“It’s so hard to meet people,” is a phrase I heard echoed by many last night in the group I led.  It’s such a common frustration, but even more so since the pandemic changed our world of interacting in such profound ways. So as a follow up to my last post about the importance of social support and the risks, both physically and emotionally of loneliness, I thought I would focus this post on what we can do about it.

First, it might be good to take stock of what social supports you do have and what might need strengthening. There are different types of support.  Emotional support is what people think about most often when we think of connection.  It’s the people who listen to you, show empathy, and tell you they care about you.  They check in on you when you are going through a hard time.  Another type of social support is practical help.  These are the people who you can turn to when you need someone to watch your child, help you move a couch, or lend you a tool.  They make the tasks of daily life easier to get through.  Information sharing is another form of social support.  It can be very helpful to have people who can give you resources or share information about how to get something accomplished such as planning an event or looking for a new job.  

Our network of social support ebbs and flows depending on our age and circumstance.  If you went to college, remember how easy it was to find someone to hang out with?  Just step out of your dorm room and there would be plenty of people hanging out in the hallway to chat with.  But now that you’re older, living in the house you always wanted, it may be much harder to have that spontaneous companionship.   People often have to make changes to their support network when they experience important life changes.  Becoming a parent or losing a spouse are often times when people may need to expand their social network to find people who are a good fit for their new circumstances.  A conscious change in lifestyle is another time when we need to renegotiate our relationships.  If you are quitting drinking or smoking, you may need to find people who can support your new choice in behaviors.  Or if you allow yourself the opportunity to take on a new hobby or explore a new identity or value set, you may really benefit from the support of joining like minded people to offer advice, knowledge, or encouragement.

Once you realize the type of support you’re looking for, it helps to have a plan of how you might find it.  The first step in your plan will most likely be getting comfortable with the fact that you will have to take some social risks (ahhhh!).  But you can do it and it gets easier with practice.  Seeking out people and introducing yourself can feel so vulnerable, but it’s much easier if you join a club or get involved in an activity or attend an event where you are more likely to meet people with something in common and a way to talk to them.  Volunteering or taking a class gives you a structure to be around people with a common activity and goal, which should make it easier to strike up that conversation.

You can also reevaluate your current social network.  Sometimes people will give you what you need if you let them know you need it.  We’re often afraid to let people know what we’re feeling, but sharing your vulnerability with others is an important way to build intimacy and understanding.  In addition, be the support for someone else that you would like to have.  We often get into habits and patterns with friendships.  If you offer to help someone move their piano, they will remember your generosity and be more likely to offer help when you need it.  And don’t be afraid to accept help, either.  Allowing someone the good feeling of being there for you deepens friendships.  When reciprocity is mutual, it increases the likelihood that a source of social support will stand the test of time.  This goes for sharing more than just things.  In order to feel accepted by others, we need to give them the chance to know who we really are.  And we need to be accepting of them.  Honesty and authenticity are truly foundations to strengthening our current relationships and feeling accepted and good about ourselves.

A good social network, like any good relationship, takes nurturing.  We can’t expect people to be there for us when we need it if we haven’t kept up our connections.  While it’s so easy to lose touch with people, small gestures can make a big difference.  Remembering someone’s birthday or the anniversary of a difficult date can mean a lot.  And picking up the phone when someone calls or returning an email sends a message that they matter.  Like our health, it helps to get in a routine of eating and exercising.  Taking 15 minutes out of your day to speak to someone or reach out is a powerful use of your time.

And yes, our phones can be a great way to connect, but it has its limits and drawbacks.  While staring at our phones, we miss making eye contact with people and the chance to acknowledge and share in what is happening around us. Having our headphones in sends a message that we’re occupied and don’t want to be bothered with conversation. Take stock in how you’re using your technology.  Is it enhancing positive and deep connection or making you feel less than or more alone?  Are you giving a message to others that you are present and interested or are you looking at your phone out of the corner of your eye while someone is telling you a story?  It’s so easy to be unaware of small gestures that may be adding up to increase our sense of isolation from one another. 

There is no doubt that working to expand our network takes patience and courage.  Research has shown that in the process of using our phones while in public or texting instead of calling, we have actually lost our confidence at being social.  We have grown more intimidated by the possibility of rejection.  In his Surgeon General ‘s Report on the epidemic of loneliness, Dr. Vivek calls on workplaces, schools, technology companies, and community organizations to make changes that will boost the country’s connectedness.  He advocates for setting up environments and activities that increase authentic interpersonal engagement.  But we can do a lot personally just with some important small changes in our daily life.  

One of the biggest tools in the social engagement tool box?  A simple smile.  We are drawn to bond with people who show us that they are friendly and interested in interacting with us.  A smile is like a welcome sign that says you are open and willing to engage.  And besides, smiling actually releases a feel good hormone in your body.  So even if no one smiles back at you, your smile will make you feel better, nonetheless!

“Hello, passengers,” Morgan says in his announcement. “My name is Morgan Calles, and I am 6 years old. I love trains and buses. Today, the M.T.A. is letting me share an important announcement: If you see someone at risk of falling onto the tracks, please get help immediately. Tell a police officer or an M.T.A. employee. Be safe and happy Autism Awareness Month.”

During the entire month of April, New York City subway riders were treated to public service announcements recorded by children with autism.  According to feedback from both subway riders and the children, it was a definite win-win experience.  Children with autism often have a special affinity for trains, intently focusing on the technical aspects of the trains, the schedules and maps, reports Jonathan Trichter, a founder of a school for children with developmental disabilities, who spearheaded the project.  The children were thrilled to hear their voices on the trains. And for the public, well, who wouldn’t crack a smile when hearing the joy in these young people’s voices.  Here, take a listen:

There is something about the authenticity of these announcements that touches me deeply.  The messages gently remind us that our society is made up of a wide variety of people, but that we all belong.  I imagine that subway car, full of people with all kinds of differences, chugging down the track together.  The person across from us may have autism. The person next to us may be homeless.  And the person next to her may have Parkinson’s disease.  We all have our unique identities and experiences, how wonderful it is to feel safe enough to announce it on the loudspeaker? To be offered acceptance, support, respect, and inclusion for being who we really are?

There is a large body of evidence regarding the importance for mental and physical health, as well as longevity, in having good social support.  But what is often overlooked is the key ingredient that makes social support protective.  It’s not just about having a lot of people in your life, or being popular.  In fact, some people have great social support, but only a few friends.  But the essence of social support is acceptance.  Supportive social connections are ones in which you can be vulnerable and authentic.  They’re the people with whom you don’t have to pretend to be someone you’re not or live up to an expectation.  These people give you a positive self image and are people you can ask for help when you need it.  

Recently the US Surgeon General, Dr. Vivek Murthy, put out an advisory titled “Our Epidemic of Loneliness and Isolation.”  In it he outlines the extraordinary costs in health, productivity, education, civic engagement, and more, of an increasing crisis of people struggling with loneliness.  He outlines the need for rebuilding social connection as a top public health priority.  According to research, one out of every two Americans is experiencing measurable levels of loneliness, a rate higher than any time measured before.  Dr. Vivek cites the breakdown of family structures, the decline in religious community involvement, isolating work environments, and increasingly atomized lifestyles as potential causes.  He writes, “and this is a time when so many people feel like we have to be a certain person to build a certain brand, to meet other people’s expectations.  I think to not be able to be who you are takes a real toll on people.”

And that clarifies for me the real public service provided by those young people with autism on the New York City Transit.  Yes, we should keep our arms and legs in the train when the doors close, we should pick up our litter and deposit it in the trash bins, and hold onto the hand rails, it’s true.   But in significant ways, these young voices announce not just the need for physical safety, but the importance of emotional safety.  They remind us of a vulnerability we all have in needing to belong and be accepted just as we are.  Awareness and acceptance are such powerful gifts we can offer someone.  It sets the stage for intimacy and authenticity, weaving our lives together in a resilient reciprocity of giving and receiving.  Maybe we can designate every month as Loneliness Awareness Month? 

Please indulge me a bit with my thinking.  I’ve been so impressed with the breathtaking scenes of this year’s wildflower superblooms, that it opened my eyes to other things that might superbloom in their own way, including people. 

“Superbloom” is a non-technical term that refers to rare episodes of above average wildflower blooms.  According to National Geographic, they happen when seeds that have laid dormant in the soil begin to germinate and blossom all at once.  I love this fact as a great metaphor.  We all have potential inside of us that lays dormant.  We may not have the time, energy, or resources to develop it, or the confidence to express it, but it builds within us, nonetheless, storing up for the right conditions to emerge.  

National Geographic elaborates that superblooms require a few basic ingredients to come to fruition:  months of consistent rain, cool night temperatures, and a well stocked seed bank.  What do people need?  I’m guessing the right combination of social support and mentorship, health, stability, and emotional readiness.  We might also benefit from the structure of a challenge in some form, like a play performance, a deadline for a project, or meeting that special person who inspires you to take a risk.

It makes me smile to think about times in my life I might look back and identify a superbloom period, like getting my doctorate, emerging from heavy grief after my sister’s death, or feeling great contentment in my every day. I can see superbloom episodes for my family, when my brother became a father, and as my children pushed through challenges, whether letting go of the “mean girl” friend or passing a high level exam that had kept them up at night with fears of failure.  Or superblooms for friends as they overcame a devastating divorce or sold a company that they had worked to make successful.  

But like the wildflower superblooms, we have to take time out to appreciate them and step back in awe to gain a full perspective.  And we have to treat the blossoms with care, no stomping or walking all over them for a photo.  Within us, we have to give ourselves permission to acknowledge our progress and celebrate our growth with tenderness.  And for others, we have to show up and “ooh and ahh” to say “I see you blooming” after what most likely required long periods of hard work and resilience.  For just like the wildflowers, human superblooms generally take years in the making. 

I guess the essence of a human superbloom is a period of time when conditions align in just the right way to nurture our inner potential into full expression. And like wildflower superblooms, it’s not a rate of growth we can expect to sustain, as nature and people have their seasons.  But when it happens, you don’t want to miss it, because it is spectacular!

Happy College Graduation, my baby girl!  You’re bloomin’ amazing!

With today being Easter Sunday and having personally just completed the Passover seders this week, I thought it was a good day to highlight the benefits of religion for good mental health.  Research is very clear and consistent that those who are involved in some sort of religious practice are healthier and happier than those who don’t!  Hard to believe?  Well, the good news is, you actually don’t have to be a true believer to be positively impacted.  Just the act of engaging in a religious practice is a process that can bring you a greater sense of peace and life satisfaction.

Overall, research shows that religious practice can help a person tolerate stress and generate a sense of purpose and forgiveness.  Religiosity reduces suicide rates, alcoholism, and drug use.  Large studies by the Pew Research Center show that adults who describe themselves as religious report higher life satisfaction, better family life experience, and are more likely to be engaged in their community.   Considerable research finds positive associations between religiosity and various dimensions of wellbeing, including physical health, mental health, life satisfaction, and happiness.  

The benefits of religion happen on many levels, which is why the results are so powerful.  One big benefit is the sense of community that religion can bring.  By being part of a religious community a person develops a sense of belonging in a group, social connections with other members, and access to reliable and safe social gatherings.  Religion also provides structure that helps with life transitions.  Rituals and ceremonies help people cope with loss as well as celebrate milestones and holidays.  And in doing so, religion provides teachings and guidelines in how to endure in hard circumstances, find moral clarity, and find forgiveness and gratitude.  

But what I found striking in my review of the effects of religion on mental health was how the process of engaging in religious practices of prayer and other ways of connecting to a higher power is much like the scientifically proven practices of mindfulness and cognitive therapy. Religious practice often involves a self reflective process that can lead to a sense of peace and greater awareness.  In a book based on her studies, Stanford anthropologist Tanya Luhrmann writes, “Prayer is a lot like cognitive behavioral therapy.  It’s a way you attend to your own inner experience, let go of distracting thoughts and focus on more positive thoughts.  By expressing gratitude, you shift your attention from the way that things are going wrong to the ways they are going right.”  In her studies, Luhrmann notes that MRI brain imaging indicates that in terms of results, talking to God resembles talking to a friend. Our efforts to connect to God are helpful in putting our thoughts and feelings into words and finding comfort and perspective in sharing them.  

So, for me, it’s easy to doubt my religious beliefs.  Especially when cleaning up all the dishes of the second night of the seders and sweeping up the layers of matzah crumbs, I begin to wonder if it’s worth all the fuss.  But then I look around the room at the people who have come together and the efforts we collectively engage in to  uphold our religious rituals and I feel truly moved.  I feel the thread of connection from the generations before me, now gone, who created these traditions, through the present generation who keep it going, and on to my children and nephews and imagine how they may carry it on in the future.  There is something truly profound in having traditions that connect us to something much bigger than ourselves, whatever religious foundation they may come from, that we share each and every year and with each and every generation.  Whether it’s an Easter egg hunt or a kugel recipe, a prayer or a psalm, the familiar rituals done in community are good for our hearts as well as our souls.  And in general, they are cheaper and easier to find than good therapy!

The weather has been really bleak for much of the season, all across the country.  I know for me, and many other people, it makes the idea of exercise really unappealing.  Going for a walk or even getting to the gym is just hard to do when it’s cold, snowy, or rainy.  Even though I know I won’t melt or get frostbite, it just feels unpleasant and makes the alternative of staying put under a cozy blanket much more appealing.  So when I came across this large new study on the benefits of exercise for mental health, I thought it best to share it as a good source of motivation.  What I like best is that even a small amount of movement was beneficial and equaled or even bettered the effectiveness of standard treatments for common mental health issues.

Scientists in the Department of Health Sciences at the University of Potsdam, Germany, completed a meta analysis review of over 41 studies including 2264 participants.  What was unique about this study was the inclusion of only studies that assigned subjects who scored positively on a depression screening measure to either an exercise or control group of non exercise, which had been a large criticism of past studies on exercise and depression.  What was surprising is not that exercise was beneficial for mental health, but how powerful the effect was.  “We found large, significant results,” said the lead author of the study, Andreas Heissel.  The findings show you don’t have to run marathons or train strenuously to benefit.  “Something is better than nothing.”  The results of the study were so strong, the authors noted the effect of exercise was not only equal to, but sometimes better than, the effects of medication or psychotherapy.  Thus exercise could be included as a front line treatment option for depression without the major obstacles of side effects or access to treatment.

Other studies on the benefits of exercise show positive impacts on other areas of mental health, including reducing symptoms of  ADHD, anxiety, and insomnia.  It also relieves stress, improves memory and people who exercise at least a few times a week report benefits in an overall sense of well being.   There are several reasons why exercise is a powerful tool.  Most significantly it produces changes in brain chemistry, including neural growth, reduced inflammation, and new brain activity patterns that promote a sense of calm.  It also releases endorphins, the powerful feel good chemicals that give you energy and positive feelings.  Physical activity immediately increases the brain’s dopamine, norepinephrine, and serotonin levels, all related to increasing focus and attention.  Plus, exercise can serve as a distraction, allowing you time away from your thoughts and what may be stressing you.  

More recent work in the area of trauma recovery has highlighted the benefits of movement.  Evidence suggests that by focusing on your body and how it feels as you exercise, you can actually help your nervous system become “unstuck” and begin to move out of the immobilization stress response that characterizes PTSD.  Exercise that involves cross body movement and that engages both arms and leg movements (such as walking, swimming, running or dancing) has especially beneficial effects.   When we engage in any cross lateral movement, we encourage one hemisphere of the brain to communicate with the other.  This boosts neural activity across the corpus callosum, increasing neuroplasticity and forming neural pathways.  This corresponds directly to emotional resilience, problem solving, and emotional regulation.

So with all this benefit, why is it hard to get us to move?  Often the very symptoms we are seeking to relieve are the barriers to engagement.  When we are depressed, anxious, or stressed, we lack motivation and the ability to see the potential positives.  Our symptoms paralyze us, keeping us stuck in a loop or doubting our own ability to change.  So often, the first step in engaging people in exercise is helping them find an activity that is more likely to be engaged in and to bring some enjoyment.  This may mean listening to music or a podcast during a walk, joining up with another person or pet, or trying something completely new, like a class at a gym or video on line.  

I’m thinking it also would help to understand the scientific benefit and how the mechanisms of exercise work.  Rather than thinking of exercise as another thing you should do, like cleaning your room or doing the dishes, we can approach exercise as treatment.  Surely these studies suggest that this is an appropriate and viable attitude and conclusion.  If we “dose” ourselves with a walk or bike ride, we may be more willing to stick with it and incorporate it into our day. And in time, we may even look forward to it.  Understanding the science behind taking a pill or going to the doctor motivates us to do it.  The same should be true for exercise.  Even if it’s a dreary day outside, you still need to take your medicine!

I’m a little tired this morning, but happy.  Springing the clocks forward always makes me feel better as the daylight is longer and Spring is just about here.  Like many, though, during the winter, when it’s dark and cold, I tend to accumulate messy piles and disorganized clutter.  The term Spring Cleaning comes to mind as a ritual we use to come out of the winter and lighten our load, both physically and mentally.  Research is clear that household clutter can be both a cause and a result of stress and depression.  So here’s some thoughts on the connection between mental health and clutter and what we can do to get our surroundings under better control.

Videos of cleaning up a “depression room” have been a recent trend on TikTok and YouTube.  The term is so accurate in describing how people experiencing depression often have such fatigue that even simple tasks seem daunting.  Brad Schmidt, a professor at Florida State University, distinguishes this from laziness or hoarding.  People with mental health issues are often “just so mentally and physically exhausted that they don’t feel they have the energy to engage with house cleaning and upkeep that they once had.”  But then a messy home can contribute to feelings of overwhelm, stress, and shame, making them feel worse.

In addition to depression rooms, another recent term that’s become popular because it so accurately describes the clutter/stress connection is a “doom pile.”  Often people who are extremely stressed, have ADHD or other issues that affect executive function, experience decision fatigue.  Clutter begins to accumulate as people become overwhelmed with all of the decisions of what to do with things, so they just leave it to later and things pile up.    

Clutter can impact your physical space by literally making it smaller.  Using precious space for things you “might” need or are not sure what to do with takes away from space that could actually be used in more effective ways.  In addition, the clutter can make it more difficult to find things and leads people to double or triple up on things they already have, adding even more to the amount of stuff they have! Of course, not everyone is affected by clutter in the same way. For example, research shows people with more perfectionistic tendencies are more likely to be bothered by clutter. But all of us, research shows, are vulnerable to the negative effects of clutter on emotional well being. 

Clutter tends to be associated with increased levels of stress.  Our homes should be a place where we can rest and relax, but clutter can interfere with this.  One study found that women who reported more clutter in their homes had higher levels of the stress hormone cortisol throughout the day compared to women with less clutter.  It’s easy to be distracted by clutter and have difficulty focusing.  Our brains only have a limited ability to focus, and so clutter can make it harder to think clearly.  It also can interfere with the ability to accomplish things.  If you have to dig through piles of paper to find something you need, or stacks of laundry to get dressed for an outing, the overwhelm at just getting started can lead to procrastination or avoidance.  And with all of that stress, it is no wonder that a cluttered environment can actually lead to relationship conflict.  The increased stress level combined with the conflicts over one person’s stuff taking up too much space can be a source for ongoing difficulty.  If you don’t feel good about your home environment, you may not invite people over or be stressed when someone wants to come visit.

One aspect of the research I found particularly interesting was the link between clutter and difficulty controlling impulses.  Studies find that people in a cluttered environment tend to adopt an “out of control mind set” that triggers unhealthy behaviors, such as poor eating choices and health behaviors.  Research suggests that it can be more difficult to control your impulses when you are in a chaotic environment.  People who described living in a cluttered environment actually report less overall life satisfaction as they tend to experience a low level of constant frustration in completing tasks and a chronic sense of shame and self criticism.  

Ok, now that I have made the case to declutter, why does it seem so hard? Besides the fatigue in keeping up with daily chores, there are some underlying themes to the psychology of clutter.  One theme is the difficulty in letting go.  Often objects remind us of important things.  We keep clothes that are too small in the hope it will inspire us to lose weight.  We keep travel brochures with the idea that we want to plan a big vacation.  Or things can represent emotional connections we want to hold on to, such as memories of our childhood or of someone we love who is no longer alive.  It’s easy to feel guilty if we get rid of something, especially when it has sentimental value.  Holding on to a possession can bring a sense of security or safety, with the fear that the connection and comfort will be lost if we discard it.

So how do we overcome these emotional and physical hurdles to free ourselves from clutter?  Most experts agree, take it slowly.  The idea of decluttering your entire home can be itself very stressful.  Besides the time it takes, emotionally it is much more complicated than just throwing things away and tidying up.  It can be helpful to set a goal of how much time you will spend on each room of your house (two weeks in your bedroom, one week in the laundry room, etc.).  Divide and conquer.  First start with things that are easy, like taking out dirty dishes, trash or laundry.  Then make four sets of piles: one for things that are easy to discard (like old papers), one for things you definitely want to keep, one for things you will donate, and one for things that you are uncertain about that you can decide later.  Having a friend to help can also help clarify decisions and reduce avoidance.

After you have gone through the sorting through phase, next comes the organization phase.  Lenore Brooks, an interior designer who became an expert at working with people to declutter, encourages her clients to notice the things they always seem to be cleaning up.  Then find better places for them to live, she says.  For example if you’re always finding your pens and papers on your couch, create a little desk area with a pen holder nearby.  Or if you have a lot of dishes that collect in your home office, get a tray to put them on and bring the tray to the kitchen at the end of each day.  KC Davis, author of “How to Keep Your House While Drowning” emphasizes maintaining a liveable space, not a spotless place.  She is a big advocate of what she calls “closing duties” inspired from her time as a waitress.  Develop a closing ritual for each day or activity that sets you up for the next day and helps maintain your decluttered environment on going.

But one of the best things you can do to maintain your decluttered environment is make sure to notice how you feel in your more ordered space.  Emphasizing what you have gained in your new space rather than what you have lost is so important for your well being.  Are you able to appreciate your home more or use all your furniture? Do you feel more at peace?  Is it easier to get started on things you need to do?  Is it fun to think about planning a social gathering rather than a terror?  And most importantly, can you invite your mother over for dinner now?  (Just a random idea…)

Cogito, ergo sum.  “I think, therefore I am” (Descartes, 1637).  But what if I think and think and think, to the point that I feel as if I’m almost not?  Or at least I think to the point of driving myself crazy?  Rumination is what we call it when you get stuck in a mental loop of worry or problems that seem to have no end.  It’s frustrating, hard on your health, and takes the joy out of your day.  Unfortunately, in our stressful world, it is also becoming quite common.  With an epidemic of anxiety taking hold of so many people, rumination is a frequent experience.  So in today’s post, I want to identify the difference between productive thinking about a problem versus rumination and share some expert’s tips on how to free yourself from this unpleasant thought loop de loop.

While rumination is not itself a mental health disorder, it is a symptom often associated with anxiety and or depression.  Examples of rumination include playing an unpleasant conversation over and over again in your mind.  Or when you can’t stop thinking about what went wrong in a presentation at work.  In some ways, rumination is an obsessive thought pattern focused on a negative idea or experience that lacks flexibility or perspective.  While we all worry and overthink, it becomes rumination when these thought loops are frequent, ongoing, and interfere with your ability to concentrate and engage in other thoughts or feelings.  It’s like a car without brakes, going and going without an ability to stop.  In addition, it often involves repetitive thoughts about things that you can no longer change.  In essence, rumination is a continual exposure to a negative experience that keeps reinforcing the negativity.

Certain people are more prone to rumination, research finds.  Women tend to ruminate more than men, as do people who tend to be perfectionistic or insecure (check check, and check…).  And rumination is also common with people with certain health issues, such as people with chronic pain, cancer, or who have suffered a heart attack.  In these cases, it’s understandable to fixate on how things could be different or whether you’ll be ok. For people with mental health conditions such as OCD, anxiety, depression, or bipolar disorder, research shows those who ruminate tend to experience worse depression for longer.

Psychologists offer certain strategies that can be helpful to break the constant stream of your distressing thoughts. The first step is to ask yourself, what is the problem here?  Identify the specific problem and make a list of strategies that you could engage in to improve the situation.  Take the passive experience of reliving a thought or feeling and turn it into an active problem solving activity.  Once you have given consideration to what can be done, let yourself know that you have gotten what you needed out of the repeated thoughts and they are no longer of any use.  Then, when they reoccur,  give yourself permission to let them go by redirecting them. Studies show that when socially anxious people redirect their attention using word games or focused attention on an active thought process, they report feeling more positive about social interactions. Talking to a friend, listening to music or a podcast, or exercising also helped to take the attention away from the rumination and lessen the level of distress. In other words, you have to give your mind something to keep it busy and help it disengage from the ruminative loop.  Reassure yourself it is no longer helpful to keep reminding yourself of what cannot be changed.

Another strategy is to actively avoid your triggers.  Notice when certain rumination is activated and use your mute button, clicker, or block feature to set a boundary.  Often when we scroll through social media or watch a movie or television show, we actually do more harm than good.  We expose ourselves to triggers we don’t have to!  Be careful and conscious in your choice of what you are engaging with.  Studies show that social media can often trigger rumination about our appearances or other social comparisons that can activate anxiety.  We become passive observers of other people’s experiences, which leads to feeling left out or rejected or “less than” in many ways.  We fill in the blanks of what we don’t know with the content of our personal concerns and insecurities.  Pick something uplifting and positive that takes more active engagement, such as playing music, creating in some way, or moving your body.

Sometimes it helps to give yourself worry time.  Designate a period of 10 to 30 minutes to let yourself think about the distressing experience.  This helps to contain your thinking and relieve the pressure.  Adding an active activity such as journaling about the situation can also help to diffuse it.  When the timer stops, you actively let go, but know you will always have tomorrow’s time to think about it, should you desire.

Of course, sometimes the intensity of rumination is too large to be diverted from.  This might be a signal that you may need a higher level of treatment intervention.  Engaging with a therapist to explore your distress may be a good next step, and even a trial of medication can be of help. Serotonin Re-uptake Inhibitors (SSRIs) have been used in a very effective manner to unlock our brains from obsessive thinking and allow us to use other coping tools in managing stress.  Often when people experience trauma, repetitive thinking is a process in which our minds replay what happened in an effort to process the trauma.  Having a supportive and safe environment to explore your experience is helpful to identify what is a beneficial form of remembering versus a reinforcing reliving of helplessness.

Spending time thinking about issues or ideas that are problematic is not in itself unhealthy.  It helps us prepare for a situation we may face again or lead us to make a choice to leave a job or behave in a different manner.  Ultimately it is the quality of our thinking and how it makes us feel that is important to pay attention to.  Having a thought is a natural occurrence.  But a key element in taking care of ourselves is recognizing our power to have a thought and then choose how we how we engage with it.  

Think of your negative thought as spoiled milk.  You take a small sip, experience the unpleasant taste and know it is spoiled.  Would you then keep sipping it to evaluate how spoiled it is while wondering how you could have let it get spoiled and thinking of how you are a terrible person for having spoiled milk in your refrigerator?  Or, would you rather take a sip, experience the unpleasant taste, and choose to go to the store to buy new milk, instead? In other words, maybe we psychologists have a different perspective than old Descartes.  While having a thought may be proof of our existence, how we choose to engage with our thoughts is proof of our humanity?  Now I’m overthinking it.

It’s estimated that 30 to 50 million people around the world will watch today’s Super Bowl game.  Whether your team is playing or not, or whether you even know which teams are playing, we all know it’s the best versus the best in a climactic winner-take-all showdown.  It’s one of the things about sports that most people love to debate and provides the irresistible drama:  Who is best in the clutch and who is likely to choke?  Which team will rise to the occasion and which will fall flat?  It’s so easy to judge and criticize from the sidelines, but I think we all have that moment while watching a player when we ask ourselves “how would I do under that kind of pressure?”  It got me thinking about performance anxiety, and while I will never be expected to throw a touchdown pass with time running out (thank goodness), we all have our own moments in which we have to put our fear aside in order to come through in a challenging moment.

Nearly any situation can trigger performance anxiety, including taking a test in school, giving a presentation to your coworkers, or even parallel parking while people are watching.  Performance anxiety involves performing more poorly than expected given your skill level in the heat of the moment.  Remember those times you studied all night and then your mind went blank the day of the exam?  Or when you complete a tennis serve perfectly most every time in practice but double fault in the match?  In fact, the more you are invested in how you will do in a situation, the more prone you are to having your own worry derail you.  It’s your own fear that disrupts your flow and causes you to hesitate, tense up, or even freeze up all together.  Our thoughts interfere with the way our brain’s have practiced and results in an unexpected outcome.

Normally during a highly practiced performance, brain activity in the prefrontal cortex, which is important for decision making and attention, is suppressed.  This allows the brain circuits responsible for routine and intuitive responding to engage without interruption.   But when we become anxious about how we’ll do, the prefrontal cortex activates and actually causes disruptions that lead to errors, especially in activities that require quick reactions and a flow of engagement, like making music or throwing a free throw.  In other words, as soon as we begin to think about the possibility of failure, our bodies tense and our mind goes into a different mode of operating, literally, our brain gets in the way of our practiced flow.  Emotionally, we move from approaching success to a state of avoiding failure.  Thinking about a potential mistake causes a change in your brain processing that is disruptive and actually makes it more likely that you will make a mistake.

Even if we’re not in the NFL, we can all benefit from what sport’s psychologists teach competitive athletes. Learning to manage your anxiety is a key to performing well in whatever challenges you. The first step is to embrace and befriend your nerves.  When we feel anxious we have the opportunity to interpret the anxiety in different ways. Top athletes can remind themselves that the tension they feel is the thrill of competition and focus their stress into heightened awareness and focus.  When they make a mistake, they put it behind them and move on to the next play with an anticipation of success. For us mere mortals, we can remind ourselves that the sweaty palms we experience prior to our presentation is a sign we are excited and ready.  It’s important to catch ourselves from predicting or anticipating failure.  Imagining and allowing our minds to play out the possible paths to potential problems will only take our focus in that direction and away from our practiced flow.  Dwelling on a mistake will only increase the chance of making another mistake.

Researchers show that distracting ourselves away from details of our performance can help us stave off the interference of our prefrontal cortex.  For example, rather than imagining someone asking us a question we can’t answer, we can look at the wallpaper in the room or what dessert we’ll choose to celebrate our good performance.  It’s also really helpful to practice under similar conditions as the stress we’ll feel on the day of our performance.  If we’re worried about performing in front of an audience, give our speech in front of some friends.  If we’re going to be videotaped, practice being videotaped.  Learning to normalize the stress of the situation to desensitize ourself is quite beneficial.  The more success we have in coping with the stress, the less our avoidance mindset will be triggered to derail us.

So when you watch the game today, remember what it takes for any of the players to have reached this moment and celebrate their effort.  Imagine both the physical and mental toughness they have already demonstrated to compete to be a champion.  And as one who grew up with a family that yelled at the tv when our team dropped a ball or missed a tackle, while safely eating our chips on the couch, I remember the wise words of my Grandmother Rose.  “Darling,” she would say, “don’t be upset.  They’re doing the best that they can.”

What if I told you that I had something that could make you happier, healthier, and even feel more connected to people?  And what if I told you it had zero side effects and was absolutely free?  Too good to be true?  Actually, not!  In fact, it’s pretty awesome!  Literally.  The complex and mysterious emotion known as “awe” has recently been given more attention and a growing body of literature supports what mystics and philosophers have known for generations.  Experiencing awe has a magical effect of making us feel simultaneously both humble, compared to something that is vast and transcendent, and more connected, in a way that makes us more generous and open hearted.  

Selfishly, I am moved to write about awe after having been to Death Valley this past weekend.  For me, it was like the Disneyland of natural wonder.  I walked on a basin of salt, climbed and ran down sand dunes (giggling like a kid), hiked to the base of rainbow and red rock canyons, and viewed the bright starscape enveloped in a very dark night sky. I was so overdosed with awe that it felt like a drug I want to keep taking!  What struck me most was the intense experience of simultaneously recognizing both my absolute insignificance and my complete uniqueness.  I felt insignificant compared to the tremendous forces and time that created these monuments of nature and completely special in how lucky I was to be alive and to have the gift of the ability, with my senses and human capacities, to take in the beauty.

Fortunately, research shows you don’t have to travel to natural wonders to experience awe.  You can find it in watching the birds in our backyard, listening to a great piece of music, or taking in a moving piece of artwork.  Some research shows that watching awe inspiring videos or reading a story can elicit our sense of awe with all its benefits.  In fact, there was a direct correlation in most studies between the level of awe reportedly evoked in a subject and the amount of improvement in stress reduction and well being.  Overall, research shows that people who reported more “wonder and sense of amazement” had lower levels of inflammation (linked to chronic disease).  

One of the most profound effects of awe is how it can change our perspective.  Awe can lead to what is referred to as the “smaller self” effect.  We literally perceive ourselves as smaller in relation to the rest of the world.  Awed people are able to see the balance of strengths and weaknesses within themselves more clearly and, in addition, to recognize how outside forces contributed to their successes.  In other words, awe brought a sense of humility and a less self centered point of view.  This may be why people who experience awe are more likely to offer help or be more generous.  

Too busy to take the time to experience awe?  Awe can even help with that!  Several studies have found that awe tends to expand our perception of time.  Study participants who were induced to feel awe agreed more strongly with statements suggesting that time was plentiful and expansive compared to control subjects induced to feel general happiness.  I know, personally, standing next to layers of striated rock that took millions of years to form certainly made me feel time on a much grander scale.  Feeling rushed felt kind of silly, noting that my entire lifetime was represented by less than a millimeter of rock in the immense wall I was standing next to.  

Finding awe can be a daily practice, fortunately.  Most practitioners who study or work in fields promoting awe explain that awe can be a matter of attitude.  When we look for it there are awe inducing phenomena all around us.  Taking an awe walk, for example, can lead to hearing or seeing things in a  different way.  Just by looking up at tall trees has been shown to induce awe!  Or you can read awe inspiring stories or watch awe inspiring videos on the internet.  Even watching a talented performer or athlete can evoke awe or having thoughts about someone you love.  The good feelings will be well worth the effort. And as far as I know, there are no rehab centers for awe junkies.  The high you experience is totally natural and is not illegal in any states I know of, yet. 

Most of us have heard of the placebo effect, yes?  In medical studies, a group of participants known as the “control group” will be given a sham treatment, often a sugar pill, that they believe is the real treatment. As a result of believing the pill is real, participants will sometimes have positive results such as feeling better or improvement in their symptoms (there are often real chemical or physical changes involved).  In other words, the expectation that they are getting helpful treatment has an actual beneficial effect!  Pretty cool, right? But in today’s post, I want to introduce you to its less known counterpart, the “nocebo effect,” as it likely is also having an effect on you, and may actually be making uncomfortable situations more uncomfortable.

The nocebo effect happens when a person’s negative expectations of treatment lead to negative side effects.  Where the placebo effect makes a person feel better beyond the actual therapeutic effects of a treatment, the nocebo effect causes people to feel worse.  Most often the nocebo effect involves mild symptoms that are noted to be common side effects of a given treatment, such as headache, dizziness, or nausea and vary significantly between individuals.  But it has been known to cause people to drop out of studies and clinical trials or decline treatment that may be helpful.  For example, in fibromyalgia studies on treatments, as many as eleven percent of people drop out of studies because of debilitating side effects from the equivalent of sugar pills.  Research also suggests that the cost of treatment can influence perceptions of how effective it is and that how doctors or nurses talk about the effects of treatment, such as expressing uncertainty or emphasizing the negative, can have a large effect on a patient’s responses.  Patients warned that a procedure might cause pain were much more likely to report higher levels of pain.

In 2007, a case study in General Hospital Psychiatry (a journal, not a soap) highlighted how powerful the nocebo effect can be.  A 26 year old man enrolled in a study of antidepressant medication. For the first month of the trial he reported improvements in his mood and functioning.  But after an argument with his girlfriend, he took all 29 of the capsules left in the bottle in a suicide attempt.  He went to the emergency room asking for help. ER doctors noted he was pale with heavy sweating, his blood pressure was abnormally low, his pulse was elevated and despite receiving intravenous fluids over four hours, remained sluggish and his heart rate remained abnormal.  At this point a researcher from the trial came to the hospital revealing that the man had received the placebo, or the inert substance.  Within 15 minutes of receiving the news, he was alert, revived, and his blood pressure and heart rate had both returned to normal. In another notable example, after a rumored toxic leak in Japan the hospitals were flooded with patients experiencing nausea, headaches, and dizziness. Investigators found no evidence of a leak and the patients fortunately quickly returned to normal.

Research shows that most of us experience the nocebo effect in some form or another.  One of the biggest predictors of the nocebo effect is “social modeling,” or hearing that other people are reporting the problem.  Which leads to a dilemma for us internet prowlers who scour the web for information about our symptoms and possible treatments.  We may be actually planting seeds of negative outcomes when we read about people who have negative experiences with a treatment we are thinking of trying.  And for doctors, it can lead to a conflict, as the ethical thing to do is to inform patients of all the possible negative side effects that can be a result of a course of treatment (those commercials with the crazy side effects that make you think, “who would take this drug”).  

Like most phenomena, being aware of it is the best antidote.  Especially helpful, according to research, is for doctors to be aware of how they present information to their patients.  Medical staff need to be careful of the wording used  to describe potential side effects and concerns of a treatment, making sure to present the positives.  Instructing patients on how to look for the potential improvements may be a way to balance the expectations. 

Even if your provider is not the bright-side-of-life type of person, we can be mindful of our own expectations.  And in a much broader sense, we can ask ourselves in how many other areas of our life do we influence our experience by our expectations?  From the movie we see, to the restaurant we try, to the new neighbor we greet, whatever we encounter, our positive or negative expectations will shape our experience.  We then need to ask ourselves what type of individual do we want to be – a placebo or a nocebo kind of person?