complete questionnaires assessing emotional clarity, negative affect intensity, and symptoms of depression. The emotional clarity items included self-rating statements such as “I am rarely confused about how I feel,” and “I can’t make sense of my feelings” (reverse-coded). Participants indicated their levels of negative affect intensity by completing items such as “My emotions tend to be more intense than those of other people,” and “My friends might say I’m emotional.”

As predicted, people receiving higher intensity of negative affect who were low in emotional clarity had higher scores on the depressive symptoms index. Moving on to a clinical sample, the authors next tested a model that allowed them to compare the effects of rumination with other possible routes linking low emotional clarity and negative affect intensity to depression symptoms. Rumination once again proved to play a key role in the findings, affecting all participants with low emotional clarity regardless of the intensity of their negative affect.

Just having negative feelings isn’t enough to lead to depressive symptoms, then. You also have to be unable to put a name to your feeling state, and then dwell on trying to identify it, in order to be at risk for the experience of depression. The authors in this study tested other models to see if various coping strategies associated with depression rather than rumination could be involved. For example, not thinking about your sad feelings could be one such coping strategy (avoidance), as could trying to put a positive spin on the situation (positive reappraisal). Neither of these were strong predictors of depression symptoms across all levels of emotional intensity. As the authors point out, though, because the majority of participants in the clinical sample also had an anxiety disorder, it’s possible that at least some of what people with low emotional clarity must deal with in handling their negative affect involves fear, worry, or dread.

Apart from these diagnostic issues, the Vine and Marroquin study highlights the importance of being able to come up with an explanation for what you’re feeling in order to be able to overcome those feelings. Some people may just have a tendency to experience emotions intensely, but this factor is an independent contributor to feelings of depression.

How can you use this study’s findings to your own benefit? The clear implication is that it’s worth, without ruminating, trying to come up with a label for the way you’re feeling at any given moment. Perhaps a boss or in-law has made you furious by treating you in an uncivil manner.  You’re feeling stirred up, but instead of recognizing your feelings as anger, you tell yourself you’re “frustrated.” You may in fact be frustrated, but this isn’t at the root of your reaction. If you can’t label your feelings as anger, you may continue to mull this over and over, and in the process, fail to come up with an appropriate strategy for dealing with the situation. If you admit to being angry, you may not decide go ahead and tell the person involved how you’re feeling, but at least you’ll know it’s anger, and not frustration, that’s causing you to be distressed. You can move on, relying on methods that have proved successful in the past to lower your levels of anger. This might be a good time for you to go to a kick-boxing class, for example, if that’s what helps you find an outlet for your feelings.

To sum up, it is important to be able to read the emotions of other people in order to be able to respond appropriately to them. Knowing your own emotions, though, is just as important for maintaining your mental health.

5 Reasons Why You May Not Know Your Psych Diagnosis

1. Getting the right diagnosis

According to basic medical principles, making an accurate diagnosis is the first step in developing a rational, evidence-based and personalized treatment plan. Because psychiatric diagnosis is not yet based on clear biomarkers in most cases (though this is beginning to shift), but is instead based largely on clinical presentation, there are unfortunately many reasons why diagnosis may be delayed or inaccurate.

One reason for difficulty making an accurate diagnosis is inadequate history. Getting a good clinical history requires a lot of time and a good connection between clinician and patient. Time may be limited because of managed care in the case of insurance-based care, or because of difficulty committing financial resources and scheduling enough time. It’s important to gather past history as well, and doing so includes obtaining prior medical records as well as, at times, speaking with family members or reviewing school records to get accurate information. These and other reasons interfere with diagnosis when important information is missed.

Clinicians may also be inclined to make rapid diagnoses based on insufficient history, leading to errors in diagnosis especially if the decision is not reviewed periodically, either as a matter of routine good care or when treatment is not working. When a particular diagnosis is popular, as ADHD currently is, clinicians may be quick to notice difficulties consistent with ADHD, and fail to recognized other issues. Many conditions are associated with distractibility, agitation and inattention, including post traumaticconditions, bipolar disorder, depression and anxiety, and others. When diagnosis is unclear, or treatment isn’t helping after a reasonable period of time, getting a second opinion and obtaining formal psychological testing may be useful

2. Accuracy of medical history

Taking a comprehensive history can be difficulty for both patient and clinician. In addition to the amount of time, there are so many possible factors to consider it is hard to cover all of them, though the use of self-report instruments can be helpful. Furthermore, there are important factors which people may not want to talk about, or may not understand are important, including substance and alcohol use, developmental adversity and trauma, and periods of time which didn’t seem problematic, but may be key information, a good example being hypomanic episodes which feel good, and aren’t necessarily seen as problematic by patients if they haven’t cause problems. Hypomanic episodes would suggest a diagnosis of bipolar disorder, rather than major depressive disorder, and the approach to care is very different. Issues like this lead to delays in diagnosis and effective care.

3. Diagnostic “chameleons”

Complex Developmental Trauma (cPTSD)

Post-traumatic consequences can present in many different ways, and in the absence of careful evaluation may easily be mistaken for other problems. For example, cPTSD (Complex Post Traumatic Stress Disorder) may appear to be a basic anxiety disorder (such as generalized anxiety disorder or panic disorder), a mood disorder, anger management issues, attention deficitdisorder, and may also present with alcohol and substance use, eating disorders, and interpersonal issues. Focusing on one facet of the presentation without seeing the big picture can be very misleading.

Well-intentioned clinicians will often take the path of least resistance, or may not be properly trained to identify more complex issues, rather than risking confrontation with patients and families about more troubling and far-reaching problems, including hidden abuse and addiction within the family. Under these circumstances, the child—referred to here as “the identified patient”—may become the sole focus of concern within a dysfunctional family. The identified patient becomes an unwitting victim of pathological family dynamics designed to cover up problems behind the guise of concern and care. This often is the case with conditions beyond ADHD, including eating disorders and behavioral problems.

When trauma hasn’t been identified, and may be omitted due to avoidance or lack of understanding of its importance, people may end up with multiple diagnoses and treatments which don’t seem to be working. On top of all this, people often have more than one condition, including both medical and psychiatric disorders which present with emotional and psychological problems. In addition, the diagnostic system itself is evolving, and is periodically revised. As we understand the brain better, and the relationship among various biological and social factors, the way we view diagnosis may change almost completely in the future.

Attention-Deficit Hyperactivity Disorder

In contrast to developmental trauma, ADHD is often more acceptable to people than other causes for difficulty with concentration and focus. It’s psychologically easier for many people to say they have ADHD. It’s not unusual for patients (or their parents) to suggest a diagnosis of ADHD, which can cover up other issues.

On the other hand, ADHD is also under-diagnosed, and often dramatically effective treatment can be delayed for far too long. This highlights the importance of diagnostic accuracy and comprehensive evaluation.

Stop Chasing Happiness, Look for Meaning Instead

There is a crisis of Meaning in our world today. Many people have told me that they feel overwhelmed, lonely, and unfulfilled. In chasing the “good life,” they have sacrificed their relationships, their health, and, at the end of the day, still find themselves with lives and work that bring them little joy and meaning. Depression is on the rise and many people simply can’t cope with the pace of change brought on by technological, cultural, and social transformations.

Throughout the many years that I have researched, taught, and written about the human quest for Meaning, people have told me they feel empty because they have lost connections with others due to the transitory natureof life :  moving across the country; no longer belonging to or feeling connected to neighborhoods, organizations, social groups, religious groups, or political causes; feeling disconnected from society and fearing that their country is on the wrong track; worrying that terrorists will further disrupt their lives and they will have no one to turn to for help and support.

People have shared with me that they feel empty because they lack purpose in their day, not having an inspiring reason to get up in the morning. They worry about being left behind in the job market as more organizations lay off workers or cut hours and benefits. They worry about the instability of constantly chasing contract or part-time jobs. They feel like they are hamsters on the treadmill of life, running faster and faster and still getting nowhere. Older people have told us they wonder if they should they have done something more or something different with their life. Did they settle for something less than they really wanted or expected in their life?

People have also told me they are feeling overwhelmed with financial pressures, drowning under a stack of bills that can’t be paid, and stressing about family obligations, including wayward teens and elders suffering from dementia. They worry that their unhealthy lifestyles have led to a vicious cycle of obesity, low energy, and depression.

Many people are sensing this emptiness, this existential vacuum1, but are not sure what to do about it. Some turn to drugs and other forms of avoidance, some put on a happy face to mask the issues, while others simply withdraw and postpone living a full life. Although not imprisoned with real barbed wire and steel, many people feel like they are “prisoners” in their own lives.

As I have written about for some time now, the solution or antidote is not about the search for happiness or “positive psychology.” Happiness is an emotion that is linked to pleasure but it is fleeting; it doesn’t last. We can share a happy moment when we are enjoying a good meal or a good laughwith a friend, but this emotion only lasts a short time. Sooner or later, we must face and respond to the challenges life throws at us. We must be ready to take on the fullness of life — the ups and downs, the joys and sorrows, the pleasures as well as the suffering. As we wrote in our book, The OPA! Way, the ancient Greek philosophers, such as Socrates, Plato, and Aristotle, wisely taught us so many years ago: life is not about living the happy life; it’s about living the complete life, the meaningful life.2

Not Talking About Mental Health Is Literally Killing Men

Our mission at MensHealth.com has always been to help men build themselves into better men. Stronger men. Healthier men.

Rooted in science and expert opinion, our content translates dense topics into easily digestible, actionable health advice. Piecemeal, the concepts are sound and effective. But overall health must be viewed holistically.

Your mental health is inseparable from your physical health. Not a revolutionary concept, but what is astounding is the stigmatization that still surrounds men who dare to talk about their mental struggles. As we move into Mental Health Awareness Month this May, we hope to change that.

Men who are vocal about any kind of mental issues can be dismissed as weak. As inferior. As flawed, broken guys who are more likely to be ostracized for their honesty, instead of rewarded for their bravery. Instead of affording a fellow man compassion, we mock, belittle, and turn a blind eye. We freely spit the phrase, “Man up,” as though your gender alone should suffice to guide you through your darkest times.

Or worse: we nonchalantly respond, “Well, that sucks,” then change the subject because talking about feelings is just too real.

What’s real is the fact that 9 percent of men experience depression on a daily basis. That’s more than 6 million men. Even if we understand what depression feels like, we rarely admit that’s the culprit. We lie and say we’re tired or just cranky. More than 3 million men struggle with anxiety daily. Of the 3.5 million people diagnosed as schizophrenic by the age of 30, more than 90 percent are men. An estimated 10 million men in the U.S. will suffer from an eating disorder in their lifetime. (Our own Style and Grooming Editor Louis Baragona eloquently and touchingly shared his battle with bulimia.) We retreat from friends and instead drown sorrows in numbing substances. One out of every five men will develop an alcohol dependency during his life.

Male suicide is rising at such an alarming rate that it’s been classified as a “silent epidemic.” It’s the seventh leading cause of death for males. That’s a staggering statistic. Drill down into the numbers and suicide is the second most common cause of death for every age group for men 10 through 39.

This macho attitude of stuffing your feelings down, or ignoring them, is antiquated and downright dangerous.

It’s okay to not have your shit together. It’s okay to feel depressed. It’s okay to feel overwhelmed. It’s okay to be sad. It’s okay to be anxious. It’s okay to be scared. It’s okay to not have everything figured out, to feel a wave of uncertainty come crashing over you and not know which way is up, or when your next gulp of air will come. These are perfectly normal feelings that every man experiences. And it’s okay to talk about it.

What’s not okay is suffering in silence.

A few courageous men have led the charge, exposing their plights to the rest of us. Singer Zayn Malik openly discussed his struggle with anxiety and his battle with an eating disorder. The Cleveland Cavaliers’ Kevin Love penned an op-ed entitled “Everyone Is Going Through Something,” chronicling his panic attacks.

When Dwayne “The Rock” Johnson recently revealed his battle with depression after his mother attempted suicide when he was a teenager, his words struck a chord with us:

“[It] took me a long time to realize it but the key is to not be afraid to open up. Especially us dudes have a tendency to keep it in. You’re not alone.”

Brain training may help with mild cognitive impairment

So far, research has been mixed on whether brain training programs can improve or slow memory decline. Yet a new study published online Jan. 4, 2018, by the Journal of the American Geriatrics Society found that brain training may help people with mild cognitive impairment (MCI), the stage between normal brain aging and dementia.

Researchers recruited 145 adults, average age 72, who were diagnosed with MCI. They were split into three groups. Those in one group did two hours of brain training every week for two months. The training focused on improving memory by learning new strategies to better encode information. For example, they remembered errands by associating tasks with specific locations in their home, a process called method of loci. They also practiced how to better control their attention.

The people in the second group also received two hours of training per week, but were taught how to focus on the positive aspects of their lives, like learning how to cope with stress and frustration. The third group didn’t follow any program.

All the participants were given memory tests at the start of the study. Afterward, the people in the brain training group scored two to four times higher on the tests. Those in the other two groups showed a much smaller improvement.

The brain trainers also maintained their improvement over a six-month period, and the researchers speculated this was because they used their training in their daily lives. More research in this area is needed, but the results suggest there could be benefits from stimulating the brain in certain ways, especially if it’s done on a regular basis.

Why It Doesn’t Feel Good When Someone Else Succeeds

Almost everyone knows the feeling. A friend or colleague has been promoted, has had some success, now has a bigger house or is making more money, and rather than feel happy for them you feel depressed and angry. And there is part of you that would really like to see them fail.

You feel embarrassed about these envious feelings, you can’t admit them to your other friends, and you certainly wouldn’t tell the target of envy. We are not supposed to feel this way, you have been told. But then you have this feeling and it is eating away at you.

Your Envious Mind
You find yourself thinking…

  • They don’t deserve this.
  • They think they are superior to me
  • They are superior to me
  • I can’t stand being around them
  • I hope they fail

And then you have these thoughts about yourself…

  • This reflects how inferior I am
  • I keep falling behind
  • People will look at me like I am a loser
  • I could have done that

So now you think “What kind of person am I that I don’t want someone else to succeed?” You are a normal person, because envy is everywhere. Kids playing at a game sometimes feel better if they and a friend both lose than they do if the other kid wins, and adults can feel the same way. We often have a hard time not being the winner. When we are envious we think of the world as a zero-sum game. If she wins, I lose. And it seems that rewards are scarce.

Three Kinds of Envy

  1. Depressive envy (“I feel like a loser compared to her”). When someone you know does better than you, it often feels like you are a loser, a failure, or inferior. You think that their success reflects your failure.
  2. Hostile envy (“I think that she manipulated her way up”). Because the other person’s success has resulted in your feeling that you can’t stand it, you may want them to fail. You enjoy hearing about successful people getting divorced, arrested, or even having accidents. Schadenfreude is tempting, because if the other person fails—after succeeding—we feel better knowing we both have “lost.”
  3. Benign envy (“That’s impressive”). This is a neutral kind of envy; you observe that someone else has succeeded and you admire them and give them credit for what they have done. Benign envy leads us to pay attention to what the other person is doing—because we often think we can learn something.

How Untreated Depression Changes The Brain Over Time

Years of untreated depressionmay lead to neurodegenerative levels of brain inflammation. That’s according to a first-of-its-kind study(link is external) showing evidence of lasting biological changes in the brain for those suffering with depression for more than a decade.

The study findings are from the same research team that originally identified a link between brain inflammation and depression. Along with subsequent research, the findings have started to change thinking about depression treatments. Evidence is increasingly pointing to the possibility that it’s not only a biological disorder with immediate implications, but over time depression may alter the brain in ways requiring different forms of treatment than what’s currently available.

This was a relatively small study of 80 participants; 25 had untreated depression for more than 10 years, 25 for less than 10 years, and 30 had never been diagnosed. All were evaluated with positron emission tomography scans (PET scans) to locate a specific type of protein that results from the brain’s inflammatory response to injury or illness. Throughout the body, the brain included, the right amount of inflammation protects us from disease and repairs us when we’re injured. But too much inflammation leads to chronic illness, including heart disease and potentially neurodegenerative diseases like Alzheimer’s and Parkinson’s.

If long-term depression results in more inflammation, the researchers expected to find more of the protein in the brains of those who’d suffered from untreated depression the longest. And that’s exactly what they found, with higher levels in a handful of brain areas including the prefrontal cortex, the brain area central to reasoning and other “executive” functions thought to be compromised by disorders like depression.

If the results hold up (via more research with more participants) this will prove to be an important finding adding evidence to the argument that depression shares similarities with degenerative disorders like Alzheimer’s, changing the brain in ways research-to-date hasn’t fully grasped.

“Greater inflammation in the brain is a common response with degenerative brain diseases as they progress, such as with Alzheimer’s disease and Parkinson’s disease,” said senior study author Dr. Jeff Meyer of the Centre for Addiction and Mental Health (CAMH) at the University of Toronto.

These findings build on a study(link is external) published in 2016 showing that patients with depression had higher levels of C-Reactive Protein (CRP), another biological marker of inflammation throughout the body, than those not suffering from the disorder. That was an observational study looking for a link between depression and inflammation (correlation not causation), but the results were significant. After adjusting for several factors, those with depression had CRP levels more than 30% higher than those without depression.

What the research is collectively indicating is that we may need to change our thinking about depression and its effects. The evidence affirms that depression truly is a biologically based disorder of the brain, and left unchecked it may run a degenerative course that damages brain tissue, possibly in ways similar to other neurodegenerative diseases. All of this places greater emphasis on the need to develop more effective treatments and, as urgently, work toward removing the stigma from those suffering.

7 Ways Boosting Your Happiness Will Improve Your Finances

Money may not buy happiness, but a positive attitude can do more than bring a smile to your face – it can boost your financial health.

“When you are negative, your brain splits resources between your work and managing your negative emotions so you have less energy to focus on the task [at hand],” says Shawn Achor, co-founder and CEO of GoodThink Inc. and author of “Big Potential.” “When you are positive, the brain doesn’t feel under threat, so it releases more resources to help you be creative and productive. This means your energy lasts longer, you are three times more creative, productivity rises, sales increase, memory deepens and test scores improve,” he adds.

While most people believe happiness is the outcome of reaching success, it’s actually the opposite: Happiness is what makes you successful and leads to improved financial well-being. In fact, a 2015 study by the Social Market Foundation and the University of Warwick’s Centre for Competitive Advantage in the Global Economy found that happiness increases productivity on work-related tasks by 12 percent on average.

Benjamin Hardy, author of “Willpower Doesn’t Work: Discover the Hidden Keys to Success,” says your emotional state has everything to do with your success – and your finances – as it determines the quality of your thoughts and overall mindfulness.

Shifting your perspective and lifting your mood can get your finances in tiptop shape. Read on to learn why starting your day with a sunnier disposition can lead to financial success.

1. A positive disposition helps you make smarter financial decisions. A sunny outlook can provide balance and clarity for making sound financial choices. Chad Rixse, co-founder of Millennial Wealth, a financial-planning firm for young professionals based in Seattle, says that happiness helps people make smarter money decisions. “We’re not so quick to make emotionally driven decisions, but rather think about how [our] decisions might impact the overall level of happiness we are currently experiencing and choose a more objective approach as a result,” he says.

Jamie Gruman, a professor of organizational behavior at the University of Guelph and founding chair of the Canadian Positive Psychology Association, says happiness also directly influences investment choices.

“Happy people will be more innovative and think more broadly in terms of the financial options they consider, and they will consider a greater number of vehicles and be more open to investment options they might have otherwise overlooked,” Gruman says. “This can diversify their portfolio, reduce risk and improve their long-term financial performance.”

2. Happiness can help you increase your income. People with a brighter outlook on lifeare typically more satisfied with their jobs, perform better on assigned tasks and are more likely to help others. As a result, content employees tend to collaborate well in team environments and gain social support from their co-workers. Employees with a positive disposition are also less likely to miss work and typically cope more effectively with challenges, all of which promote career advancement.

“When we are happy, we are better able to focus, concentrate and have greater motivation to tackle challenging tasks,” says Kristina Hallett, clinical psychologist and executive coach based in Suffield, Connecticut. Not only does a positive attitude create a better work environment, it also increases productivity in both quality and quantity of work and can increase your chance for getting a raise or a promotion and a better evaluation from your supervisor, she adds.

3. A positive mindset can open doors to new business opportunities. Happy people have greater success in networking due to their willingness to engage with others and form relationships more quickly, which can lead to new business partnerships and increased sales.

“When you are happier, more people are attracted to working and collaborating with you,” says Rebecca Cafiero, lifestyle expert, speaker and trainer at RebeccaCafiero.com, where she helps people find success and turn their passions into a business. “People don’t buy what you sell, they buy you, and no one wants to buy a negative person or their services.”

Jennifer Winsor, a wellness expert with Waves and Willows, a lifestyle website and blog, says that a positive person is more likely to be asked to participate in a team or group project because they are a pleasure to be around. “In an employment setting, this could lead to exciting new career opportunities or training which could allow for career advancement and increased financial benefits,” she adds.

How Does Spontaneous Gratitude Increase Daily Well-Being?

Gratitude, day-to-day variations and consistency over time.

Previous research on the positive effects of gratitude has shown that gratitude appears to reduce stress and foster well-being (e.g. Wood et al., 2010). A recent prospective study in which people were instructed to list things they were grateful for on a daily basis supports this notion (Krejtz et al., 2016). However, little if any, research has looked at whether spontaneous (non-directed) changes in gratitude track with well-being and stress response. Rather than being a stable personality characteristic (a “trait”), gratitude may be more of a “state,” varying over the course of time—or perhaps a combination of both. Do daily fluctuations in gratitude correlate with well-being and indicators of happiness, stress, and depression? Furthermore, does gratitude serve as a buffer for stress and negativity, helping to offset toxic effects on more challenging days?

In order to look more closely at how natural day-to-day levels of gratitude may interact with various indicators of well-being and stress, researchers Nezlek, Krejtz, Rusanowska and Holas (2018) followed 131 participants for two weeks, using daily self-assessments to investigate correlations among gratitude and factors related to well-being and stress. Daily measures included gratitude, positive and negative emotional states, self-esteem, depressogenic adjustment (optimism about oneself and life), worry, and rating of important events of the day on how stressful and how positive they were. Participants reported on 10 possible categories for events: family, interpersonal, partner, work, finances, official, health, hobby, values, and other/everyday events.

As in previous studies looking at intentionally cultivated gratitude, researchers found that on every measure, gratitude was significantly correlated with well-being. On days when people felt more grateful, well-being was reported as being higher. Likewise, on higher stress days, participants reported lower well-being, and on lower stress days, participants reported greater well-being.

Using gratitude to buffer stress responses.

Importantly, they found that gratitude did in fact appear to act as a buffer for stress. On days with fewer positive events, gratitude and well-being were more strongly related, suggesting that gratitude may serve to bolster resilience, amplifying lower positive emotions on difficult days or perhaps even providing, essentially, internal positive events to compensate for a lack of external positive events. This is especially noteworthy because people often have difficulty tapping into gratitude when difficulties arise, focusing on negatives with bitterness or pessimism.

Gratitude therefore appears to provision us internally with a positive response when external events fail to do so. For people who are able to muster up gratitude when the going gets rough, not only as a generally characteristic but also as a just-in-time response to stress and negative events, gratitude can be a “bridge over troubled water” that helps to keep us from getting pulled down into a negative spiral of maladaptive coping. People who use gratitude in this way must be able to do so, rather than undermining resilient responses.

Low Cholesterol and Suicide

The human brain needs a lot of cholesterol to wrap around nerves, to serve as components of cell membranes, and to aid in communication between neurons. While cardiologists have been racing to lower serum cholesterol more and more (and drug companies keep coming up with fancy new cholesterol-lowering drugs*), the importance of cholesterol in the brain relative to cholesterol and heart health has been mostly ignored.

It was felt that lowering serum cholesterol wouldn’t have much affect on the brain for a couple of reasons: most of the cholesterol used in the brain is made in the brain (cholesterol from the blood doesn’t really get into the brain, which is separated by the blood-brain barrier), and most of that has a pretty low turnover. The cholesterol that wraps around nerve sheaths tends to stay where it is and not float around and be recycled like the cholesterol-carrying particles in the blood.

Despite these reasonable suppositions, many studies over decades have (for the most part) consistently linked low total serum cholesterol with suicide, violence, and depression. Total cholesterol levels below 160, and especially below 130, correlate with a higher risk of mental problems. And despite the blood-brain barrier and little movement of cholesterol from the blood into the brain, brain and serum cholesterol do tend to go up and down at the same time. There are other curious findings as well…cholesterol tends to be lower in Alzheimer’s Disease**, and cholesterol has been found to be lower during a manic episode in bipolar disorder and tends to pop up again when the episode gets better.

Now none of these findings prove that low cholesterol causes problems in the brain. Those affected with Alzheimer’s are known to eat less, for example, due to the cognitive impairment. Depression is known to affect appetite as well. Most of the early studies linking suicide and depression and low cholesterol only checked total cholesterol levels, which we now know is an unreliable indicator of overall health (the subfraction that is HDL or triglycerides compared to the total are much better indicators of cardiovascular health), so it was hard to know what to make of the findings.

However, a Mexican study was recently published*** that can shed some light on these many questions. In this study, patients hospitalized with depression, many after suicide attempts, were compared with age and body-weight matched healthy controls in the community. In order to remove some confounding variables, anyone with known medical conditions that affect the blood lipids, such as diabetes or metabolic syndrome, and anyone on a statin was excluded from the study. These researchers also measured the clinical lipid panel that is routinely used to measure cardiovascular risk, including HDL, LDL, triglycerides, VLDL, and total cholesterol. They used a term I’ve never heard before (but I like a great deal), “hypocholesterolemia” to mean folks with a total cholesterol of under 150. Over the course of several years they managed to study nearly 500 people, enough to give the researchers some decent statistical power.

Here is the gist of what they found: those with hypocholesterolemia were over four times more likely to have major depressive disorder and over five times more likely to have attempted suicide. In fact, half the suicide attempters had a total cholesterol less than 150 compared with 38% of the total group of depressed individuals and 14% of healthy controls. Triglyceride and VLDL levels, on the other hand, were higher in the depressed and suicide-attempt group.

How Marriage Changes Your Personality

It’s often said that married couples grow more alike over the years. But can marriage really change your personality? New research by University of Georgia psychologist Justin Lavner and his colleagues shows that people’s personalities change in predictable ways within the first year and a half after tying the knot.

Psychologists are divided on the question of whether personality is innately determined by your genes or shaped by experiences in early childhood, with many believing it’s probably a combination of both nature and nurture. By adulthood, however, personality is usually established and doesn’t change greatly after that. Still, some research has shown that major life events can nudge personality in particular directions. For example, a strong introvert with a desire to teach can learn to be more extroverted in the classroom.

Marriage, of course, is one of the most important events in a person’s life. Since married couples have to find ways to get along on a daily basis, it’s perhaps not surprising that they’d experience changes in their personality as they adapt to partnered life. This is the hypothesis that Lavner and his colleagues tested.

For the study, 169 heterosexual couples were recruited to respond to questionnaires at three points in their marriage: 6, 12, and 18 months. This way, the researchers could detect trends in personality change. At each point, the couples (working individually) responded to two questionnaires, one assessing marital satisfaction and the other measuring personality.

The most widely accepted theory of personality is known as the Big Five. This theory proposes that there are five basic personality dimensions. The Big Five are usually remembered with the acronym OCEAN:

  • Openness. How open you are to new experiences. If you’re high in openness, you like trying new things. If you’re low in openness, you’re more comfortable with what’s familiar.
  • Conscientiousness. How dependable and orderly you are. If you’re high in conscientiousness, you like to be punctual and keep your living and working spaces tidy. If you’re low in conscientiousness, you don’t get uptight about deadlines, and you’re comfortable in your cluttered environment.
  • Extraversion. How outgoing you are. If you’re high in extraversion, you like socializing with lots of other people. If you’re low in extraversion (that is, introverted), you like having time to yourself.
  • Agreeableness. How well you get along with others. If you’re high in agreeableness, you’re easygoing and happy doing what everyone else is doing. If you’re low in agreeableness, you’ve got to have things your way, no matter what the rest of us want.
  • Neuroticism. How emotionally stable you are. If you’re high in neuroticism, you experience big mood swings and can be quite temperamental. If you’re low in neuroticism, your mood is relatively stable, and you live your life on an even keel.

When the researchers analyzed the data after 18 months of marriage, they found the following trends in personality change among the husbands and wives.

  • Openness. Both husbands and wives showed decreases in openness. Perhaps this change reflects their acceptance of the routines of marriage.
  • Conscientiousness. Husbands increased significantly in conscientiousness, whereas wives stayed the same. The researchers noted that women tend to be higher in conscientiousness than men, and this was the case with the husbands and wives in this study. The increase in conscientiousness for men probably reflects their learning the importance of being dependable and responsible in marriage.
  • Extraversion. Both husbands and wives became more introverted (lower in extraversion) over the first year and a half of marriage. Other research has shown that married couples tend to restrict their social networks compared to when they were single. This drop in extraversion probably reflects that trend.
  • Agreeableness. Both husbands and wives became less agreeable over the course of the study, but this downward trend is especially noticeable for the wives. In general, women tend to be more agreeable than men. What these data suggest is that these wives were learning to assert themselves more during the early years of marriage.
  • Neuroticism. Husbands showed a slight increase in emotional stability. However, the wives showed a much greater one. In general, women tend to report higher levels of neuroticism (or emotional instability) than men. It’s easy to speculate that the commitment of marriage had a positive effect on the wives’ emotional stability.

Concussions Can Be Detected With New Blood Test Approved by F.D.A.

The Food and Drug Administration on Wednesday approved a long-awaited blood test to detect concussions in people and more quickly identify those with possible brain injuries.

The test, called the Banyan Brain Trauma Indicator, is also expected to reduce the number of people exposed to radiation through CT scans, or computed tomography scans, that detect brain tissue damage or intracranial lesions. If the blood test is adopted widely, it could eliminate the need for CT scans in at least a third of those with suspected brain injuries, the agency predicted.

Concussion-related brain damage has become a particularly worrisome public health issue in many sports, especially football, affecting the ranks of professional athletes on down to the young children in Pop Warner leagues. Those concerns have escalated so far that it has led to a decline in children participating in tackle sports.

“This is going to change the testing paradigm for suspected cases of concussion,” said Tara Rabin, a spokeswoman for the F.D.A. She noted that the agency had worked closely on the application with the Defense Department, which has wanted a diagnostic tool to evaluate wounded soldiers in combat zones. The Pentagon financed a 2,000-person clinical trial that led to the test’s approval.

According to the Centers for Disease Control and Prevention, there were about 2.8 million visits to emergency rooms for traumatic brain injury-related conditions in 2013, the most recent year for which the numbers were available. Of these, nearly 50,000 people died. Most patients with suspected traumatic brain injury are evaluated using a neurological exam, followed by a CT scan.

One of the challenges of diagnosing concussions is that symptoms can occur at different times. In some people, they appear instantly, while in others they can show up hours or even days later. Symptoms also vary from person to person. Some experience sensitivity to noise, others lose their balance, and still others become sensitive to bright light.

“A blood test to aid in concussion evaluation is an important tool for the American public and for our service members abroad, who need access to quick and accurate tests,” said Jeffrey Shuren, director of the F.D.A.’s medical device division. The agency, often criticized for the pace of its approvals, noted that it had cleared this diagnostic device in less than six months.

“This is something that has been a long time coming,” said Colonel Dallas Hack, who was director of the Army’s Combat Casualty Care Research Program from 2008 to 2014 and is now retired.

“The concept originally was that we would have something that medical personnel in the field would be able to use to assess whether somebody who had received a head injury needed a higher level of care,” Dr. Hack said.

The test works by measuring the levels of proteins, known as UCH-L1, and GFAP, that are released from the brain into blood and measured within 12 hours of the head injury. Levels of these blood proteins can help predict which patients may have intracranial lesions visible by CT scan, and which won’t. In a statement announcing the approval, the F.D.A. said that the brain trauma indicator was able to predict the presence of intracranial lesions on a CT scan 97.5 percent of the time, and those who did not have such lesions 99.6 percent of the time.

The possibility of testing an athlete on the sidelines could also be used in all sports, but particularly football, which includes high-speed collisions on every play. While professional and collegiate athletes have access to trainers and doctors, players on high school teams and in youth leagues often make do with a volunteer physician or an emergency medical technician, if at all.

Far more athletes play football at younger ages. More than one million boys play football in high school, about the same as those who play baseball and basketball combined. Many more play football in youth leagues, including Pop Warner, one of the most established organizations.

These organizations have seen their insurance costs rise in part because parents of injured players have sued them for not doing enough to protect their children.

Putting an athlete with a concussion back on the field can also have grave consequences. A player who suffers a concussion is susceptible to second-impact syndrome, which occurs when the brain swells after a second concussion, but before the first concussion has been diagnosed.

Staying Mentally Fit

“When I was depressed I couldn’t motivate myself to do the things that make me feel good. When I was feeling better, I didn’t think about restarting them. I guess I need to change how I think about my depression: there’s depressed; there’s not depressed; then there’s working to keep myself healthy.”

The difference between fitness and treatment of an illness:

Healthy living is something most of us strive for.  To keep people motivated to stay in shape, the fitness industry is forever coming up with new gadgets, developing new diet and exercise programs. Keeping in shape, however, is not the same as treating an illness. You don’t tell someone who is having an exercise-induced asthma attack to keep on pedaling. And you don’t tell someone who is depressed to be happy or socialize more.  You would be ignoring the fact that this person is suffering right now and needs to treat the asthma so they can breathe, in order to be able to exercise. Just as the depression needs to be treated for the person to be able to “be happier” and socialize more.

I had been working with Laura, a woman in her 30’s, for about a year and a half when she was diagnosed with lymphoma. She was married and had two children in grade school when she was diagnosed. Laura would describe herself as a strong person that can handle almost anything that is thrown at her.

Starting at a young age, when she was in grade school, she would escape the chaos and neglect at home by going on day-long bike rides. “Sometimes I would see a parent playing with their daughter in the playground and I would go over and ask to play. I would point in the general direction of a building nearby and tell them that I lived right over there, so my mom can watch me from the window.”

The first time she remembers being treated for depression was when she was in college, just after her father died. “I was so down all I wanted to do was sleep. I stopped going to classes and spent most of my time getting high. I didn’t know what to do so I went to the student counseling center for therapy. The next time I got depressed was shortly after getting married. My husband pushed me to see someone for medication. That’s when my friend gave me your name. I have always been the kind of person who does everything I can to take good care of myself but lately it’s been a struggle to do anything.  I feel like I am not trying hard enough to feel better which makes me feel worse. I never wanted to become one of those people who ‘needs’ medication to be happy.  The only reason I’m willing to take medication now is because it is hard for me to even enjoy my kids, I just want them to leave me alone, and I hate feeling like that.”

We slowly started her on a medication and, as her symptoms improved, she was able to restart all the activities she engaged in before the depression took hold.

After she had been doing well for about a year she wanted to try coming off the medication. We slowly tapered the medication. She had no problem coming off of it and we made a plan that she would follow up with me if she needed to.  That’s when she got a diagnosis on lymphoma.

A few months later I received a call from her to schedule a follow up.  “I had my yearly physical and some lab work done and there were some abnormalities. Anyway, to, make a long story short, I was diagnosed with Lymphoma. This sucks. I was feeling so good until this happened. Now I can feel some of those familiar symptoms of depression and think I should go back on the medication before it gets worse. My family is already having to deal with the cancer, I don’t want my kids to see me depressed too.”

She went through a year of aggressive treatment for the Lymphoma with some difficult side effects—loss of appetite, loss of taste, weight loss, hair loss, and numbness in her feet. Her mood remained as good as could be expected and at the end of the year she was declared cancer free.

She continued to work with her psychotherapist and remained on her antidepressant. Over the next six months the side effects from the chemo went away—her hair grew back, her taste came back, she gained weight, and the numbness improved. About six months after, during a follow up session, I asked how she is feeling about remaining on the medication.

“I was going to ask you if you think I should increase it?”

“You seem like you’re doing well, but if you are asking me that I am guessing that you notice something is not right.”

4 Strategies for Families Facing Addiction

Is there a family today not experiencing addiction in a loved one, relative, friend, or co-worker? Whether it is the opioid epidemic seizing this country, or alcohol, stimulants (like cocaine, meth, Adderall or Ritalin), marijuana, or a variety of tranquilizing and sedating drugs doesn’t really matter. What matters is that someone you care about is reaching or has reached dependence on a psychoactive substance that can pirate away their brain, their life and their future. I will not speak here to tobacco, which warrants a post of its own as the leading preventable cause of death, worldwide.

There are four strategies to help families face addiction. They can help clear a path to recovery and a life restored to its potential.

1. We need to start with prevention. As has been said, an ounce of prevention turns into at least a pound of cure. Maya Angelou wrote: “. . . let us try to offer help before we have to offer therapy. That is to say, let’s see if we can’t prevent being ill by trying to offer a love of prevention before illness.”

While in many instances the addiction already has set in, there are others still at risk, especially the younger children in a family or other youth in school and faith-based settings.

There are two proven strategies we do too little of; and they meet the test of common sense. The first involves youth and the second their families.  Life Skills Training (LST), with curricula for elementary, middle and high schools, provides youth vital, often underdeveloped problem-solving and decision-making skills, as well as emotional regulation techniques that protect them from turning to drugs. Taking dinner together as many nights as possible is another proven protective activity; President Obama did that with his wife and two daughters throughout his eight years in the White House.

For families, especially with children still at home, there is the Strengthening Families Program for Parents and Youth. Parents too can learn skills that enable them to support their children in positive ways and to encourage school and after school activities like sports, music, dance, art, and volunteer work – which we know to be protective against turning to drugs.

Remember too, that you are not alone. There are so many others who are facing or have faced addiction in their loved ones and friends. Find out who they are, and talk with them. Turn to trusted family members and others you know. Facing the challenges of addiction will test the strongest of people, and we all do better when we are not alone.

2. Uncover the problem and seek help as early as possible. I urge mothers and fathers, sibs and others as well, to trust what they are seeing at home – observable changes in their child, such as labile mood, irritability, isolation, unusual sleep patterns, poor hygiene, muddled and tangential thinking, loss of weight, and other changes in mood, thinking and behavior. Write these down, simple notes about what you see, especially what you see over weeks or longer. Not what you feel, but what you have seen. Share these with someone you trust, who knows your child, to validate what you are observing.

We often don’t want face into the problems our children are demonstrating right in front of us, concerned about starting a fight, their denial, and more distancing. Yet those reactions are to be expected, they are part of the problem. The difficulties you are seeing will only grow if avoided. Find the right moment to speak with your child, clearly when not high; only say what you observe (e.g., you haven’t slept in a couple days, your pants are falling off you, you don’t answer calls from friends or go to practice, etc.) Do so with another person who also has witnessed what you have. Don’t expect a miracle, just begin the conversation, and commit to continue your effort until that person sees someone who can help, like a doctor, clergy person, or mental health clinician.

This same approach applies to friends and co-workers. Speaking with someone you care about who is in trouble is hard, but it is a true measure of concern and love.

3. If your loved one is beginning treatment, or not responding, you need to be active, and advocate for good care. There are two principles of good care for you to pursue: treatment that is comprehensive and treatment that is continuous.

Comprehensive care means that the program or clinician is not simply relying on one approach. 12-Step Recovery programs (like AA and NA) can be very useful for youth and adults. But they work better when combined with therapy, especially cognitive-behavioral therapy focused on helping a person resist the power of cues to drink or drug; with family education and skill building (as above); with evaluation (and treatment) of a co-occurring mental disorder (like depression, bipolar disorder and PTSD); and with offering a person with an addiction a medication to help control cravings and prevent relapse (the three most common are Suboxone and methadone for opioid addiction, and Vivitrol for alcohol and opioid use; there is also NAC, an over-the counter supplement). Each form of treatment enhances the other: more is really more.

5 Myths About Depression We Need to Shut Down Immediately

Depression, like art, can never be adequately described in words alone, though Andrew Solomon comes close in his memoir Noonday Demon. In it, he writes:

I felt as though I had a physical need, of impossible urgency and discomfort, from which there was no release—as though I were constantly vomiting but had no mouth. My vision began to close. It was like trying to watch TV through terrible static, where you can’t distinguish faces, where nothing has edges. The air, too, seemed thick and resistant, as though it were full of mushed-up bread.

Through metaphor and allegory, Solomon draws a vivid picture of the ineffable, as have writers and artists throughout history, from the paintings of Edvard Munch and Vincent van Gogh to the writings of Sylvia Plath and Virginia Woolf.

Though words can do some justice and art can convey an essence, unless one has endured the experience, the intangible nature of depression, like other “invisible illnesses,” makes it that much more challenging for sufferers and non-sufferers alike to reconcile.

We often fear what we don’t understand, and both fear and lack of understanding breed fertile ground for stigma. Given that depression is estimated to become the second most common health problem in the world by 2020, the fact that stigma continues to exist is a perplexing one. More disturbing is that because of such societal stigma, self-internalized stigma and shame are sometimes perpetuated. Given this, a large percentage of those who experience depression will not be treated.

Below are some common myths about depression explained.

Myth #1: “Depression is something you can simply ‘pull yourself out of’”

Depression is a disease of the brain. It is not a choice. “No individual would desire the symptomology it brings,” says Dr. Gabriella Farkas, founder of Pearl Behavioral Health & Medicine PLLC. “There are complex, reciprocal relationships between brain chemistry, functioning and environment.” She points out that neurological factors are largely beyond human control. “People may be predisposed to becoming or remaining depressed due the state of their brain alone [but] there are crucial, environmental factors.”

Myth #: 2: “Depression is something you can ‘think yourself out of’.”

Thinking positive thoughts, or choosing to see the glass as “half full” is a frequent suggestion offered in self-help books and some therapeutic modalities. For some this can be useful advice. However, to create a positive narrative around a negative situation requires our use of deliberate cognitive processes. According to Harold W. Koenigsberg, M.D., Professor of Psychiatry, Mount Sinai School of Medicine, “In clinical depression, the bodily concomitants (e.g. low energy level, inability to activate pleasure circuitry, etc.) are fixed [and] cognitive patterns lose their flexibility. When this happens, it becomes hard to ‘pull oneself out.’”

When someone has a true debilitating diagnosis like major depressive disorder, simply getting out of bed to take a shower can feel physically impossible. As Solomon writes of his own experience,

I knew that for years I had taken a shower every day. Hoping that someone else could open the bathroom door, I would, with all the force in my body, sit up; turn and put my feet on the floor; and then feel so incapacitated and frightened that I would roll over and lie face down. I would cry again, weeping because the fact that I could not do it seemed so idiotic to me. At other times, I have enjoyed skydiving; it is easier to climb along a strut toward the tip of a plane’s wing against an eight-mile-an-hour wind at five thousand feet than it was to get out of bed those days.

Myth #3: “You must have a reason to be depressed.”

Depression is deceptive and as persuasive as a corrupt politician, convincing you of all sorts of untruths such as, “You have no right to be depressed. Look at all you have. You should be grateful.” Being clinically depressed requires no justification. Even though the world measures happiness through externals and then determines that you should be happy if you have enough, that doesn’t make it so.

Such remarks that come from loved ones, though they may be well-intentioned, only reinforce and worsen guilt, which is a common symptom of depression. Being clinically depressed requires no more justification than does getting the flu.

“Our culture often reinforces these beliefs.” says Suzanne Smolkin, LCSW-C, VP of Clinical Operations, Behavioral Health UM at HMC HealthWorks. “In books and movies the hero generally just sets her mind to doing something and accomplishes it through sheer willpower and grit. While that may work with many things,” she says, “dealing with depression is different. Depression saps the energy that helps us deal with things.”

Another important point Smolkin makes is that unlike many other medical conditions, depression distorts one’s perception of self and the world, and this is where self-blame comes in. “When you are suffering from depression you often aren’t able to see the situation realistically or respond to it adequately without help.”

The Mental Benefits of Vacationing Somewhere New

Coming off the winter holidays, most of us start dreaming of, if not planning, our spring and summer getaways. It’s tempting, of course, to default to the same vacation each year: your family’s cabin, a familiar beach town, your favorite city, that resort the kids loved. We often choose to spend our hard-earned dollars for comfort, predictability, and relaxation, and there are benefits to doing so.

But as a psychologist, I believe that travel should routinely be used to achieve the opposite: to get out of your comfort zone, expose yourself to uncertainty, and eschew rest for exploration and learning. The result is personal growth — greater emotional agility, empathy, and creativity. A recent trip to Sri Lanka, with an unexpected stop in Thailand, led me to think more deeply about the positive impact of adventures that challenge us.

The first benefit is enhanced emotional agility, or the ability to not react immediately to emotions, but to observe those that arise, carefully collect information to understand the possible causes, then intentionally decide how to manage them. In a study of 485 United States adults, exposure to foreign travel was linked to a greater ability to direct attention and energy, which helps us function effectively in diverse situations and display appropriate verbal and nonverbal signals of emotion. Visiting more countries (breadth) or greater immersion into the local culture (depth) enhanced these effects, and they remained after the study subjects returned home. By spending time in unfamiliar towns, cities, or countries, you become tolerant and even accepting of your own discomfort and more confident in your ability to navigate ambiguous situations.

I felt this growth during my two weeks in Sri Lanka. Standing amid a slew of older, short men dressed in rainbow-colored robes and speaking Sinhalese, I’d never felt more foreign. I knew I wouldn’t be able to navigate the narrow roads full of tuk-tuks, bicyclists, and pedestrians in a rental car, and the prospect of purchasing transport, food, clothes, or art without any indication of their price was daunting. But eventually I got my bearings. After a few days on the ground, I even got up the nerve to take a yoga class taught entirely in Sinhalese. I now know that any initial anxiety is just a reaction, one that will dissipate as I begin to operate in it.

Empathy also increases when your travels thrust you into new territory. In that same study of Americans, those who’d traveled abroad showed a greater ability to suspend judgment about a person until acquiring information beyond surface qualities (age, sex, race, or ethnicity). They were also more adept at discerning whether another person’s actions reflected deep-seated personality attributes or a variety of situational factors that could be influencing their behavior. When researchers in China gave a survey to 197 adults before and after traveling, they uncovered similar influences on the exertion of effort to attend to pronounced cultural differences in normalized values and behavioral patterns in everyday social interactions. People who traveled to more countries developed a greater tolerance and trust of strangers, which altered their attitudes toward not only strangers but also colleagues and friends back home. They became more appreciative of people with new knowledge, philosophies, and skills.

Binge Watching and Its Effects on Your Sleep

I like a good binge-watching session as much as anyone. Not long ago, I blew through all 96 episodes of Entourage in about two weeks! It seems I’m in good company. According to a recent survey, 70 percent of Americans are binge watchers.

With technology including streaming services and on-demand content transforming the way we consume media, it’s important to ask: What effects does all this binge viewing have on the soundness of our sleep?

Binge watching and sleep quality

A new study tackles just that question. Scientists from University of Michigan and Belgium’s University of Leuven investigated the prevalence of binge watching, and how these extended viewing sessions impact sleep. The study included 423 young adults ages 18-25. Researchers analyzed their regular TV-watching habits and binge-watching habits—the latter defined as “watching multiple, consecutive episodes of the same TV-show in one sitting”—along with assessments of their sleep quality, fatigue, and insomnia.

They found strong links between binge watching and sleep problems:

  • Slightly more than 80 percent of participants considered themselves binge watchers—and among those, slightly more than 20 percent had binge watched at least a few times a week over the past month
  • Among people identified as poor sleepers, about 1 in 3 experienced poor sleep quality linked to binge watching.
  • Binge watching was linked to insomnia symptoms, fatigue, and poor sleep quality.

Researchers found differences between regular TV watching and binge viewing. Regular TV watching wasn’t associated with poor sleep quality—but binge watching was.

How does binge watching disrupt sleep?

There may be a number of factors involved. Researchers in this study found sleep disturbances from binge watching were a result of mental stimulation that came from extended viewing in the evenings, a form of stimulation known as “pre-sleep arousal.” Being exposed to the content of the programming—storylines, action, imagery—stimulates brain activity and alertness. And the duration of a binge-watch session creates enough pre-sleep arousal to interfere with our ability to fall asleep. Watching back-to-back episodes of your current favorite show may feel like a relaxing escape at the end of the day, but it’s actually getting your brain fired up, not helping it wind down.

Binge watching is a relatively new phenomenon, and scientific findings about its relationship with mental and physical health are just beginning to arrive. Recent research links binge watching to feelings of loneliness, as well as depression and anxiety. A new study out of the United Kingdom shows that nearly a third of UK adults and teenagers think binge-watching has caused them to miss out on sleep or feel tired.

There’s a longer history of research into the effects of TV watching—and plenty of evidence suggesting that too much of it is bad for sleep, as well as mental and physical well being. Watching more than two hours of TV on a daily basis is linked to several common sleep problems:

  • trouble falling asleep
  • waking during the night
  • waking early in the morning and being unable to fall back to sleep

The lure of television can push bedtimes later and result in greater sleep debt, according to research. Sleep debt is the difference between the amount of sleep you need and the amount of sleep you actually get.

This One Thing Makes You a Nicer Person

Mindfulness — the practice of staying attuned to what’s happening in the present moment — is a bonafide health trend right now, and for good reason. Research suggests it can reduce stress, help with problem drinking, lower blood sugar levels and help people succeed at work. Now, according to a new study, it may even help you become a nicer person.

The research, published in the Journal of Experimental Psychology, found that mindfulness training inspired people to be kinder and more empathetic to a stranger who had been ostracized during a simulated online scenario.

“When people witness someone being victimized, it’s really common for us to get distressed by it,” says study author Daniel Berry, an assistant professor of psychology at California State University San Marcos. But that distress doesn’t always translate into empathy. “Sometimes that upset is displaced so that we’re not feeling upset for the other person; we’re just feeling negatively,” Berry explains. “When that happens, people actually tend to turn away from the person in need.”

In the study, “the folks who received mindfulness instruction seem to be better at regulating their emotions…allowing them to be present for the strangers they were witnessing being victimized.”

The study consisted of four experiments, each with roughly 100-150 people enrolled. In most experiments, about half of the group was led through an audio-recorded guided meditation meant to help them stay present, while the others either received no training or an attention-focused audio training. Next, people played a computer game in which four characters, including one controlled by the person in the study, tossed balls back and forth. Study participants were told that each character was controlled by a person — but in reality, all of the other characters were automated.

In the first phase of the game, the computer was programmed to exclude one player after they received two tosses, leaving them to stand by and watch as the others played out the rest of the round. The goal of the study, Berry explains, was to see how people responded to the exclusion of a stranger, and to determine whether mindfulness changed their reactions in any way.

The researchers observed marked increases in empathetic behavior among players who did mindfulness training before beginning the game, compared to people who did attention training or no training at all, Berry says. While everyone in the study was able to identify the ostracized character, players who had undergone mindfulness training showed more concern for that person and were more likely to compensate for their exclusion with extra tosses during the next round, or with kind words in a post-game follow-up email.

Click Read More to view the full article.

Five Mistakes People With Depression Make

A trap for those suffering from depression and anxiety is that many of people’s natural coping reactions make the problem worse rather than better.   Here are a few examples of that, and some practical solutions.

Note: Please be compassionate with yourself if you can relate to any of these patterns. They’re common pitfalls, not an indictment on you as a person.

1. You don’t fix problems that frustrate you.

Feeling irritable is one of the main symptoms of depression for many people. Some problems that trigger repeated irritation and frustration are easily fixable. However, people with depression often go into a passive “survival” mode and don’t address these issues, even though they could.

For example, you don’t have enough power outlets in the spot where everyone in your household likes to charge their devices. You’re constantly annoyed about people unplugging your device in favor of their own. This is the type of tension that can be solved by getting a multi-plug, or another similar practical solution.

People with depression often just put up with this type of issue (and complain about it), rather than deploying a solution. It’s understandable to do this, but not very helpful.

2. You’re waiting for your sleep to improve before you take other actions.

Difficulty sleeping is one of the most horrible symptoms of depression.  Unfortunately, it’s often the last symptom to resolve when people’s mood starts to improve. Therefore, even though it’s hard, it is important that you start other strategies even though you’re feeling tired and grumpy. For example, exercise. If you over-focus on getting your sleep right before you start other strategies, you’re setting yourself up to fail.

3.  Wanting a pill as a cure all.

Medication is helpful for many people with depression but it certainly doesn’t address all of the thinking and behavioral patterns that are associated with depression. For example, you’ll likely still need psychological strategies to deal with tendencies towards rumination (overthinking) and avoidance/procrastination.

Solution: Try drawing a pie chart and estimating what role you think medication has in your depression recovery. Include whatever is relevant for you in your pie chart, such as thinking changes, exercise, meditation, laughter, problem-solving etc.  Your personal pie chart won’t be the same as someone else’s since everyone’s preferred mix of strategies for depression recovery is a little bit different. When you start adding all these other components to your pie chart, you’ll see that medication is only a part of the picture.

Click Read More for more ways.

Top Ten Tips for a Healthier Brain in 2018

How’s this for a New Year’s resolution?Resolve to improve your mood, concentration, and energy, lower your stress hormone levels, re-balance your hormones, and reduce your risk for dementia and many other chronic diseases—all by Valentine’s Day. All you have to do is commit to a brain-healthy lifestyle—starting with diet.

What is a brain-healthy diet, you ask?

The very same diet that is healthy for the rest of your body, thankfully. With all the confusing, contradictory and constantly-changing headlines about which foods are good or bad for us, it’s easy to be frustrated and even to give up trying to eat “healthy”, because it seems nobody seems to agree on what a healthy diet is. The reason for this is that the majority of nutrition headlines are based on poorly-designed rodent research and “epidemiological studies” instead of on dietary experiments in humans. The “conclusions” of epidemiological studies are literally GUESSES based on food and health questionnaires and statistical manipulation. These guesses are often heavily influenced by the dietary beliefs and preferences of the scientists who design the studies. When these guesses are later tested in clinical trials, more than 80% of them are eventually proved wrong. THIS is why nutrition headlines are so bewildering. One day eggs are bad for you (epidemiology), the next day they’re fine (clinical trials).

The information I’ve compiled for you in this simple list is 100% epidemiology-free. Instead, the guidelines below are grounded in the science of anthropology, biochemistry, botany, human physiology, and human clinical trials. All underlined phrases within the list are live links to scientific references or fully-referenced articles with more information.

There are no magical superfoods or supplements involved in this all-natural, science-based approach. Just a few simple, common-sense rules about what to eat and, perhaps most importantly, what NOT to eat.

Ready? Onward!

Ten Tips for a Healthier Brain

  1. Eat only real, whole, “pre-agricultural” foods: seafood, red meat, poultry, eggs, vegetables, fruits, and nuts. I recommend avoiding all grains (wheat, corn, rice, oats, etc). and legumes (beans, peas, lentils, hummus, soy, etc.) because they are low in nutrients and high in anti-nutrients and lectins that pose risk to human health.
  2.  Drink water or unsweetened, naturally-flavored water/seltzer when you’re thirsty. Drinking sweetened beverages is dangerous—putting you on the fast track to a damaged metabolism and then keeping you there. It is just as important to avoid fruit juices, even all-natural juices with no sugar added, as the body cannot distinguish between various forms of liquid sugar. Click here for a table of sugar content in various beverages including fruit juices.
  3. Avoid refined carbohydrates like the plague. Concentrated, processed sugars and starches cause unnaturally high spikes in blood sugar and insulin levels that destabilize brain chemistry and damage brain cell metabolism. Examples include sugar, flour, fruit juice, and processed cereals.
  4. Avoid refined “vegetable” (seed) oils like soybean, safflower, and corn oil, and choose natural unprocessed animal and fruit fats instead. Industrially-produced seed oils tend to be high in omega-6 fatty acids, which promote inflammation and fight against the omega-3 fatty acids our brains and immune systems require to function properly. Examples of healthier fat choices include lard, schmaltz, beef tallow, olive oil, avocado oil, and coconut oil. See my post Cooling Brain Inflammation Naturally with Food for a table of the omega-6 content of various plant and animal fats.
  5. Include animal protein in your diet on a regular basis—seafood, poultry, red meat, eggs, etc. Plant proteins are not only harder to digest and absorb, but the foods they come from are high in “anti-nutrients” that rob the brain (and body) of key minerals and other essential nutrients. I realize that there are many reasons to eat a plant-based diet that are unrelated to brain health, so if you choose to eat a vegan or vegetarian diet, please learn all you can about proper supplementation of key nutrients, including B vitamins, vitamin K2, EPA, DHA, iron and zinc. Read my post The Vegan Brain for more information.
  6. Minimize alcohol and be careful with caffeine, especially if you have anxiety or insomnia. For more information, read Foods and Substances That Can Cause Anxiety and Insomnia.

The Rise and Fall of Craving

A couple of years ago I came across a paper in Addiction Biology called “Recent updates on incubation of drug craving: a mini-review.” The studies it summarized show that drug craving has a distinct timetable. I want to review and comment on these findings. They can be immensely valuable if you’re trying to stay recovered.

The paper reviews research on rats as well as humans. And why not? We’re all mammals and we share a lot of the same neural hardware. But while we have a similar “motivational brain,” humans have other problems that make rodent life look like easy street. We have this enormous cortex (linked to a hippocampus that fills it with zillions of explicit memories), and so the cues that trigger craving often come from, and are magnified by, our own ruminations. That can be a real drag.

Most of the studies in this review involve rats. In a typical study, rats get themselves addicted to cocaine, meth, or heroin (with considerable help from humans), and then their supply is cut off. After the withdrawal period is over, the rats are given cues that are associated with the drug they were on. These are called “conditioned stimuli” in Pavlovian conditioning. Then the experimenters measure how much the rats crave the drug  (based on how often they take it, or how much they hang out in the place where it gets delivered) in the days and weeks that follow. The craving goes up, not down, as time goes on. And then finally it peaks and diminishes several weeks later.

The first thing to note is that the craving is always “cue-induced.” It is literally triggered by a sight or sound (a green light or a buzzer) that previously meant “Come and get it!”

The second thing to note is that the incubation period (the period of increasing craving) is longer than we might like, but it’s not forever. Typically 10 days to a few weeks for rats. For humans, undoubtedly longer (in one study, it peaked at 60 days abstinence for alcoholics; in another, it peaked at three months for meth users).

It’s very important to realize that craving in the absence of cues decreases much more quickly, often beginning almost immediately after quitting. That’s a great rationale for hanging out on your uncle’s farm in Idaho for a few months after quitting.

What’s going on in the rat’s brain that makes it vulnerable to cue-induced craving? The amygdala is the main culprit, and the nucleus accumbens is its partner in crime. The amygdala registers emotional significance. If something is emotionally meaningful, whether the emotion is fear, anger, desire, or whatever, the amygdala will increase its firing. This is where the cue starts the process of emotional arousal and readiness. Then the nucleus accumbens takes over (stoked by a tide of dopamine). The nucleus accumbens is the part of the brain that produces an urge go after a goal: it narrows attention to the goal, gives you that feeling of “I really want it”, and then activates behaviors…like prancing to the part of the cage where the coke gets dispensed, if you’re a rat, or picking up the phone and calling your dealer, if you’re a human.

If you’re a rodent, that’s all it takes. Craving is a learned emotional response. You’ve learned that something felt really nice, and it might be available, and because your brain is efficient and determined, you’re going to go after it. By the way, rats on a high sugar diet show very much the same response once they’re cut off. So we’re not just talking about drugs.

But what if you’re a human? I assume you are if you’ve read this far. Then you’ve got a whole other set of problems. The initial cue can be the hands on the clock, telling you it’s about that time. It can be a mental image, a rumbling in your gut, the ragged touch of rising depression, an image on TV. It can be a baggie, an email, a neon sign, a dream. So far, you’re just a very intelligent rat. You just got a surge of dopamine to your nucleus accumbens; you’re alert, wanting, wishing…but you’re also thinking, and that’s where things get much worse.

You’re thinking that the day feels so empty without it. What am I going to do with my time? Thinking that there’s really nothing that can fill that gap. Thinking maybe that you deserve it, or you deserve how shitty you’re going to feel tomorrow, or both. One thought leads to another leads to another, and these thoughts fill your head. The amygdala and accumbens both connect to many many parts of the cortex, and they literally unleash these thoughts, which then trigger other related thoughts through direct synaptic connections. That’s rumination — the pathway to craving.

The problem is that the habit you’ve developed isn’t just a learning and feeling habit; it’s a thinking habit. And until you start to become accustomed to living without that thing, those habits have little to replace them.

So, it would be ideal to avoid cues, but that’s just not entirely possible since they can come from anywhere (including your own brain). In which case, you have to work on your thinking habits until thought patterns readjust and the cue-trigger starts to lose its force (this can take weeks or months for humans).

But how do you work on those ingrained habits of thought? There are many ways. Two come to mind immediately:

1. Shift your thinking as soon as you start to ruminate. Don’t even wait ten seconds. You can turn off cascades of thinking far more easily before they build momentum.

2. Fill your days with other attractive, compelling activities. Provide your day with contour: a beginning, middle, and end, so that the rumination habits don’t have so much traction.

But there’s one more highly valued strategy, and in this, you’re no different from a rat: Get connected to others when you quit. Cue-induced craving is greatly reduced by “environmental enrichment” for rats and for humans. Remember Rat Park? Interpersonal, social activities are incredibly powerful cues for humans as well as rats, and they can drown out the cues connected to drug-taking.

And one more thing: Be brave.

The Importance of Kindness

Kindness is defined as the quality of being friendly, generous, and considerate. Affection, gentleness, warmth, concern and care are words that are associated with kindness. While kindness has a connotation of meaning someone is naive or weak, that is not the case. Being kind often requires courage and strength. Kindness is an interpersonal skill.

You’ve heard about survival of the fittest and Darwin. Survival of the fittest is usually associated with selfishness, meaning that to survive (a basic instinct) means to look out for yourself. But Darwin, who studied human evolution, actually didn’t see mankind as being biologically competitive and self-interested.  Darwin believed that we are a profoundly social and caring species. He argued that sympathy and caring for others is instinctual (DiSalvo, Scientific American, 2017)

Current research supports this idea. Science has now shown that devoting resources to others, rather than having more and more for yourself, brings about lasting well-being.  Kindness has been found by researchers to be the most important predictor of satisfaction and stability in a marriage. Many colleges, including Harvard, are now emphasizing kindness on applications for admission.

There are different ways to practice kindness. One way to be kind is to open your eyes and be active when you see people in need.  Do you notice when people could use a helping hand? A sense of community is created when people are kind to those who need help.

Opening your eyes means noticing when others are suffering. A kind word, a smile, opening a door, or helping carry a heavy load  can all be acts of kindness. Celebrating someone you love, giving honest compliments, sending an email thanking someone, telling someone how s/he is special to you, helping an elderly neighbor with yard work or food, taking a photo of someone and sending it to the person, sharing homemade food, refusing to gossip, and donating old clothing and things you don’t need are all ideas about how to practice kindness.

Kindess is a willingness to full-heartedly celebrate someone else’s successes. Gottman’s work shows that your response to someone’s successes may determine more about your relationship than how you respond when times are difficult. Do you minimize the success, not pay attention to it, or bring up all the problems with the success? Kindness is to be openly happy for the other person.

Kindness is also about telling the truth in a gentle way when doing so is helpful to the other person. Receiving accurate feedback in a loving and caring way is an important part of a trusted relationship. The courage to give and receive truthful feedback is a key component to growth and flexible thinking.

Kindness includes being kind to yourself. Do you treat yourself kindly? Do you speak gently and kindly to yourself and take good care of yourself?

There are many ways to be kind and many opportunities to practice. Perhaps kindness is a value that could add more satisfaction to and strengthen your relationships.

No, mindfulness is not a fad

You can’t open a magazine these days without seeing something about “mindfulness.” The concept has become so ubiquitous, a friend asked me the other day if its popularity was just a fad.

As a social psychologist who has studied mindfulness for nearly four decades, I am certain that it is not. Unlike, say, the hula hoop, mindfulness actually is enlivening, and it can improve our lives greatly in measurable ways.

But I do see a risk in its newfound currency: The idea of mindfulness could become so watered down or misrepresented that we fail to fully appreciate its ability to better our lives — that we become mindless about mindfulness.

Mindfulness is often described as the ability to be in the moment, to be in the present, to be aware. The problem with this is that everyone thinks they are already aware. Some people meditate to become more mindful. Meditation is really just a tool that leads to post-meditative mindfulness. Although it’s a good tool, it’s a tool nonetheless, not the end.

There are other ways to work toward mindfulness. One is to simply notice new things. When we notice new aspects to something we thought we knew well, we come to realize that we didn’t know it as well as we thought we did, and then naturally we give it more attention.

Often we are in this more mindful state when we travel to a new destination. In a foreign environment, we don’t have to try to be mindful. Since we are already expecting to see new things, we are in a state of active noticing.

To be mindful is to be in this state even in familiar contexts and relationships. When we think we know a place or a person, we tend to tune out. When we’re not sure about something, we tune in.

You can experiment with these different states by actively noticing five new things about a close friend or someone you live with. As you begin to take in new information, the person is likely to come alive to you in ways he or she previously was not.

By recognizing that we don’t fully know something, we exploit the power of uncertainty. Alternative interpretations — of situations, of others, of ourselves — become available to us. Things we have perceived as fixed may suddenly appear unfixed. Noticing new things puts us in the present.

Over 40 years of studying mindfulness, I have found wide-ranging benefits to all this. Mindfulness can improve competence, relationships, happiness, even health and longevity.

Much of this work started with a study I conducted in the 1970s with my colleague Judith Rodin. One group of nursing home residents was given a choice of plants and encouraged to decide where to put their plants, as well as when and how much to water them. Another group was given plants and told that the nursing staff would take care of them.

The most startling result was that, a year and a half later, twice as many residents in the first group were alive than in the second. Making choices about things like the care of plants resulted in mindfulness, and that mindfulness had powerful consequences.

A few years later I conducted the “counterclockwise” study, in which eight men in their 70s lived for five days as though they were 20 years younger. Their surroundings were a time warp, designed to conjure 1959. As a result of putting their minds in this earlier place, their vision and hearing improved, as did their strength and memory. They even looked younger at the end of the week.

Brain Imaging Shows We Can Unlearn Chronic Pain

Two new studies, one published last month and another slated for publication in early 2018, confirm through brain imaging and other techniques, that pain that persists long after the physical injury that originally caused the pain has healed, is a type of learned behavior that can be “unlearned” through a variety of non-medical interventions.

For a September 2017 electronic pre-print of an article to appear later this year in the journal Psychological Medicine, Yoshino and colleagues of Hiroshima University Medical School examined the resting state functional magnetic resonance (rFMRI) of both chronic pain patients and healthy controls. rFMRI, shows which parts of the brain are intrinsically connected to each other  by demonstrating correlated simultaneous activity among multiple brain regions.  Brain regions that are wired together typically “fire” at the same time “rest” at the same time, because one of the brain regions presumably stimulates another through synaptic connections. Thus separated regions of the brain that exhibit correlated activity are said to belong to the same “Intrinsic Connectivity Network (ICN).

Yoshino’s research in 29 chronic pain sufferers and 30 healthy control subjects revealed abnormally high ICN connectivity within the “Dorsal Attention Network” (where consciously directed focal attention is thought to originate)—including structures such as the orbitofronal cortex and inferior parietal lobule— in chronic pain sufferers vs. healthy controls. This finding lead the authors to suggest that the brains of chronic pain suffers might rewire themselves when patients’ repeatedly focus attention on pain and/or anticipation of pain.  Furthermore this rewiring could play a key role, according to Yoshino, in the continuance of pain after physical damage that caused the pain has healed.

Neuroscientists such as Dr. Waschulewski-Floruss of Eberhard-Karls University of Tuebingen in Germany have found  that “learning” of chronic pain, and re-wiring of the brain, arises through the process of classical conditioning.

Here’s how.

In his original experiments on classical conditioning in dogs, Pavlov noticed that dogs naturally salivated when they saw food. The food, in Pavlov’s example was an Unconditioned Stimulus (UCS) and the salivation an Unconditioned Response (UCR) to seeing the food. After Pavlov repeatedly paired the ringing of a bell with the presentation of food, the bell, even in the absence of food, became a Conditioned Stimulus (CS) that produced salivation. Salivation produced by a bell—not food–was called the Conditioned Response (CR).

This type of learning in dogs is associated with the formation of novel neural connections, where sensory inputs from the dog’s acoustic system, which did not originally stimulate parts of the dog’s brain that triggered salivation, grew new connections (or greatly strengthened existing connections) that enable the acoustic system to stimulate salivation.

The figure below represents how an injury could lead to “learned” chronic pain, and the formation of new neural pathways (“natural” pathways are shown in blue, learned pathways are depicted in red ), even after an injury is healed.

Eric Haseltine
As shown in the figure, classical conditioning of chronic pain would occur as follows: The original physical injury is an unconditioned stimulus (UCS), the original pain from the injury is the unconditioned response (UCR), the conditioned stimulus (CS) is the memory of the events (context) surrounding the injury or obsessive worries about the pain, while the Conditioned response (CR) is the experience of pain in the presence of the CS (memory of injury and/or obsessive worries about the injury).

Drug Overdoses are Leading Cause of Death for those under 50

As the first of three successive deadly hurricanes carved their way through the Caribbean and Gulf Coast states, an annual memorial from another kind of deadly hurricane was taking place on August 31—International Overdose Awareness Day. Since drug overdoses are now the leading cause of death among Americans under 50, it is important to call attention to a steadily growing epidemic that often gets overshadowed by more popular trending topics.

While some attention has been paid to the opioid crisis (more than 183,000 died from opioid related deaths between 1999 to 2015), 2016 saw the largest spike of overall drug overdoses in U.S. history with an estimated 59,000 deaths (according to preliminary data compiled by The New York Times).

On top of that, this deadly epidemic is leaving bystanders and children in its destructive wake as a staggering 85,937 children in the U.S. were placed in foster care in 2015 due to parental drug use.

How did we get here?

First, let’s take a look at some factors that led to wider adoption of opioids. To share, opioids are a class of drug used to reduce pain which include fentanyl, heroine, oxycodone, hydrocodone, codeine, methadone and morphine.

Prior to 1995, opioids were only prescribed in the most extreme cases, such as for people with advanced stages of cancer and for people undergoing major surgery. Then a movement grew, potentially instigated by pharmaceutical industry funded research, which suggested that opioid prescriptions could be safe for people with chronic pain.

Before long opioid prescriptions exploded and public perception of their danger declined. In 2012 alone, more than 250 million opioid prescription were written in the U.S. as reported by the Centers for Disease Control and Prevention. This number is staggering as the World Health Organization reports 13.5 million people regularly take opioids, including the 9.2 million who use heroin.

To put the growing phenomenon into perspective, New Hampshire, which currently leads the nation in opioid related deaths, experienced a 70% increase in emergency room visits in four months (Feb-Jun 2016) and witnessed 64 overdoses within two-weeks. First responders in the area are also pointing to the growing use of carfentanil related overdoses, a horse tranquilizer 100 times stronger than fentanyl, that is spreading across the east coast and slowly making its way across the Mississippi to the west coast.

While opioid usage is on the rise, cocaine is used by approximately 15 million people worldwide while more 35 million people regularly use methamphetamine.

Impacts on children

Viewers of the AMC’s critically-acclaimed series Breaking Bad may be surprised to learn that methamphetamine is sought after by a high percentage of women of child-bearing age due to its ability to enhance energy and control appetite while being readily available and inexpensive. Others point to the origins of meth adoption by low-skilled workers to stay awake and fend off boredom as they take on multiple jobs with long hours filled with tedious and menial tasks.

Of course, the downside is that while many mothers (and fathers) may be using methamphetamine to improve their parenting abilities, the grim reality is that the addictive drug deteriorates the body and transforms the brain, producing paranoia, hallucinations, aggression, violence, self-absorption, impaired thinking, judgment and memory. The result is decreased safety for children, leaving them neglected, malnourished, abused, and traumatized. In fact, researchers and law enforcement reports reveal that the increased use and manufacture of methamphetamine across the U.S. has resulted in a dramatic escalation in the severity of child abuse crimes and abuse-related deaths. Worse, the cycle gets repeated as children of drug abusers are 8 times more likely to be an addict.

On top of that, one of the largest studies of its kind has revealed the vast costs on children who have been exposed to traumatic events, or Adverse Childhood Experiences (ACEs). Researchers have found that childhood exposure to neglect, abuse, and/or witnessing abuse has resulted in a shortened lifespan along with increased alcohol and prescription drug addiction, intimate partner violence, increased cancer rates, heart disease, chronic pulmonary disease, depression, suicide, financial distress, poor academic and work performance, and a host of other problems. Click here to a full list of medical journal reports.

One challenge for children placed in foster care due to drug abusing parents is that solutions are state by state, so when family members are impacted across states, the state where the drug abuser and their children (if any) reside takes precedent. Often times, drug abusers are in jail and/or on the streets while children become a ward of the state and are placed in foster care as courts try to help parents seek reunification. Therefore, any family members that live out of the state are unable to provide housing to the children due to lack of any federal regulations that would bridge the individual’s states regulations. In addition, the lack of a unified approach for recovery has led to countless drug rehabilitation centers and therapies that contradict each other, leaving many bewildered about what to do (some say practice tough love and let the addict hit “rock bottom” while others recommend stringent and consistent intervention).

How Helping Others Can Relieve Anxiety and Depression

When we’re depressed, it’s hard to feel good about ourselves. We’re quick to see our own limitations and slow to remember our strengths. For example, people with depression are more likely to:

  • Blame themselves when something goes wrong.
  • Believe that other people don’t like them.
  • Feel a general sense of dislike for themselves.
  • Interpret their actions in the worst possible light.
  • Remember the mistakes they’ve made.

Low self-esteem is a significant predictor of future depression. On the flip side, our view of ourselves improves as depression improves, and increases in self-esteem during psychotherapy can prevent relapse into depression.

Thus finding ways to feel better about ourselves would appear to be one way to lift depression.

A recent study examined two ways of trying to increase one’s sense of self-worth in a sample of adults with depression and/or anxiety:

  1. Self-image goals focused on “obtaining status or approval and avoiding vulnerability during social interactions.” Examples included “getting others to notice your positive qualities” and “avoiding showing your weaknesses.”
  2. In contrast, compassionate goals were about “striving to help others and avoiding selfish behavior”—for example, “making a positive difference in someone else’s life.”

The researchers measured how much each participant focused on these goals, and also assessed their depression and anxiety symptoms and their degree of conflict with other people.

Analyses showed that a greater focus on self-image goals was linked with more relationship conflict and a worsening of symptoms during the 6-week study period. In contrast, compassionate goals were associated with lower levels of symptoms and less relationship conflict.

The research team carried out an important follow-up study, asking a significant other for each participant (a romantic partner, family member, or close friend) to rate that person’s self-image and compassionate goals.

These ratings by significant others were also linked to relationship quality as judged by the partners or family members. Thus the important people in one’s life also feel the effects of where we focus our energy when we’re anxious or depressed.

These results are both good and bad news for people with anxiety and depression.

The bad news is that trying to boost our self-image by avoiding vulnerability and seeking others’ approval backfires in more ways than one: It leaves us feeling depressed and anxious, and also damages our relationships. These two effects can reinforce each other, leading to a downward spiral.

On the other hand, the really good news is that by turning our attention toward helping others, we make everyone feel better—ourselves included. We find not only relief from our depression and anxiety, but also improvements in our relationships.

Taken together these two effects can trigger a “virtuous circle” in which improved relationships lead to feeling better leads to improved relationships and so forth.

The Weekend Effect

In a previous blog, I mentioned that most American workers report that their well-being increases on Friday evening and decreases dramatically on Sunday night to reach a low point on Monday morning. Why does working, or even just the thought of working, affect our well-being so negatively? Is working inherently bad for us? Does it have to be?

Richard Ryan and his research team report that this “weekend effect “ is caused by a lack of autonomy at work, compared to the autonomy we experience on weekends through engaging in activities we are interested in. Weekends also give us opportunities to connect with important people in our lives.

A lot of research now shows that we need to experience three things in order to have high well-being. First, we need to feel competent in the activities we engage in. Second, we need to have some autonomy to decide what we do, how we do it, when we do it, etc. Third, we need to have positive and meaningful relationships.

Workers who feel competent, autonomous, and related, experience more positive emotions, are less burned out, are more committed to their organization, experience more meaning and interest, perform better, and are less absent and less likely to leave their job.

What research on the “weekend effect” shows is that, though we are often able to experience competence at work, we are particularly at risk of experiencing low autonomy and relatedness. This effect was found for all kinds of workers, from laborers to physicians and lawyers. It didn’t matter how much they made, how many hours they worked, whether they were married or not, or how old or educated they were.

So if your mood is more negative, and if you suffer aches and pain and feel less energetic at work than outside of work, ask yourself three questions. Do I feel competent in my work? Do I have some autonomy to decide how I do my work, when I do it, or even what work I do? Do I have positive and meaningful relationships at work? If the answer to one or more of these questions is “no”, you may have found the key to solving your well-being problem at work.

If the problem is not feeling competent, first ask yourself if you have the necessary skills and knowledge to do this work. If the answer is no, is there training you can access? If the answer is yes, then look into whether you have the necessary resources and support to do good work. If you don’t, try seeking out additional resources.

If the problem is not feeling autonomous, look at how your job is designed. Do you have any autonomy to decide what you will work on, or how you will do the work? If the answer is no, you can try to negotiate having more discretion or decision-making power. Do you see the impact of your work on others? If not, it can be difficult to find meaning in your work. New research suggests that crafting your own job can help enhance its meaningfulness. Altering your tasks and who you interact with can enhance your job and your work environment.

If the problem is not feeling related to other people at work, try to create some opportunities for interactions either at work or outside of work with your colleagues. You can also try to be a good listener: new research shows that providing support to others is as good for the giver’s well-being as it is for the receiver. And such behavior is likely to be reciprocated in the future, creating a positive work climate for all.

Of course, organizations and managers can also do many things to promote feelings of competence, autonomy and relatedness at work. I will address this in future blogs.

Breakthrough may lead to ability to diagnose CTE in living football players

Dr. Ann McKee, the neuropathologist credited with some of the most high-profile CTE diagnoses, said she was buoyed by the recent discovery, calling it “the first ray of hope” in a years-long effort to understand the disease.

“To me, it feels like maybe now we can start going in the other direction,” she said. “We’ve been going down, and everything has just gotten more and more depressing. And now it’s like, ‘Yeah, we’re going to actually find some answers here.’”

In a new study published Tuesday in the journal PLOS ONE, researchers from BU and the VA Boston Healthcare System studied the brains of 23 former football players who were diagnosed with CTE, in addition to those of 50 non-athletes who suffered from Alzheimer’s disease and 18 non-athlete controls. They found significantly elevated levels of a protein related to inflammation called CCL11 in the group of ex-players compared with the non-athletes. The levels were even higher in those who played the game longer.

She cautioned that a lot more research is needed. The BU findings are preliminary and have to be validated. But researchers are hopeful that if an elevated biomarker in a living person might indicate the presence of CTE, research into prevention and treatment of the disease can begin to move forward.

“It’s a unique disease, and it’s going to have unique proteins that are modified in this disease, and this is the first indication that we’ve found one of the unique proteins,” said McKee, the director of BU’s CTE Center and senior author of the new study.

Researchers have been studying the disease in earnest since Dr. Bennet Omalu first published a paper in the journal Neurosurgery 12 years ago called “Chronic Traumatic Encephalopathy in a National Football League Player.” While leading experts agree the disease is linked to the repetitive hits suffered on the football field, it can be diagnosed only after a player has died. That has meant that many former players who suffered late in their lives from the effects of CTE never knew for certain they had the disease.

Why We Need To Structure Our Days Differently Than We Think

Once we get up, we are typically on a roll. We jump out of bed—complete our morning ablutions—do some cooking prep, maybe—slip into some clothes—grab a coffee—hop on the train or into the car—arrive at work—and grind away. Mid-morning sees the first energy drain, but lucky for us, coffee comes to the rescue. We eventually meet lunch with a deep sigh of relief, but after lunch, the uphill battle begins. The rest of the day is often either a drag or a wasteful distraction. Mid-afternoon draws our eyes to the clock with a longing for the day’s end. And just as our work days end, we have home life looming ahead. A relief, to be sure, but often filled with its own work and complications.

This automaton lifestyle may seem to get the job done, but in fact, it short-changes you more than you think. To make the best use of your brain, you really have to build short and frequent downtime—booster breaks—into it. And you have to make a habit of it for more than 2 months if you want it to stick. Let’s take a look at your objections and why you need to get over them.

1. “I just don’t have the time to build in frequent breaks”: Reality check—people spend 46.9% of their days daydreaming anyway. So you definitely have the time to daydream more effectively.

2. “How can daydreaming be effective?” I have a job that needs to get done”: Generally, daydreaming makes you miserable. But Jerome Singer has studied daydreams extensively, and he has made the point that not all daydreaming is the same. Slip into a daydream, or ruminate over the prior night’s indiscretions, and you will be sure to waste your time. But if you plan a 15-minute daydreaming time-out, then engage in some undemanding activity (knitting, gardening, or walking), and jumpstart your daydreaming with positive, wishful imagery (whatever floats your boat from tinkering underneath a car to laying on a yacht in the Mediterranean), you will likely become more creative, and more energized.

3. “Ok, so I buy the booster break idea. But exactly how crucial is this?” It turns out, it’s pretty crucial. Your brain occupies a mere 2% of your body’s volume, but it needs a lot of energy (20% of the body’s energy, to be precise) to work, when it is rest. (“What? Why does resting it require so much energy?”) In the “idle” setting, your brain is doing some of its best and most important work. This is when it is putting puzzle pieces together, driving you toward your own eureka experiences, unjumbling information, re-energizing your focus, activating memories, and also helping you stay self-connected.

4. “What does self-connection have to do with anything? It sounds bogus anyway. I know how I am” Once again, “knowing” is overrated. Most of what is going on in your brain is unconscious—you don’t actually “know” this. Yet, unconscious though it is, it matters. You are far more than your LinkedIn profile. There are subtle elements of you that really matter—they stabilize your every action.  These subtle elements of self are registered in the unfocus circuit. When you unfocus, your brain has time to put together subtle elements of who you are. Keep going like an energizer bunny, and you rob yourself of this richer experience of yourself.

5. “Okay, so I’m not going to daydream. Anything else I can do that doesn’t feel like a waste of time?” Actually, what is a waste of time is running on empty. You can’t go far without gas in the tank. What makes you think your brain doesn’t need an energy boost? I’ not just talking about “vegging out” here—I’m talking about strategic rest.

Facing Your Depression

“Laugh, and the world laughs with you; weep, and weep alone.” So wrote the poet Ella Wheeler Cox. Emotions are contagious, and most people intuitively seek out the positive while avoiding the negative. The exception, however, is those who are suffering from depression. The depressed misread emotional facial cues, finding gloom and doom where others see contentment.

We’re generally pretty good at reading the emotional expressions of others as portrayed on their faces, at least when it comes to the basic emotions, like happiness, sadness, and anger. We read the emotions of those we’re interacting with and regulate our own mood in response. After all, we can’t cooperate effectively with others if our emotions are out of sync. Crying at a party will likely get you shunned, as will laughing at a funeral. You’ve got to express the right emotion for the occasion.

Facial expressions of emotion are innate, but we do have some ability to fake or suppress them. Even though you’re feeling down, you may decide to put on a happy face at a party just to get along. And since others then respond to your positive expression, you might start feeling better as well. Likewise, you may need to put on a sad face at a funeral to fit in, even though you feel no loss or grief.

Our innate ability to read emotional expressions on the faces of others breaks down, however, as we fall into depression. The depressed can still read obviously happy or sad faces, but a problem arises when others display ambiguous feelings. This can occur either because the other person is trying to suppress their emotional expression, or because they aren’t sure how they feel at the moment.

When facial expressions of emotion are ambiguous, people tend to project their own feelings onto them. Happy people read ambiguous expressions as happy ones. And those in a low mood interpret them as sadness. Thus we fall into a cycle—either vicious or virtuous—depending on whether we’re depressed or not.

It’s hard to tell exactly where a vicious cycle begins—do we see others as sad because we’re sad, or do we feel sad because we see sadness in others? British psychologist Ian Penton-Voak and his colleagues think they have an answer to that question. These researchers study the perception of emotional expressions, and they’ve found some interesting patterns.

It’s already established that depressed people tend to interpret ambiguous emotional expressions as negative. What’s also well-known is that after a course of drug therapy with an SSRI like Prozac, depressed patients report a lift in their mood. They also shift their negative bias in interpreting facial expressions of emotion to a more positive one. In other words, ambiguous expressions that they interpreted as “sad” before treatment they now read as “happy” after treatment. But which comes first, the improved mood or the positive bias in face perception? Or do they occur together?

It generally takes a couple of weeks before patients report an improvement in mood after starting a regimen of antidepressants. Penton-Voak and his colleagues took advantage of this time lag to test their hypothesis that a positive bias in facial perception precedes an improvement in mood. Their results support this hypothesis. In other words, patients show a positive shift in the interpretation of ambiguous facial expressions even before they report an improvement in their mood. The researchers found that sometimes patients shifted to a positive bias in face perception after just a single dose of an SSRI—while they were still in the throes of depression!

There are lots of problems with drug-based approaches to treating depression. First, the drugs don’t always work. Doctors often need to try out several different prescriptions before they find one that’s effective for a particular patient. Second, even when the drugs do work, they frequently come with a host of negative side effects. Finally, some people object to a chemical solution for what they perceive as a psychological problem—and if they have a personal or family history of substance abuse, this attitude is quite understandable and reasonable.

Given these issues with drug therapy, Penton-Voak and colleagues wondered if they could bypass the drugs altogether and work directly with patients on changing their patterns of face perception. In a procedure called cognitive bias modification, depressed patients view pictures of faces on a computer screen and rate each as “happy” or “sad.” The computer then gives them feedback. When the patients rate ambiguous faces as “sad,” the program lets them know other people rated these faces as “happy.” After just four sessions, the patients show a clear positive shift in their perception of emotional expressions. More importantly, though, two weeks after the training was complete, these patients reported an improvement in mood. This evidence clearly suggests that changing the way you view other people’s facial expressions can lead to an improvement in your mood.

What You Need to Know About Stress and Self-Care

Stress affects everyone. It impacts the mind and body in direct and powerful ways. Stress saps our energy and contributes to fatigue, negative thinking, and distressing emotions, including anxiety, fear, frustration, anger, self-pity, and depression. Ongoing stress makes us more susceptible to emotional imbalance, illness, and disease. Numerous medical conditions are caused or exacerbated by stress, including hypertension, heart disease, and cancer. It can play a major role in beginning involvement with alcohol and other drugs, and in continuing that involvement. For people in recovery, stress is frequently involved in the process of relapse.

Stress is frequently talked about, but what exactly is it? Stress is an imbalance between your current coping abilities and the expectations or demands placed on you, including demands that you place on yourself—both real and perceived.

Stress arises from positive as well as negative events

It’s important to understand that stress doesn’t only come from negative or problematic experiences. Positive experiences can also create considerable stress. Graduating high school or college, starting a new and promising job, getting married, having a child, buying a house, and planned relocations are all generally positive events. However, they also represent significant life changes that, for most people, are naturally and normally quite stressful. For most people, change—even when it is extremely positive—creates stress.

Stressors—the factors that generate stress—take three fundamental forms:

  • Internal: Primarily “self-inflicted” based on self-imposed expectations, values, or standards that you (e.g., perfectionism) or others (e.g., other people are supposed to behave a certain way) “should” or “must,” maintain.
  • External-Interpersonal: Based on interactions and relationships with others—tension, conflicts/arguments, abuse, violence between people who know one another.
  • External-Impersonal: Environmental—weather, natural disasters, wars, random acts of violence, big-picture political-economic circumstances, etc.

Stress, anxiety, & fear—oh my!

Fear, anxiety, and stress are a vicious triangle—they contribute to and reinforce each other. The more fear and anxiety people experience, the more stressed out they tend to be. And, the more stressed out people are, the more anxious and fearful they tend to be. Stress automatically and unconsciously activates the systems in your body involved when quick response and rapid action are required. These include survival-oriented fight-flight-freeze reactions to perceived threats.

These fight, flight, or freeze stress reactions are your body’s way of protecting you in the face of actual threats to your safety and life. However, the stress-activated responses of the brain and body don’t differentiate between physical and emotional threats, or between dangers that are real or imagined. When you’re stressed over a busy schedule, an argument with a friend, coworker, partner, or child, a traffic jam, or your monthly bills, your brain and body react essentially the same way as they would if you were facing a life-or-death situation that requires a flight or fight response.

Chronic, ongoing exposure to stress interferes with your attitude, social and family relationships, work, and health. Regardless of whether you are in actual physical danger or simply feel like you are—chronic stress negatively affects nearly every system in your body. It can raise your blood pressure, suppress your immune system, increase your risk for heart attack and stroke, and speed up the aging process.

The symptoms of excessive stress can include:

  • Mental—forgetfulness, cynicism, negativism, self-criticism.
  • Emotional—irritability, low frustration tolerance, decreased empathy, anxiety, depression.
  • Physical—fatigue, tightness of neck or back, stomach aches, headaches.
  • Behavioral—interpersonal conflict, proneness to accidents, decreased productivity, sleep disturbance (increased or decreased sleep), appetite disturbance (eating more or less), decreased involvement with others, or isolation.

Like other repetitive experiences, long-term stress rewires the brain, leaving you more vulnerable to fear, anxiety, depression, and yes, more stress. As a result, learning and practicing ways to facilitate relaxation in order to counteract the stress you experience is vital to health, balance, and healing.

Self-Calming: Managing and decreasing your stress (and fear and anxiety)

There are many methods and practices that can help you manage and reduce your level of stress. All of these represent tools to help you self-calm. Self-calming practices generally combine intentional breathing and focused attention to help relax and quiet the mind and the body. Intentional breathing is only one of a wide variety of practices that you can learn to activate your body’s relaxation response. The relaxation response is the physiological opposite of the stress response that triggers fight-flight-freeze reactions.

5 signs you should ask your doctor about depression

A common perception of someone suffering from depression is a person who’s sad and/or crying. Although you certainly may feel this way if you’re depressed, the illness may also present itself in more subtle ways that you might not expect.

Depression is a very common illness, with about 16 million adults in the U.S. having at least one major episode of depression in the past year. Despite there being many different types of treatment available, about two-thirds of people with major depression never seek treatment.

Sometimes they think they’ll “snap out of it” on their own or they may be too embarrassed to address the condition. But delaying treatment could have devastating effects in every area of your life, and at its worst, could result in suicide.

The following five signs are solid indicators that it could be time to talk to your doctor about depression.

Your mind seems foggy.

If you have trouble concentrating or making decisions on an almost-daily basis, Health’s website says, this could be a sign of depression. It can cause fuzzy, unfocused thinking that can affect your memory and ability to make good decisions. This could make you forget work deadlines as well as tasks you need to complete at home. At its most extreme, it could even lead you to engage in unhealthy, risky behavior.

You tend to get angry.

Although most people probably associate depression with sadness, it can also cause you to feel irritated or angry over things that you would normally shrug off. If you find yourself raging at little things at work and home, you may actually be depressed. This can be especially true of men, Reader’s Digest says, who may find it more socially acceptable to express anger rather than sadness when they go through something such as divorce.

You have unexplained pain.

The Mayo Clinic says that unexplained pain such as back pain or headaches can sometimes be the first or only sign of depression. In fact, pain and depression can create a vicious cycle. If your depression is causing pain, this can make you further depressed, which increases your pain. In addition, depression-related pain that continues over time can create additional problems such as stress, low self-esteem and difficulty sleeping. Some forms of treatment can help with both pain and depression, while others treat only one condition, so you and your doctor can talk about what’s best in your particular case.

Your eating habits have changed.

Depression can affect many aspects of your life, including your eating habits. Health says you may experience a loss of appetite as well as a decreased interest in food and cooking. It can also have the opposite effect, making you more likely to try to soothe yourself by binge eating on unhealthy food. In addition, if you normally eat a healthy diet but find yourself suddenly turning to junk food, you may want to talk to your doctor about depression.

Smartphone App Helps Teens Recover From Concussions, Study Suggests

Rachel Butler suffered a number of concussions over a five-year span, and though she was treated for them by a doctor, her symptoms never quite went away, CBS2’s Dr. Max Gomez reported.

“I had really bad headaches. I would sleep so much. I was really irritable all the time,” she said.

Then, her doctor suggested using a smartphone app called SuperBetter. It’s a game that makes the patient the hero in a personal recovery story, battling foes along the way, like dizziness and headaches.

“Instead of, ‘I’m so frustrated, I can’t get rid of this headache,’ it rewrites it to say, ‘Did you battle the headache bad-guy today? And if so, how did you do?’” explained researcher Lise Worthen-Chaudhari, of the Ohio State Wexner Medical Center.

Traditionally, concussion patents are advised to stay away from screens during their recovery. But that can often lead to isolation and depression, especially for teenagers.

So researchers conducted a study at the Ohio State University Wexner Medical Center to see if limited exposure to the right content could help.

“We wanted to see, we wanted to test — was it possible for them to use screens just a little bit each day and get the bang for the buck with that,” she said.

In teens treated for concussions that did not use the app, only half reported improved symptoms. The other half said their symptoms got worse, and there was no improvement in optimism about recovery.

But in teens that did use the app, all of them reported improvements in both symptoms and optimism.

Butler said she felt less isolated and more motivated to get better.

“Having all the screens taken away was too much. But then when you added something in that was still beneficial, it helped a lot,” she said.

Other studies have started to show that complete brain rest may not be best path to concussion recovery.

This particular approach with a smartphone app may be especially useful for young people who really feel lost without their primary means of communication with their whole social network.

Here’s How Money Really Can Buy You Happiness

“Whoever said money can’t buy happiness isn’t spending it right.” You may remember those Lexus ads from years back, which hijacked this bumper-sticker-ready twist on the conventional wisdom to sell a car so fancy that no one would ever dream of affixing a bumper sticker to it.

What made the ads so intriguing, but also so infuriating, was that they seemed to offer a simple—if rather expensive—solution to a common question: How can you transform the money you work so hard to earn into something approaching the good life? You know that there must be some connection between money and happiness. If there weren’t, you’d be less likely to stay late at work (or even go in at all) or struggle to save money and invest it profitably. But then, why aren’t your lucrative promotion, five-bedroom house and fat 401(k) cheering you up? The relationship between money and happiness, it would appear, is more complicated than you can possibly imagine.

Fortunately, you don’t have to do the untangling yourself. Over the past quarter-century, economists and psychologists have banded together to sort out the hows, whys and why-nots of money and mood. Especially the why-nots. Why is it that the more money you have, the more you want? Why doesn’t buying the car, condo or cellphone of your dreams bring you more than momentary joy?

In attempting to answer these seemingly depressing questions, the new scholars of happiness have arrived at some insights that are, well, downright cheery. Money can help you find more happiness, so long as you know just what you can and can’t expect from it. And no, you don’t have to buy a Lexus to be happy. Much of the research suggests that seeking the good life at a store is an expensive exercise in futility. Before you can pursue happiness the right way, you need to recognize what you’ve been doing wrong.

Money misery

The new science of happiness starts with a simple insight: we’re never satisfied. “We always think if we just had a little bit more money, we’d be happier,” says Catherine Sanderson, a psychology professor at Amherst College, “but when we get there, we’re not.” Indeed, the more you make, the more you want. The more you have, the less effective it is at bringing you joy, and that seeming paradox has long bedeviled economists. “Once you get basic human needs met, a lot more money doesn’t make a lot more happiness,” notes Dan Gilbert, a psychology professor at Harvard University and the author of Stumbling on Happiness. Some research shows that going from earning less than $20,000 a year to making more than $50,000 makes you twice as likely to be happy, yet the payoff for then surpassing $90,000 is slight. And while the rich are happier than the poor, the enormous rise in living standards over the past 50 years hasn’t made Americans happier. Why? Three reasons:

You overestimate how much pleasure you’ll get from having more. Humans are adaptable creatures, which has been a plus during assorted ice ages, plagues and wars. But that’s also why you’re never all that satisfied for long when good fortune comes your way. While earning more makes you happy in the short term, you quickly adjust to your new wealth—and everything it buys you. Yes, you get a thrill at first from shiny new cars and TV screens the size of Picasso’s Guernica. But you soon get used to them, a state of running in place that economists call the “hedonic treadmill” or “hedonic adaptation.”

Even though stuff seldom brings you the satisfaction you expect, you keep returning to the mall and the car dealership in search of more. “When you imagine how much you’re going to enjoy a Porsche, what you’re imagining is the day you get it,” says Gilbert. When your new car loses its ability to make your heart go pitter-patter, he says, you tend to draw the wrong conclusions. Instead of questioning the notion that you can buy happiness on the car lot, you begin to question your choice of car. So you pin your hopes on a new BMW, only to be disappointed again.

More money can also lead to more stress. The big salary you pull in from your high-paying job may not buy you much in the way of happiness. But it can buy you a spacious house in the suburbs. Trouble is, that also means a long trip to and from work, and study after study confirms what you sense daily: even if you love your job, the little slice of everyday hell you call the commute can wear you down. You can adjust to most anything, but a stop-and-go drive or an overstuffed subway car will make you unhappy whether it’s your first day on the job or your last.

How Can We Build + Nurture Our Circle of Support?

Last April, my brother passed away suddenly after being in an accident. He was 55 years old and my only sibling. In the days and weeks that followed, I subsisted in a foggy state—unsure how to process the events and unable to make even the smallest decision. And everywhere I turned, there was a friend, a family member, or someone from one of my micro-communities—neighbors, members of my meditation group, people from my synagogue—stopping by to lend an ear and maybe a shoulder, cook a meal for my family, and check in to see if there was something I needed.

Those people—the ones who both held me up and held my hand during those dark, incomprehensible days—are my choir. They are the same people with whom, in happier times, I can dance, share a bottle of wine, talk politics, walk my dog and do yoga. I have never been so grateful to have them.

It is our relationships, according to results from a nearly 80-year study done at Harvard, that are the number one predictor of our well-being—both emotionally and physically. More than money. More than fame. “The surprising finding [from the study] is that our relationships and how happy we are in our relationships has a powerful influence on our health,” said Robert Waldinger, director of the study, a psychiatrist and a professor oat Harvard Medical School. “Taking care of your body is important, but tending to your relationships is a form of self-care too. That, I think, is the revelation.”

You don’t need to wait until something tragic happens to notice, nurture and appreciate the relationships that enhance your life from day to day—it may be a gym friend, a work colleague or a cousin who lives far away; your spouse, a church member, or someone you befriended on the internet.

Try asking yourself who’s in your choir, and consider how you can nurture those relationships. Here are a few suggestions:

Carve out time.

Many of us live very busy lives and can be challenged to find time for the people we care about in our technology-tethered world. See if you can carve out 30 to 60 minutes daily to check in with a good friend or family member. Even if it’s for a quick catch-up on the phone or via text. While hard to imagine, before cell phones and the Internet, we were chatting it up with our neighbors and sharing lengthy, family meals.

Be grateful and say so.

Since losing my brother, I often think about the feelings I will never get to share with him. It only takes a minute to send a quick note or text to thank someone you care about. Maybe it’s for taking out the garbage. Maybe it’s because you’re just thankful for their friendship. And if you have some extra time, try writing a gratitude letter to someone you care about, who has helped you at some point in your life—an exercise that research has shown is consistently associated with increased happiness.

Seek out people with common interests.

Some of us may be looking for an additional person or people to bring into our choir. One way to do this is to get involved with an organization or attend an event that is connected to one of your interests—community action, playing an instrument, knitting, for example. Libraries often have book groups and classes that bring local people together, and religious institutions usually offer groups meetings around different themes. Engaging with others who have a common interest, such as a hobby or experience, can make meeting new people feel less intimidating and more welcoming.

Science Says Happier People Have These 9 Things in Common

That’s why the science of happiness has gained more attention in recent years —researchers have started to produce reports on happiness around the globe, and positive psychology, which focuses on what makes individuals and communities thrive, has skyrocketed in popularity.

At this point, we actually know a fair amount about how certain behaviours, attitudes, and choices relate to happiness, though most research on the topic can only find correlations.

Researchers think that roughly 40 percent of our happiness is under our own control; the rest is determined by genetics and external factors. That means there’s a lot we can do to control our own happiness.

Here are nine happiness-promoting behaviours backed by science.

1. Relationships are essential. A major study followed hundreds of men for more than 70 years, and found the happiest (and healthiest) were those who cultivated strong relationships with people they trusted to support them.

2. Time beats money. A number of studies have shown that happier people prefer to have more time in their lives than more money. Even trying to approach life from that mindset seems to make people more content.

3. But it helps to have enough money to pay the bills. People’s well-being rises along with income levels up to an annual salary of about $75,000, studies have found. (That number probably varies depending on your cost of living, however.)

4. It’s worth stopping to smell the roses. People who slow down to reflect on good things in their lives report being more satisfied.

5. Acts of kindness boost the mood. Give your friends a ride to the airport or spend an afternoon volunteering. Some research has shown that people who perform such acts report being happier.

6. Breaking a sweat is about more than burning calories. Studies show that increased levels of physical activity are connected to higher levels of happiness. Exercise tends to help mitigate the symptoms of some mental illnesses as well.

7. Fun is more valuable than material items. People tend to be happier if they spend their money on experiences instead of things. Researchers have also found that buying things that allow you to have experiences — like rock climbing shoes or a new book to read — can also increase happiness.

8. It helps to stay in the present in the moment. Several studies have found that people who practice mindfulness meditation experience greater well-being.

9. Time with friends is time well spent. Interactions with casual friends can make people happier, and close friendships — especially with happy people — can have a powerful effect on your own happiness as well

Depression changes structure of the brain, study suggests

Alterations were found in parts of the brain known as white matter, which contains fibre tracts that enable brain cells to communicate with one another by electrical signals.

White matter is a key component of the brain’s wiring and its disruption has been linked to problems with emotion processing and thinking skills.

The study of more than 3000 people — the largest of its type to date — sheds light on the biology of depression and could help in the search for better diagnosis and treatment.

Scientists at the University of Edinburgh used a cutting-edge technique known as diffusion tensor imaging to map the structure of white matter.

A quality of the matter — known as white matter integrity — was reduced in people who reported symptoms indicative of depression. The same changes were not seen in people who were unaffected.

Depression is the world’s leading cause of disability, affecting around a fifth of UK adults over a lifetime. Symptoms include low mood, exhaustion and feelings of emptiness.

Experts say the large number of people included in the sample — 3461 — means that the study findings are very robust.

Participants were drawn from UK Biobank, a national research resource with health data available from 500,000 volunteers.

The study forms part of a Wellcome Trust initiative called Stratifying Resilience and Depression Longitudinally (STRADL), which aims to classify subtypes of depression and identify risk factors.

Heather Whalley, Senior Research Fellow in the University of Edinburgh’s Division of Psychiatry, said: “This study uses data from the largest single sample published to date and shows that people with depression have changes in the white matter wiring of their brain.

“There is an urgent need to provide treatment for depression and an improved understanding of it mechanisms will give us a better chance of developing new and more effective methods of treatment. Our next steps will be to look at how the absence of changes in the brain relates to better protection from distress and low mood.”

12 Ways to Strengthen Your Brain

When it comes to keeping your body’s muscles fit, you often hear the expression “use it or lose it.”

Yet most people don’t know that your body’s controlling organ – your brain – is similar to a muscle, too. In fact, keeping your brain “fit” with plenty of mental stimulation is a great way to support your healthy cognition, mental function and memory throughout your life.

Isn’t that exciting?

It is just as important to exercise your brain, as it is to exercise your body. It can be fun, too!

Dr. Amen’s 12 Ways to Strengthen Your Brain

1. Dedicate yourself to new learning.

Put 15 minutes in your day to learn something new. Einstein said that if anyone spends 15 minutes a day learning something new, in a year he or she will be an expert! Learn by taking a class. Try square-dancing, chess, tai chi, yoga, or sculpture. Parents, work with modeling clay or Playdough with your kids. It helps develop agility and hand-brain coordination!

2. Cross train at work.

Learn someone else’s job. Maybe even switch jobs for several weeks. This benefits the business and employees alike, as both workers will develop new skills and better brain function.

3. Improve your skills at things you already do.

Some repetitive mental stimulation is okay as long as you look to expand your base skills and knowledge. Common activities such as gardening, sewing, playing bridge, reading, painting, and doing crossword puzzles have value, but push yourself to do different gardening techniques, more complex sewing patterns, play bridge against more talented players to increase your skill, read new authors on varied subjects, learn a new painting technique, and work harder crossword puzzles. Pushing your brain to new heights helps to keep it healthy and strong.

4. Limit television for kids and adults.

In a study published in the journal Pediatrics it was reported that for every hour a day children watch TV there is a 10% increased chance of them being diagnosed with attention deficit disorder (ADD). This means if the child watches five hours a day they have a 50% increased chance of being diagnosed with ADD! Watching TV is usually a “no brain” activity. To be fair, most studies did not specifiy if watching programs that teach you something had the same effect as situation comedies, reality shows or sports. I suspect that no-brain TV shows are the primary problem.

5. Limit video games.

Action video games have been studied using brain imaging techniques that look at blood flow and activity patterns. Video games have been found to work in an area of the brain called the basal ganglia, one of the pleasure centers in the brain. In fact, this is the same part of the brain that lights up when researchers inject a person with cocaine! My experience with patients and one of my own children is that they tend to get hooked on the games and play so much that it can deteriorate their school work, work and social time – a bit like a drug. Some children and adults actually do get hooked on them.

6. Join a reading group that keeps you accountable to new learning.

Almost any mental activity you enjoy can be used to protect your brain. The essential requirement is that it activates several different brain areas, one of which should be the hippocampus (in the temporal lobes), which stores new information for retrieval later on. By recalling information (using your hippocampus), you are protecting your brain’s memory centers. In essence, as long as you learn something new and work to recall it later for discussions, you are protecting short-term memory. Reading stimulates a wide variety of brain areas that process, understand, and analyze what you read, and then store it for later recall if you decide it’s worth remembering. The neurons in these activated brain areas are stimulated with specific patterns of information.

27 Facts About the Best Ways to Treat Depression

Major depression can be a devastating—even life-threatening—condition. Thousands of studies have examined what works in restoring hope and vitality.

I’ve compiled 27 important facts about depression treatment, based on the latest research. Whenever possible I’ve relied on the most recent meta-analyses which combine results from all relevant studies to establish general trends.

Take care in interpreting these findings, as research in these areas is ongoing.

  1. Medication and cognitive behavioral therapy (CBT) are equally effective in treating depression. Medication can help with severe depression even as much as CBT.
  2. There is a very strong placebo effect in depression treatment. The average person in a clinical trial does just about as well on placebo as on medication—a 40 versus 48% reduction in symptoms, respectively, based on a major review.
  3. Chronic and more severe depression responds better to a combination of medication and therapy. Medication plus CBT is more effective than meds alone, and medication adds additional benefit for those receiving CBT. For mild, non-chronic depression, a single treatment typically works as well as the combination—and avoids the additional time, effort, cost, and side effects.
  4. About 1 in 8 adults in the US are taking medications that are prescribed for depression. Two-thirds of these individuals are taking a selective serotonin reuptake inhibitor (SSRI) like Prozac or Zoloft.
  5. CBT is not the only type of talk therapy that works well in treating depression. Psychodynamic therapy—which is based largely on a Freudianunderstanding of the mind—has gotten a bad rap in the era of evidence-based treatment. However, there’s growing evidence that short-term psychodynamic therapy is helpful, as is a more general type of treatment called “nondirective supportive therapy.” The Society of Clinical Psychology—a division of the American Psychological Association—keeps a list of treatments with the strongest research support.
  6. Exercise can be a powerful antidepressant treatment. Researchers have found benefits of walking, jogging, running, resistance training, and other forms of movement. More intense activity generally leads to greater depression relief.
  7. Improving diet may be an effective way to relieve depression. A study from earlier this year found that educating people about better eating habits could lead to big reductions in depression. Participants were advised to increase consumption of vegetables, whole grains, legumes, healthy fats, and lean proteins, among other foods; and to reduce heavily processed and sugary foods, as well as alcohol.
  8. The addition of omega 3 fatty acids is not considered an effective treatment. A review from 2007 had suggested the these supplements were effective, but cautioned that it was “premature to validate this finding” as more research was needed. A more recent meta-analysis found minimal effectiveness of omega 3s compared to placebo—although it’s worth noting that the same has been found for medications for depression, and “placebo” doesn’t mean there was no benefit.
  9. Self-directed CBT can be an effective treatment for depression. It tends to be somewhat less helpful than partnering with a therapist, and is probably most appropriate for those with mild to moderate depression. A hybrid approach—self-help with some guidance from a professional—can be just as effective as face-to-face therapy.
  10. There is a high risk for relapse after discontinuing medication for depression. In a meta-analysis of 31 trials, people who were switched to placebo had about a 40% risk for relapsing in the following 4-36 months; continuing on medication reduced that risk to 18%.

Combo of sleep apnea and insomnia linked to depression in men

Men with both obstructive sleep apnea and insomnia are much more likely to have depression symptoms compared to men with either sleep disorder alone, suggests a recent Australian study.

The depression symptoms also seem to be worse for men who have both apnea and insomnia compared to men with depression but without this combination of sleep problems, the authors report in the journal Respirology.

“Obstructive sleep apnea and insomnia are the two most common sleep disorders and can occur together in the same individual,” lead author Dr. Carol Lang, a researcher at the Basil Hetzel Institute at the University of Adelaide Queen Elizabeth Hospital Campus, told Reuters Health.

“We know that each of these disorders is individually associated with poor physical and mental health outcomes in patients. However, we don’t know very much about if, or how, the two disorders interact with each other and the health outcomes when they coexist in the same individual,” Lang said in an email.

A person with obstructive sleep apnea has their breathing interrupted multiple times during sleep by narrowed or blocked airways. The condition is often treated by wearing a continuous positive airway pressure, or CPAP, mask to keep the airway open.

Insomnia was defined in this study as the inability to fall or stay asleep together with feeling fatigued during the day.

The Simple Mindfulness Tool Anyone Can Use

It recently dawned on me after a day of teaching mindfulness to elementary school students: many adults probably don’t know the simple tools I’m sharing with these kids. In fact, being aware of the present moment probably comes more easily to children than it does for most adults.

Mindfulness is becoming increasingly popular in schools and for good reason. Numerous studies have shown its effectiveness at improving student concentration, behavior, memory, attendance, and overall happiness. But children aren’t learning some special secrets to the Universe in Mindfulness class while chanting om, they’re mostly learning how to best utilize their own brains.

I tell my students to put their two fists together to see an approximate view of the size and shape of their brains. I then instruct them to wrap the fingers of each hand around the thumb, and put the fists together once more.

Each thumb represents the amygdala, a small area in the middle of each hemisphere of the brain that is primarily responsible for sensing stress. The amygdala is the brain’s alarm clock; triggered by any stressful situation, it responds with the primal protection reactions of fight, flight, or freeze.

This is a good thing, if you are being chased by a tiger. But since, as my students point out, tigers don’t live in the city, or even in our country for that matter, we are unlikely to face that situation anytime soon. Try telling that to the amygdala, however.

The amygdala doesn’t know the difference between a stressful exam, an argument with a loved one, and being chased by a tiger. All it knows is that you are in danger. And when the amygdala senses danger, and reacts with stress, it blocks the pre-frontal cortex — the part of the brain that’s responsible for logical thought.

The pre-frontal cortex is located behind the forehead and is where all higher reasoning takes place. Which is actually handy to have in a stressful situation, since you’re likely to want more options available than fight, flight, or freeze. My students as young as five years old tell me they experience stress daily—stress is a near universal occurrence.

So what can we do when stress takes over and we just can’t think clearly? Luckily, there is a simple tool available to anyone, anytime that quickly and efficiently calms the amygdala and eases stress. Everyone alive can do it, in fact, you wouldn’t be alive without it—it’s breath.

Deep breaths flood the brain with oxygen, signaling to the amygdala that it’s okay to calm down. I tell my students to stop and take 10 deep breaths whenever they’re feeling stressed, counting slowly to three on both the inhale and the exhale. They tell me this really helps them. And I find it helps in my life too, when I am mindful enough to do it.

So the next time your heart starts racing and you feel the pressure rising, remember your amygdala. And if you aren’t being chased by a tiger or other scary creature, try taking 10 deep breaths—it might just make you feel a whole lot better.

Risky Business: Prescription Drug Misuse

What do we mean by “misuse”?

Misuse is when a person uses a prescription drug that is not intended for them, or uses a prescription in a way that is different than how the doctor indicated (using larger amounts, taking it more often, or using it for longer than prescribed).

How many people misuse prescription drugs?

7.1 percent of people aged 12 and older misused prescription drugs in the past year. [1]

What kinds of prescription drugs are people misusing? [2]

12.5 million people misused opioid pain relievers
6.1 million people misused tranquilizers
5.3 million people misused stimulants
1.5 million people misused sedatives

Misuse is higher among people with mental illness

People with mental illnesses are 3 times more likely to misuse prescription drugs.[3]

How does misusing prescription drugs affect mental health?

Opioid pain relievers, tranquilizers, stimulants and sedatives all have the potential to lead to addiction.
Prescription drug misuse may cause people to experience symptoms of mental health disorders. These symptoms generally improve after a person stops using the drugs, but may take a month or more to go away completely.[4]
Drugs that slow down or calm people can cause symptoms of depression when misused. If a person goes into withdrawal from these drugs, they are likely to have anxiety.[5]
rugs that act as stimulants can cause symptoms of psychotic and anxiety disorders when misused. If a person goes into withdrawal, they are likely to have symptoms of major depression.[6]
Opioid pain relievers, tranquilizers, stimulants and sedatives may all cause sleep and sexual troubles.[7]

Why do people misuse prescription drugs?

People who misuse prescription drugs may be self-medicating to control symptoms of an existing (and possibly undiagnosed) physical or mental health disorder, or because they like the way the drugs a˜ect them and think they are safe to use.

16% of parents and 27% of teens
believe that using prescription drugs to get high is safer than using street drugs. [8]

Are you experiencing a prescription drug use disorder?

It is always dangerous to use prescription drugs that do not belong to you or in a way that is not prescribed. Use the checklist below to determine if you may have a serious problem with prescription drugs.

  • Used prescription drugs in large amounts or for longer than intended?
  • Wanted to stop misusing prescription drugs, but were unsuccessful in your attempts to quit?
  • Spent a great deal of time getting, using, or recovering from prescription drugs that you have been misusing?
  • Had strong cravings or urges to misuse a prescription drug?
  • Failed to perform work, school, or home duties because of misuse?
  • Continued  to misuse despite it causing problems with relationships?
  • Stopped participating in activities you used to enjoy because of prescription drug misuse?
  • Misused prescriptions in dangerous situations (driving, etc.)?
  • Continued misusing prescription drugs despite physical or mental health problems that it has caused or made worse?
  • Developed a tolerance (needed more to get the desired effect) to a prescription you were misusing ?
  • Felt withdrawal symptoms when you stop misusing prescriptions possibly using again to relieve your discomfort?

If you have experienced two or more of the following signs in the past year, you may have a prescription drug use disorder.[9]

How common are prescription drug use disorders?

OVER 3.2 MILLION PEOPLE

met the criteria for a prescription drug use disorder in the past year. [10]
That’s enough people to hold hands from New York to Los Angeles. [11]

Less than half received treatment. [12]

What can you do about prescription drug misuse?

Use medications as directed.
Talk to your doctor about non-addictive options for treating the condition that you are being medicated for if you feel at risk for misusing your prescription. Also make sure to consult your healthcare provider before adjusting medication dosage.
Store medications in a safe place where they cannot be accessed by others who many want to use them inappropriately.
Call 911 or get immediate help if you or a loved one have a medical emergency related to prescription drugs.
Properly dispose of expired or unused medications. Over half of people who misused prescription pain relievers got them from friends or relatives. [13]

Walgreens has over 600 safe medication disposal kiosks in 45 states. To locate a disposal kiosk, visit: bit.ly/kiosk2017. If there is not a kiosk located in your area, you may call the DEA’s Registration Call Center at 1-800-882-9539 to find a collection receptacle for unused or unwanted prescription drugs.

Risky Business: Sex

Sex is big business

Strip clubs are a $6 billion industry in the United States. [1]
30% of data sent over the Internet is porn-related. [2]
In 2016, U.S. sales of male enhancement drugs generated over $2.6 billion. [3]

Sex can also be risky business

High-risk sexual behavior takes place when a person puts themselves at risk for negative consequences like catching a sexually transmitted infection or disease, or unplanned pregnancy.

Some high-risk sexual behaviors include:

  • Unprotected sexual contact
  • Multiple sexual partners
  • Sex while under the influence of drugs or alcohol
In a study of college students, less than half (46.6%) who engaged in oral, anal or vaginal sex in their most recent hookup reported using a condom. [4]

While not everyone who engages in risky sex has issues with compulsive sexual behavior, many people with compulsive sexual behavior have high-risk sex.

What is compulsive sex?

Compulsive sexual behavior is when a person has excessive or uncontrolled sexual behaviors or thoughts that may cause them distress and negatively affect their relationships and work. In some cases, compulsive sexual behaviors may also cause a person to have financial or legal troubles. Compulsive sexual behavior is also sometimes called nymphomania, hypersexuality, sex addiction, or excessive sexual desire.

Compulsive sexual behaviors are generally divided into two categories: those that are generally socially acceptable when not done compulsively (nonparaphilic behaviors), and those that are not (paraphilic behaviors). This information focuses on behaviors that are nonparaphilic, like masturbation, use of porn, and consensual sex which may be paid for or extramarital.

5-8% of people have a compulsive sexual behavior. [5]
Compulsive sexual behaviors are more common in men. [6]

NOTE: The information being presented is not about those who commit sexual assault or other sex-related crimes.

How does compulsive sex affect mental health?

  • People may neglect responsibilities in pursuit of sexual gratification, causing feelings of guilt and shame.[7]
  • Compulsive sexual behaviors like excessive porn watching or sex with prostitutes can create unhealthy or unrealistic expectations of what healthy sexual experiences should be like.[8]
  • People who get sexually transmitted infections or diseases as a result of compulsive sexual activity may feel intense shame and decreased self-esteem.
  • Feelings of betrayal and anger are common among people whose significant others have lied or kept secrets in order to satisfy their compulsive sexual behaviors.

How is compulsive sexual behavior related to mental illness?

Compulsive or hypersexual behaviors may be induced by manic episodes in people with bipolar disorder, substance abuse, medications, or tumors and injuries to the frontal lobe of the brain. Once a person receives treatment for these conditions, compulsive or hypersexual behaviors generally subside. [9]
Over 83% of people who identify as sex addicts have other addictions like alcohol or drug dependency, compulsive working behavior, or compulsive gambling. [10]
Thirty–eight percent of people who identify as sex addicts have some form of eating disorder. [11]
One study found that 58% of people who struggled with compulsive sexual behaviors also had major depression at some point in their lives. [12]
People with compulsive sexual behaviors are at higher risk for attempting suicide. [13]

Are you showing signs of compulsive sexual behavior?

In the past 6 months have you:

  • Felt like your sexual fantasies, urges, and/or behaviors have caused you distress and impacted your ability to function?
  • Wanted to stop or reduce your sexual fantasies, urges, and/or behaviors, but were unsuccessful in your attempts?
  • Spent a great deal of time pursuing or engaging in sexual fantasies, urges, and/or behaviors?
  • Turned to sexual fantasies, urges, and/or behaviors to deal with stress, or other feelings like depression, anxiety, or boredom?
  • Continued to engage in sexual behavior despite the physical or emotional harm it has caused either you or those you care about?

If you answered “yes” to most of the questions above, you may be dealing with a sexual behavior disorder and should seek professional help. [14]

How is compulsive sexual behavior treated?

Some professionals classify compulsive sexual behaviors as an obsessive-compulsive disorder, while others classify it as an impulse control disorder or addiction. Because compulsive sexual behaviors have different patterns and features from person to person, there is no one specific treatment for compulsive sexual behavior. [15]
Support groups modeled after 12-step programs are helpful in dealing with compulsive sexual behaviors. Sex Addicts Anonymous (saa-recovery.org),  and Sexaholics Anonymous (sa.org) are some support groups that offer meetings across the United States.
Cognitive behavior therapy (CBT) and psychodynamic psychotherapy are the two most common forms of therapy used to treat compulsive sexual behaviors. Therapy may be provided one-on-one, in a group, or with a person’s significant other.
Medications such as antidepressants, mood stabilizers, and treatments that target hormones may be used in addition to therapy to manage unwanted or intrusive sexual thoughts or urges.

Risky Business: Exercise Extremes

Not Enough

When a person does not regularly exercise or does not meet the bare minimum recommendations for physical activity as outlined by the Centers for Disease Control and Prevention (CDC), it is called having a sedentary lifestyle. [1]
80% of adults DO NOT meet the guidelines for both aerobic and muscle-strengthening activities. [2]

 

Too Much

When a person misses important social or professional obligations so they can workout; feels extremely sad or guilty when they don’t exercise; doesn’t give their body time to recover after an intense workout; or continues to exercise despite illness or injury, it is called compulsive exercise, or exercise addiction. [3]
3% of people meet the criteria for behavioral addiction to exercise. [4]

 

What is the recommended amount of exercise?

The recommended amount of exercise for an adult includes aerobic activity and muscle strengthening activities. [5]

Aerobic Activity

Aerobic activity must be done for at least 10 minutes at a time to have an impact. stop watch The minimum amount of aerobic activity that should be done in a week depends on the intensity of the exercise.

150-300
Minutes per week

75-150
Minutes per week

Moderate-intensity aerobic activity (heart rate is raised, light sweating, should be able to talk but not sing) Vigorous-intensity aerobic activity (heart rate is raised significantly, heavy sweating, can’t say more than a few words at a time) .

 

Muscle-strengthening

2 or more days per week

Muscle-strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms)

What are the health risks of too much or not enough exercise?

Too Much [6] Not Enough [7]
Dehydration & fatigue Colon & breast cancer
Increased injuries, cartilage damage & arthritis Obesity
Fractured bones & osteoporosis Diabetes
Irregular periods & reproductive issues Cognitive decline & depression
Heart problems Heart attack & stroke

 

How is exercise related to mental illness?

Sedentary lifestyle may be a symptom of depression or anxiety when coupled with withdrawal from activities that one used to enjoy or social isolation. Additionally, living a sedentary lifestyle increases a person’s risk of developing depression.
When compulsive exercise is used as a way to “purge” calories that have been consumed, it can be a symptom of an eating disorder. [8]
Eating disorders often accompany exercise addiction. Approximately 39-48% of people who have an eating disorder also struggle with exercise addiction. [9]

Get moving

If you’ve been living a sedentary lifestyle and want to get started with an exercise program:

  • Talk to your doctor to see if there are any special considerations you should take when exercising.
  • Start slow and work up to harder activities.
  • Find a friend to exercise with to keep you motivated and accountable.

Take control of compulsive exercise

  • Take days off from exercising or substitute your normal routine with less strenuous workouts.
  • Remind yourself that a certain body type or weight will not automatically lead to happiness.
  • Avoid negative self-talk like, “You’re a lazy slob if you don’t go to the gym,” or, “Nobody will want to date you with a body like that.”
  • Make sure you are eating enough to fuel your body for exercise.
  • Tell a trusted friend or family member about your struggles. Make plans to do something besides workout a couple of days each week.
  • Know when to seek professional help.

Risky Business: Marijuana Use

From Mental Health America – Please note- this webpage is speaking about marijuana in general and not CBD or other derivatives.

Availability is increasing. Attitudes are changing.

twenty  

states have legalized marijuana for medical use. [1]

Eight  

states and the District of Columbia have legalized marijuana for medical AND recreational use. [2]

 

57% of American adults support the legalization of marijuana. [3]

 

69% of American adults believe alcohol is more harmful to health than marijuana. [4]

 

Marijuana is widely used

Lifetime use of marijuana/cannabis [5]
15.7% 46.9%
Among Youth 12-17 Among Adults 19 and older

Marijuana use is higher among people with mental illnesses

Past year use of marijuana/cannabis [6]
23.2% 11.5%
Among adults with mental illness Among adults without mental illness

When does marijuana use become a problem?

Marijuana use becomes a problem when it interferes with a person’s ability to function in their personal and/or professional lives.

In the past year have you:

  • Used marijuana in large amounts for longer than intended?
  • Wanted to stop using marijuana, but weren’t successful in attempts to quit?
  • Spent a great deal of time getting, using, or recovering from marijuana?
  • Had strong cravings or urges to use?
  • Failed to perform work, school, or home duties because of marijuana?
  • Continued use despite it causing problems with relationships?
  • Stopped participating in activities you used to enjoy because of marijuana use?
  • Used  marijuana in physically dangerous situations (driving, etc.)?
  • Continued using marijuana despite physical or mental health problems that it has caused or made worse?
  • Developed a tolerance to marijuana (needed more to get the desired effect)?
  • Felt withdrawal symptoms when you stopped using marijuana, possibly using again to relieve your discomfort?

If you have experienced two or more of the following signs in the past year, you may have Marijuana (cannabis) Use Disorder.[7]

Marijuana (cannabis) Use Disorder affects: [8]
3.4% of youth ages 12-17 1.5% of adults ages 18 and older

 

Can marijuana cause mental illnesses?

More research is needed for a clear answer to this question. Here’s what we do know:

up arrow Marijuana may increase the risk of developing psychotic disorders like schizophrenia. It can also worsen symptoms in people who already have psychosis.[9]
brain icon Marijuana use during adolescence can have lasting effects, including changes to the reward system in the brain and trouble with thinking and remembering.[10]
warning sign Marijuana use can cause symptoms of mental health problems like psychosis (hallucinations), anxiety (panic attacks), depression, and sleep disorders, but these symptoms generally fade after the effect of the drug has worn off. [11]
disoriented facial expression People may get “too high” by using a strain of marijuana that is stronger than they thought it would be, by using too much, or by consuming it in di˙erent ways. Smoking marijuana usually takes effect quickly (a matter of minutes), while consuming edibles usually takes longer (a matter of hours) for an individual to feel the effects, and they may end up consuming too much because they “don’t feel it” at first. [12]
marijuana leaf on brain Adults who have been diagnosed with marijuana (cannabis) use disorder have high rates of mental health disorders including anxiety, depression, PTSD, and ADHD [13]. It is hard to know whether the marijuana use disorder or the mental health disorder appeared first, since many people use drugs to self-medicate.

Can marijuana treat mental illnesses?

Much of the research supporting the use of marijuana or cannabis as a treatment for mental illnesses is based on:

man with speech bubble OR rat icon
Anecdotal Evidence
(personal accounts)
Experiments using different chemicals from marijuana in rats

 

In some states that have legalized medical marijuana, it can be prescribed to reduce symptoms of Post-Traumatic Stress Disorder (PTSD) or stimulate appetite in people with anorexia. Depending on the state, doctors may also be able to prescribe marijuana for other mental health problems (like anxiety) at their discretion if traditional methods of treatment have not been successful.

map of states that have legalized prescription marijuana

 

Take control of marijuana use

  • Keep track of your marijuana use to see if you notice patterns.
  • Be specific with yourself about how you would like to change your marijuana use (how often, when, where, etc.) and your reasons for making changes.
  • Take a month-long break from marijuana. This enables your body to get rid of the drug, reduce tolerance, and get over the discomfort of withdrawal that some people feel when stopping.
  • Identify what triggers the urge to use, and think about what you can do to manage those triggers.
  • Avoid using marijuana before activities that require thinking and remembering, like school and work, or before an important or new challenge.
  • Don’t mix marijuana with alcohol or other drugs.
  • Get immediate help if you are unable to control your use or if you have a medical emergency.

 

Risky Business: Internet Addiction

America is online

88.5% of Americans are Internet users. [1]
Yet less than 40% of the world has Internet access. [2]
40% of young adults (ages 18-24) use social media in the bathroom. [3]
An estimated 75% of Americans use a smart phone, tablet or mobile device to get online. [4]

 

For some people, going online becomes an addiction

There is no one definition for internet addiction; however, it is generally agreed upon that people who are addicted to the Internet have trouble filling personal and professional obligations because of their online activities, and their use of the Internet causes strain on relationships with family and friends. People who are addicted to the Internet often experience negative emotions or withdrawal symptoms when their Internet access is restricted.

Internet Addiction may also be called computer addiction, compulsive Internet use, Problematic Internet Use (PIU),  Internet dependence, or pathological Internet use. [5] Researchers estimate that 6% of people are addicted to the Internet. [6]

There are 5 types of Internet addiction [7]:

Cybersexual: Cybersex and Internet porn
Net compulsions: Online gambling, shopping, or stock trading
Cyber-relationships: Social media, online dating, and other virtual communication
Gaming: Online game playing
Information Seeking: Web surfing or database searches

 

Why do people become addicted to the internet? [8]

  • Accessibility: Most Americans can get online easily and almost immediately, at any time of day or night.
  • Control: People can go online when they want and without other people knowing, causing them to feel in control.
  • Excitement: Going online gives people a sort of “high.” The suspense of bidding in online auctions, gambling, or playing games can be especially thrilling.

The combination of accessibility, control, and excitement make the addicted person want to continue going online.

How is internet addiction related to mental illness?

Adolescents who struggle with Internet addiction often have other mental health problems like alcohol and substance use, depression, suicidal ideation, ADHD, phobias, schizophrenia, obsessive-compulsive disorder, and/or aggression. [9]
Adults who are addicted to the Internet are also likely to have depression, anxiety, alochol problems, compulsive behaviors, sleep disorders, ADHD, anger issues, and/or dissociative experiences. [10]
There is debate about which comes first for people, Internet addiction or the co-occuring mental health problem. [11]

 

Are you dealing with Internet addiction?

If you agree with most of the statements below, it may be time to seek help [15]:

  • I think about being online almost constantly. If I’m not online, I’m thinking about the next time I can be or that last time that I was.
  • I need to online longer and longer each time before I feel satisfied.
  • I have tried to control, reduce, or stop my internet use, but haven’t been able to do so successfully.
  • I feel irritable or depressed when I try to reduce the amount of time that I am on the Internet or when I can’t get online.
  • The way I use the Internet has threatened a relationship with someone I care about, my job, or my school work.
  • I lose track of time when I’m online.
  • I sometimes lie to important people in my life about the amount of time I spend, or the types of activities I participate in on the Internet.
  • Being online helps me to forget about my problems or improve my mood when I’m feeling sad, anxious, or lonely.

How is Internet addiction treated?

Some professionals classify Internet addiction as an obsessive compulsive disorder, while others liken it to an impulse control disorder. Therefore, there is no one specific treatment for Internet addiction. [12]
Internet addiction treatment aims to create boundaries and balance around Internet use rather than eliminating it entirely. However, if there is a certain app, game, or site that seems to be the focus of the addiction, stopping its use may be part of treatment. [13]
Therapy is almost always incorporated into the treatment of Internet addiction. Cognitive-behavioral therapy (CBT) and group therapy are common.
Medication may be used to manage symptoms of underlying mental illness and control intrusive thoughts about going online.
Exercise may be incorporated into Internet addiction treatment to ease the effects of reduced dopamine in the brain resulting from restricted Internet use. [14]

 

Take control of Internet use

  • Take breaks. For example, try to take a 15 minute break for every 45 minutes of Internet use.
  • Fill your free time activities that are physically intense or require a lot of concentration to distract you from thinking about going online.
  • Don’t bring your smart phone or tablet with you when you leave the house.
  • Keep track of non-essential Internet use (use that isn’t related to school or work) to see if you notice patterns. Do you go online when you are bored? Are you going online to relieve feelings of loneliness or depression?
  • Make a list of things of things that you enjoy doing or need to get done that don’t include the Internet. If you feel tempted to go online, choose an activity from your list instead.

Risky Business: Compulsive Buying

For some people, shopping turns into compulsive buying

Compulsive buying is an uncontrollable desire to shop which results in spending large amounts of time and money on the activity. Generally a person who buys compulsively gets the urge to shop in response to negative emotions (not to be confused with occasional “retail therapy”) and often has problems with relationships and finances as a result of their shopping behavior.

The four stages of compulsive buying

  1. Anticipation: Thoughts and urges start. They may focus on a specific item or the act of shopping itself.
  2. Preparation: Research and decision making take place. A person may look into sales or debate about where to go shopping.
  3. Shopping: Shopping happens. This is the so-called, “thrill of the hunt.” The person gets a “high” while doing it.
  4. Spending: Something, or many things, are purchased. The personis sad that the shopping experience is over and may be disappointed about how much they’ve spent afterwards.

Are you at risk for a compulsive buying problem?

If you agree with most of the statements below, it may be time to seek help.

  • If I have money left in my paycheck, I have to spend it.
  • Other people would judge me if they know how much I spend.
  • I buy things that I can’t afford.
  • I’ve overdrawn my bank account buying things that I didn’t need.
  • Buying things makes me feel better.
  • I’m anxious on days that I don’t go shopping.
  • I pay the bare minimum on my credit card(s), but keep charging items.

How is compulsive buying related to mental illness?

People who have Compulsive Buying Disorder often meet the criteria for other mental illnesses as well, such as mood disorders, anxiety disorders, substance use disorders, eating disorders, ADHD, and a variety of impulse control disorders.
Excessive spending can be a symptom of Borderline Personality Disorder.
Spending sprees may occur during manic episodes of Bipolar Disorder; however, this is different from Compulsive Buying Disorder and spending sprees generally stop once a manic episode has ended.
Compulsive buying is often driven by feelings of anxiety, depression or low self-esteem.

How is compulsive buying treated?

Some professionals classify compulsive buying as an obsessive compulsive disorder, while others liken it to an impulse control disorder [12]. Therefore, there is no one specific treatment for compulsive buying.
Treatment for compulsive buying is determined by a provider after consulting with an individual.
Medication may be used to manage symptoms of underlying mental illness and control unwanted or intrusive thoughts about shopping.
Cognitive behavioral therapy (CBT) is almost always incorporated into treatment for compulsive buying.
Support groups modeled after 12-step programs have been helpful in dealing with compulsive buying behaviors. Debtors Anonymous (www.debtorsanonymous.org) is one such support group and has meetings at locations across the country.
Other ways of addressing compulsive buying include self-help books and simplicity circles. [13]

 

Take control of spending

  • Keep track of your spending to see if you notice patterns.
  • Set a budget for how much you can spend on shopping. You may want to set weekly limits. Use cash for shopping purposes and keep your credit and debit cards at home when you go out.
  • Identify what triggers the urge to shop or spend, and think about what you can do to manage those triggers.
  • Do your best to avoid the urge to shop for unnecessary items before bills are due or immediately after getting paid.
  • When you have money that is “burning a hole in your wallet,” transfer it to a savings account or use it to pay o˜ credit card balances.
  • If you can’t fight the urge to shop completely, channel it productively. Buy necessities like cleaning supplies or toiletries instead of clothing, electronics or other luxury items.

Mental Illness Is On The Rise But Access To Care Keeps Dwindling

More Americans than ever before are experiencing mental health problems, yet access to treatment for those issues is becoming more difficult to receive, a new study has found.

A new analysis of data from the Centers for Disease Control and Prevention’s National Health Interview Survey shows that serious psychological distress, or SPD, defined as severe sadness and depressive symptoms that interfere with a person’s physical wellbeing, is on the rise just as resources for mental health treatment are declining.

Researchers from NYU’s Langone Medical Center analyzed almost a decade’s worth of data and found that more than 8.3 million Americans ― or an estimated 3.4 percent of the adult population ― suffers from a serious mental health issue. The latest data is a departure from previous reports on the CDC’s survey, which estimated that fewer than 3 percent of American adults experienced serious psychological distress, according to the study’s authors.

The statistics were pulled from surveys collected between 2006 and 2014. The report included more than 200,000 Americans between the ages of 18 and 64. Individuals were represented from all states and across all ethnic and socioeconomic groups, according to the study authors.

One of the more dismal discoveries from the report is that access to professional help for mental health issues is deteriorating. The study found the 9.5 percent of people surveyed in 2014 did not have health insurance that provided access to a psychiatrist or counselor, a rise from 9 percent in 2006.

Approximately 10.5 percent of people experienced delays in getting treatment due to insufficient mental health coverage ― a 1 percent increase from 2006. And almost 10 percent of individuals in 2014 could not afford to pay for necessary psychiatric medications, which went up from 8.7 percent in 2006.

The findings indicate there’s a growing problem when it comes to mental health services. This could especially affect smaller communities. A 2016 report published by Mental Health America found there’s a glaring shortage of mental health professionals in the United States, specifically in rural areas. Alabama, for example, has one worker per every 1,200 people. Nevada, another rural state, was ranked last in MHA’s report, largely in part because of the state’s lack of available mental health professionals.

What this means

There’s a clear need for more emphasis on mental health in primary care facilities and hospitals across the country, according to Judith Weissman, lead study investigator of the CDC data and a research manager in the Department of Medicine at NYU Langone Medical Center.

“Among people with any type of illness, people with SPD are the ones experiencing the most disparities in terms of utilizing health care,” Weissman told The Huffington Post. “It leaves people with SPD just spinning through the system and makes you wonder what’s going on. Why isn’t the health care system addressing people with mental illness?”

What Happy People Do Differently

For psychologists who frequently fly cross-country, how we describe our career to seatmates—mentioning for example, that we are psychologists—determines whether we get five hours of airborne intrigue or inside access to a decaying marriage or more detail than you can imagine about an inability to resist maple-glazed Krispy Kremes. Even wearing oversized headphones often fails to dissuade the passenger hell-bent on telling her story of childhood abandonment (which is why it is handy for research psychologists to simply say we study ” judgments”). For those of us who risk the truth and admit that we study happiness, there’s one practically guaranteed response: What can I do to be happy?

The secret of happiness is a concern of growing importance in the modern era, as increased financial security has given many the time to focus on self-growth. No longer hunter-gatherers concerned with where to find the next kill, we worry instead about how to live our best lives. Happiness books have become a cottage industry; personal-development trainings are a bigger business than ever.

The pursuit of happiness is not uniquely American either—in a study of more than 10,000 participants from 48 countries, psychologists Ed Diener of the University of Illinois at Urbana-Champaign and Shigehiro Oishi of the University of Virginia discovered that people from every corner of the globe rated happiness as being more important than other highly desirable personal outcomes, such as having meaning in life, becoming rich, and getting into heaven.

The fever for happiness is spurred on, in part, by a growing body of research suggesting that happiness does not just feel good but is good for you—it’s been linked to all sorts of benefits, from higher earnings and better immune-system functioning to boosts in creativity.

Most people accept that true happiness is more than a jumble of intensely positive feelings—it’s probably better described as a sense of “peace” or “contentedness.” Regardless of how it’s defined, happiness is partly emotional—and therefore tethered to the truth that each individual’s feelings have a natural set point, like a thermostat, which genetic baggage and personality play a role in establishing. Yes, positive events give you a boost, but before long you swing back toward your natural set point.

True happiness lasts longer than a burst of dopamine, however, so it’s important to think of it as something more than just emotion. Your sense of happiness also includes cognitive reflections, such as when you give a mental thumbs-up or thumbs-down to your best friend’s sense of humor, the shape of your nose, or the quality of your marriage. Only a bit of this sense has to do with how you feel; the rest is the product of mental arithmetic, when you compute your expectations, your ideals, your acceptance of what you can’t change—and countless other factors. That is, happiness is a state of mind, and as such, can be intentional and strategic.

7 Ways to Get Yourself Unstuck

It’s easy to get in a rut. Maybe you have goals but for some reason you are not reaching for them. Maybe self-judgment is causing you to lower your expectations, or low self-worth is preventing you from making positive changes. You can also get stuck in worry, afraid to make a decision or change something in your life. Or maybe you’re disappointed with how a particular situation turned out, and it just feels too hard to move on.

When we get stuck, we often wait for external change to happen. But change doesn’t happen to us, it comes from within us. Change is scary and painful, but it’s also necessary for getting unstuck. And when that happens, many opportunities open up.

Try these seven strategies when you feel stuck:

1. Let go of the past. 

Listen to the stories in your head. Are you thinking about events that happened in the past? Are you unable to forgive yourself for mistakes you made? Are you blaming yourself or others for things that did not turn out the way you hoped? Ask yourself why you are stuck on these memories, and what you can do to live with them, accept them, and move forward. You can’t undo the past, but you can choose to find peace. Forgivingyourself or others is a way to let go and move on.

2. Change your perspective. 

Once you release the grip of the past, you will see your reality in new ways and feel freer to change your attitude. To gain a new perspective, meditate or spend time alone and listen to your inner voice. If you can, travel or take a break from your daily routine to clear your mind and get distance from your current situation. Open yourself up to new people and ideas, and introduce regular physical activity into your routine. All of these changes will help you gain a new perspective on the future and what is possible.

3. Start with small changes. 

Change stimulates different parts of the brain that improve creativity and clarity of mind. You can start small by changing your daily routines, moving things in your house, or making new friends. Every choice matters. You might be tempted to skip the little things because they don’t always seem important in the moment. But after a while, an accumulation of small changes will help you accomplish your goals, and you will start feeling unstuck.

4. Explore your purpose. 

Your life purpose is not just your job, your responsibilities, or your goals—it’s what makes you feel alive. These are the things you are passionate about and will fight for. Examples of a life purpose could be:

  • Helping people overcome the sadness of being ill.
  • Helping others reach their full potential.
  • Growing as a human being.
  • Protecting animals who suffer.

You may need to change your life purpose if it no longer inspires you. Or, if you feel like you haven’t had a purpose, this is a great time to define it. Ask yourself the following questions as you consider your life purpose:

  • What makes me happy?
  • What were my favorite things to do in the past?
  • What are my favorite things to do now?
  • When do I enjoy myself so much or become so committed to something that I lose track of time?
  • Who inspires me the most, and why?
  • What makes me feel good about myself?
  • What am I good at?

Why Conflict Is Healthy for Relationships

This past weekend my partner and I flew across the country to go house hunting. This is a recipe for disaster, as evidenced by entire cable networks built around this conflict-ridden activity. We spent a lot of the weekend in agreement and then in disagreement, feeling overwhelmed, and then on the edge of our seat waiting to hear back from the sellers on our offer. And of course there was conflict. As a communication professor I know that conflict can be healthy for relationships, yet this doesn’t make conflict any more pleasant when it is happening to me.

A couple days after we arrived home my husband and I were apologizing to each other about our bad behavior (apologizing and owning your mistakes is one key to making conflict healthy instead of unhealthy), and he said something I thought was quite wise, that it is unfortunate that the person we care for and love the most is often the primary recipient of our negative emotions. He is right! Because I spend most of my time with him and feel most comfortable with him, he has to hear about it when I’m feeling stressed at work and deal with my moods even though he is the last person I want to burden with my negativity. Many people cringe at the mere thought of conflict likening it to a tornado, volcanic eruption, or other terrifying natural disaster. Understanding why and how conflict can be useful is the first step to changing our perceptions of conflict.

A large amount of research in the communication field has focused on conflict since it is such an important and unavoidable part of being in a close relationship. Fortunately, that research has determined that conflict can be quite healthy for relationships. Below I describe three things you need to know about conflict in relationships to harness the good that can come from disagreement.

  1. Perhaps the number one reason why conflict is healthy for relationships is that conflict signals a need for change for both parties and provides an opportunity for making change if both partners are up for it. Conflict gives you a chance to work on the problems in your relationship.
  2. Conflict shows you and your partner that your lives are interdependent. If they weren’t, then you would not experience conflict as conflict only comes about when two people whose lives are interdependent hold goals that conflict with one another. For example, my husband and I share a car. This makes us extremely interdependent when it comes to transportation since we have to coordinate who is using the car when. Often on the weekends he wants to head up to the local ski resort to snowboard while I want to stay in town and attend yoga. Conflict ensues. Whose goal or activity is more important? Can either of us get a ride from someone else? This is a simple conflict that isn’t going to tear our relationship apart, but you get the idea. We are interdependent yet our goals and what we choose to do with our time sometimes conflicts.
  3. Conflict is almost never about what it seems to be about on the surface. Your partner not taking the trash out tonight isn’t really why you are mad, it is something deeper. Perhaps you are really upset because his or her actions indicate that s/he doesn’t respect your time and the effort you make to keep the house clean. Searching for the deeper reasons for conflict is an important step to take in improving your relationships, but is not something easily done in the heat in the moment. If you have to, take a beat, and let yourself cool down. We operate much more rationally when we are calm and collected. When we are fired up and angry we tend to say and do things we regret. According to Walter Mischel and his colleagues (2006), we are often running on hot emotions when we are in conflict: we are irrational, reactive, and quick to respond. Later, once we cool down, we can be rational, calm, and level headed. Conflict is a great example of how our thoughts, and then our communication, is influenced by our emotions. When you search for the deeper reasons for conflict you can address core issues in your relationship rather than focusing on surface issues. Addressing those core issues can be a healthy outcome of conflict.  

Is Technology Destroying Happiness?

Alongside the rights to life and liberty, crafters of the United States Declaration of Independence added a third: the pursuit of happiness. Historian Yuval Noah Harari writes that happiness itself is not an inalienable right—the pursuit of it is. Semantics matter. 

In Homo Deus: A Brief History of Tomorrow, Harari picks up where his last book, Sapiens, left off. Happiness is an important theme as it has become one of the most elusive emotional conditions of our era. While Americans often consider it to be a default setting, Harari points out that initially happiness was introduced as a check on state power. 

He writes a society built on the right to make your own decisions in the “private sphere of choice, free from state supervision” was the intention behind Jefferson and crew. Over the last few decades, however, Americans have turned more toward British philosopher Jeremy Bentham’s demand that the sole purpose of the state, financial markets, and science “is to increase global happiness.” 

But we’re not happier. In many ways we’re more distraught than ever. This counterintuitive condition makes no sense of the surface. Harari notes that in ancient agriculture societies 15 percent of deaths were caused by violence; during the twentieth century that number dwindled to 5 percent; and now, over the last seventeen years, we’re at 1 percent, which made him realize, “sugar is now more dangerous than gunpowder.”

Technology alone is not to blame, as in many ways our uneasiness with our condition seems an old trait. The human nervous systems is wired to be on constant alert for threats in the environment. Given how few we encounter on a regular basis, this threat detection system has been co-opted by the luxury of security, causing Harari to realize that:

The most common reaction of the human mind to achievement is not satisfaction, but craving for more.

And we’re good at more. Since the fifteenth century an increasing desire for goods has taken root in societies across the planet. America is usually targeted as the primary driver behind unnecessary purchasing, though history professor Frank Trentmann points out a trifecta of “comfort, cleanliness and convenience” that took root centuries earlier in the Netherlands, Italy, and China, the latter which he calls a “proto-consumer culture.” 

Sub-Concussions: A Threat to Brain Health

In 2002, Jeff Astle passed away at the age of 59 after suffering years of slowly declining mental health. Astle was a professional English soccer player in the 1960s and 70s. Prior to his death, doctors and family members thought he was suffering from early-onset Alzheimer’s disease, but the coroner found a different cause of death – chronic traumatic encephalopathy (CTE). Astle’s death raised many questions. CTE is most commonly associated with high-contact sports, such as football or boxing, where serious head traumas and concussions occur frequently. How could someone without a history of concussions or major head injuries die from a disease like CTE? Nicknamed “The King,” Astle was a prolific player known for his skill at heading the soccer ball. Could years of heading the ball be to blame?

Since 2002, concussions have quickly risen to the forefront of sports research. Gone are the days when a severe blow to the head during a football game could be brushed off as part of the game. With an expanding pool of knowledge and research, concussions are now considered a major public health issue.

But what about cases like Jeff Astle’s? What about when doctors find posthumous brain injuries in people who haven’t had a series of concussions? As more and more professional athletes are diagnosed with neurodegenerative diseases, the long-term consequences of repeated head impacts are becoming clearer.

Recent findings indicate that a newly identified threat, called sub-concussive head impacts, may be doing more damage than previously thought. Researchers are finding positive correlations between CTE and the amount of time spent playing sports with long-term exposure to sub-clinical head trauma. “This indicates that the cumulative head impacts or sub-concussive hits may be more important than concussions” says Peter Kiernan, a research assistant at Boston University’s CTE Center, which performed the definitive studies on CTE.

A doctor can diagnose a concussion based on any number of symptoms that appear as a result of an impact to the head. Symptoms may include headaches, vision problems, balance issues, as well as possible changes in hearing, speech, or smell. Sub-concussions differ in that they do not present any signs or symptoms. Doctors define a sub-concussive impact as any impact or force to the head that does not result in a concussion diagnosis. Yet sub-concussions may have major consequences. Anthony Petraglia, a neurosurgeon at Rochester Regional Health, NY, and expert in sports related neurological injuries says, “This concept of sub-concussion is a significant emerging one that definitely requires thorough consideration.”

Several studies show that athletes at college, high school, and youth levels can sustain anywhere from several hundred to over a thousand head impacts during a single season of football. A 2016 study out of Wake Forest School of Medicine examined structural changes in the brains of 25 youth football players (ages 8-13) following a full season. Researchers performed brain imaging scans prior to the start of season and after the season ended. The scientists kept detailed data measuring both number and severity of head impacts for each individual player. They only measured sub-concussive events; if a player sustained a concussion, the researchers excluded him from the study. At the conclusion of the football season, researchers found a significant relationship between the number and severity of head impacts and structural changes in certain areas of the athletes’ brains. For these participants, stronger and more frequent head impacts corresponded with larger physical brain changes.

New Research on Treating Depression

New research on treatments for depression presents an intriguing finding: a healthy diet may help depressed patients.

It is part of the nascent field of nutritional psychiatry which uses changes in diet to help treat mood disorders. Researchers are always looking for new treatments for depression and other mental-health disorders because many people don’t respond to antidepressant medications and psychological therapies.

The study, published Monday in the journal BMC Medicine, found that a third of patients assigned to a group that followed a modified Mediterranean diet met the criteria for remission in 12 weeks, compared with just 8% in a control group. Remission as assessed by a patient’s score on a diagnostic questionnaire used by psychiatrists to determine the severity of depression.

There is a large body of evidence, both observational studies and animal studies, that links diet to the risk of developing depression and the prevalence of depression, said Felice Jacka, a professor of psychiatric epidemiology and nutritional psychiatry at Deakin University in Australia and senior researcher on the study. Dr. Jacka is also president of the International Society for Nutritional Psychiatry Research.

Psychiatrists cautioned that the study provides no evidence that diet changes could replace traditional treatments for depression; but it could be beneficial as an add-on treatment.

It may also be an impractical prescription: cooking healthy meals requires motivation and planning, a big demand for depressed patients. Depressed patients have difficulty putting plans into action so would likely require assistance, experts said.

“They have this sense of fatigue and inability to get up and go, and any mental effort they feel is overwhelming and exhaustive,” said Robert Shulman, associate chairman of psychiatry at Rush University Medical Center in Chicago.

The study, the first randomized controlled one, consisted of 67 people diagnosed and already being treated for a major depressive disorder. The mean age was 40 and most were overweight.

There Are Two Kinds of Happiness. Getting Outside Boosts Both.

If you’re reading Outside, you’re likely a pusher—someone who runs, climbs, kayaks, hikes, skis, or bikes far more often and intensely than many other people in your life. And while we spend lots of time considering the physical consequences of these endeavors, we don’t spend nearly as much time considering the psychological and spiritual ones. Dating back to the ancient Greek Empire, happiness, or what Aristotle called “an activity of soul…the highest good…the ultimate end,” has been a primary goal for those of us living in the Western world. So we have to ask: Do our active lifestyles make us happy? And are there things we can do to become even happier?

The definition of the word “happiness” has been the subject of a fierce battle in psychological science over the past few decades. It pits eudaimonic happiness, which deals with finding meaning and striving for self-realization, against hedonic happiness, or the attainment of positive emotions and pleasure and the avoidance of pain. But according to Acacia Parks, an associate professor of psychology at Hiram College, in Hiram, Ohio, and chief scientist at Happify, an app that claims to help users increase their happiness and life satisfaction via activities and games, the dichotomy is overdone and often altogether false. “Eudaimonia, or the kind of happiness that comes from doing meaningful things, is inextricably entwined with positive emotions,” Parks says. “How do we know we have done something good? Because it brings us a feeling of satisfaction and contentment.”

This isn’t to say that you have to run ultramarathons or climb mountains to find happiness, but you can’t just sit around eating candy and drinking beer, either. “Many positive emotions are hard won,” says Parks. “It’s not all about seeking out immediate pleasures like snorting cocaine and eating cupcakes. When it comes to enduring happiness, there are no quick fixes that last.”

Centuries ago, Aristotle, in his Nicomachean Ethics, said much the same: “The happy life is thought to be virtuous; a virtuous life requires exertion, and does not consist in amusement.”

5 Physical Ways to Build Mental Strength

The ancient Greeks recognized the connection between the mind and the body. It’s taken a long time for Western medicine to adopt this notion, yet science continues to prove—over and over again—that there’s a strong link between our physical health and our mental health.

If you’re feeling down and you don’t know why, or if you’re worried about your financial situation, “positive thinking” might not be the solution. Sometimes, the best treatment involves doing something different with your body, not just your mind.

As a psychotherapist, I’m fortunate to work in a comprehensive health clinic that provides everything from dental care to podiatry. Working with physicians to treat the entire person is instrumental in addressing patients’ overall health and well-being.

If you’re struggling with psychological distress, there are many ways to treat the problem. Here are five simple ways you can use your body to heal your mind:

1. Walk to reduce depression.

Multiple studies show physical activity can be an effective treatment for mental health problems—and you don’t have to do intense cardio to reap the benefits. Studies show that 200 minutes of walking per week (less than 30 minutes per day) greatly reduces depression and improves quality of life. In fact, some studies show walking can be just as effective as taking an antidepressant.

But it’s not only people with depression who can experience the mental health benefits of walking. Taking regular walks boosts emotional health for people who aren’t depressed as well.

2. Smile to decrease physical pain.

Researchers have discovered there’s some truth behind the old saying, “Grin and bear it.” If you’re in pain, smiling can help you feel the discomfort less intensely. Frowning, on the other hand, can intensify your pain.

Studies show how smiling influences your physical state: A smile can decrease your heart rate during a stressful activity, even if you don’t feel happy. So the next time you’re about to undergo a painful procedure, think about your “happy place,” or a funny joke, and it might not hurt as much.

3. Take deep breaths to improve attention span.

A few minutes of deep breathing can improve your concentration, and counting those breaths can be especially beneficial if you’re a heavy multitasker.

Studies show that people who multitask have trouble taking tests and performing activities that require sustained concentration. Taking a few deep breaths can provide an immediate boost in focus, which can improve performance.

4. Do yoga to reduce stress and the symptoms of PTSD.

Almost anyone who enjoys yoga likely already knows that it can reduce stress. Research shows how yoga increases the level of gamma-aminobutyric acid (GABA)—a neurotransmitter—in the brain. And increased GABA levels may counteract anxiety and other psychiatric conditions.

Wealth is not the answer to happiness

I believe my life will really begin – that I’ll be happy – when the right person, or circumstance, comes along. Ring any bells?

Being happy. The eternal quest is especially pertinent at this time of the year. It’s when we tend to take stock of our selves and lives – with the result that January is divorce month in many nations. Some have named the first working Monday after New Year’s as D Day.

Reasons include giving the relationship one last go over the festive season and deciding it won’t work, budgets bursting the world over as people lose sense and overspend, contemplating whether they are “happy” and concluding they are not.

Money – as expected – is an especially volatile topic this month.

Happy. Take a moment to think what that means to you.

Perhaps you are confusing it with “happyism”: a selfish and consumerist version of happiness.

Happiness comes in various forms. Like hedonic or eudaemonic, and boy are they different. Allow me to introduce you to both:

Here’s the science bit: they engage different parts of the brain, therefore they are very different.

Hedonic: pleasure-oriented. It’s all about “me”. Think of it as individualistic and material.

Eudaemonic: Aristotle would approve. It includes having a sense of purpose, taking on new challenges, growing as a person. It’s all about what I can do and be.

Reading around these issues reminds me of a dear friend. She lacks for nothing, has lots of money, is in the longest, committed, marriage I know, travels extensively, you name it.

But her life is on hold. Not entirely her choosing, but still she yearns for a sense of purpose and the uplift it’ll bring.

She needs eudaemonia in her life. Women who scored high on psychological tests for it weighed less, slept better, and had fewer stress hormones and markers for heart disease than others, including those who had achieved hedonic happiness, according to a study led by Dr Carol Ryff, a professor of psychology at the University of Wisconsin-Madison.

The women who were better off were purposefully engaged in life, and pursued self-development.

Truth be told, I don’t like the word happy. I prefer joy. Think: what brings you joy, what do you enjoy? I’m sure this is an easier ask than “are you happy?”

More importantly, you can imagine, and implement, things that are joyous.

If you actively include them in your life, you’re in a virtuous circle.

This is how someone who gets joy out of poetry could create their nirvana: have poetry books in every room in the house. Join a poetry group that meets once a month.

Go with a friend to poetry readings. Try their hand at writing poetry during their weekend.

It has been proven that actively incorporating and pursuing this sort of joy brings you longer lasting pleasure than say getting a bonus – even though both make you happy to start with.

My eudaemonia-lacking friend started taking flying lessons and loves it. Not everyone has her budget so here’s something you can do for very little: social engagement. The age-old therapeutic act of hanging out with great friends really does do you good.

But none of this will work if you don’t make a key decision: to be happy. It is a choice.

To help you be happy, or happier, I highly recommend you read Hector and the Search for Happiness – read, not watch the movie.