SCIENCE BEHIND HAPPINESS

December 13, 2019 Paul Longobardi

It is the holiday season, a time for happiness. But what is happiness and is there a science of happiness? Later this week, I will be holding a webinar on this topic on Friday, 12/13/19 at 5 PM PST. For information about the webinar and registration for it, please go to https://royaltygroup.synduit.com/TCWL0004. For now, let’s go over some information. While there are many different definitions of happiness, I will use the following: “Happiness is the appreciation of life, moments of pleasure, but overall it has to do with the positive experience of emotions”. What would make you happy? I, like many others, think winning the lottery would do it. However, research by Dan Gilbert found that after one year of living with change, lottery winners compared to quadriplegic patients leveled out at the same level of happiness. This may be related to how our frontal lobe (prefrontal cortex specifically) helps us generate two types of happiness. One is natural happiness when we get something we want. The other is synthetic happiness or what we make when we don’t get what we wanted. It is possible to create your own happiness despite the common belief that only positive things make us happy.

So, a happy life is not always about getting what you want. It is about learning to enjoy what you get. Natural happiness primarily relies on external factors whereas synthetic happiness primarily relies on internal factors. Synthetic happiness can be a more long term, stable form of happiness than natural happiness.

Chemicals in the brain play a role in happiness. These include Serotonin, Dopamine, and Oxytocin. We can increase these through such activities as focusing on positive memories, exercise, setting and completing goals, and receiving more physical contact.

However, there are other practices associated with happiness in scientific study. One of the clearest findings, per studies at Harvard under Robert Waldinger, is that good relationships keep us healthier and happier. They protect our bodies and brains as well. How can you develop deeper relationships in your life?

Yet another way to foster a happier disposition is to practice gratitude. People who regularly practice gratitude report experiencing more joy, pleasure, optimism, happiness, and higher levels of positive emotions. Consider using a gratitude journal, I use this often with my patients. Practice the motions of smiling and saying thank you. Use prayers of gratitude if it fits with your spiritual traditions.

Another path toward happiness is to practice mindfulness. This practice warrants its own book. It is defined as a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations. Research has shown that those who practice mindfulness regularly are happier because their thoughts are not consumed by fears of things to come, controlling future situations, or analyzing circumstances that have passed.

One of my favorite paths toward happiness is to connect with nature. Research is growing on the connection that nature makes us healthier and happier people. Nature teaches us that there is nothing wrong with us. In nature, time slows down and urgency and deadlines melt away while we surrender control and reinforce acceptance. When were you last in nature?

Research also has shown that possessing wealth and material goods does not lead to happiness, giving them away actually does. Studies of people who practice giving, donating, and volunteering show that they have better psychological, mental, and increased longevity.

So, if you would like to be more happy, consider some or all of the following:

Savor the moment

Take control of your time

Act happy

Exercise and make time for sleep

Give time and attention to close relationships

Be mindful

Spend more time in nature

Express gratitude

Give more

The key to happiness is knowing you have the power to choose what to accept and what to let go. As I always say, stress is a choice but so is happiness. May you choose happiness and not stress. For information about stress management, please see our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.) available on Amazon at https://www.amazon.com/dp/1542458056. For details about the book, authors, and other stress related information, please see our website at www.manageyourhealthandstress.com.

Good luck on your journey.

Dr. Paul Longobardi

For information on these and related topics, please visit my website at www.successandmindset.com

SCIENCE BEHIND HAPPINESS

December 12, 2019 Paul Longobardi

So, if you would like to be more happy, consider some or all of the following:

Savor the moment

Take control of your time

Act happy

Exercise and make time for sleep

Give time and attention to close relationships

Be mindful

Spend more time in nature

Express gratitude

Give more

Good luck on your journey.

Dr. Paul Longobardi

For information on these and related topics, please visit my website at www.successandmindset.com

SCIENCE BEHIND HAPPINESS

December 11, 2019 Paul Longobardi

So, if you would like to be more happy, consider some or all of the following:

Savor the moment

Take control of your time

Act happy

Exercise and make time for sleep

Give time and attention to close relationships

Be mindful

Spend more time in nature

Express gratitude

Give more

Good luck on your journey.

Dr. Paul Longobardi

For information on these and related topics, please visit my website at www.successandmindset.com

SCIENCE BEHIND HAPPINESS

December 10, 2019 Paul Longobardi

So, if you would like to be more happy, consider some or all of the following:

Savor the moment

Take control of your time

Act happy

Exercise and make time for sleep

Give time and attention to close relationships

Be mindful

Spend more time in nature

Express gratitude

Give more

Good luck on your journey.

Dr. Paul Longobardi

For information on these and related topics, please visit my website at www.successandmindset.com

HOW CAN YOU AND YOUR CHILDREN BETTER MANAGE STRESS AND DIABETES?

December 4, 2019 Paul Longobardi

We have just completed Diabetes Awareness Month but the challenges of managing stress and diabetes continue for parents and their children. In the United States, 29.1 million people are living with diagnosed or undiagnosed diabetes, and about 208,000 people younger than 20 years are living with diagnosed diabetes according to the New England Journal of Medicine. We know that childhood/youth diabetes is on the rise. What is less well know is that there are research finding supporting the conclusion that poor management of life’s stressors exacerbates the diabetic condition. The co-occurrence of depression and diabetes is statistically significant across multiple studies (see post for 11/27/19 last week). We all need to be more aware of the risks for diabetes and the need to stay aware of healthy living to either avoid developing the disorder or manage it better if you already are so diagnosed. If you want to take a short self-assessment as to your risks, you can go to diabetes.org/alertday. In our book on stress management (I Can't Take It Anymore: How to Manage Stress so It Doesn't Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056, we discussed stress management tips/strategies to help better manage your diabetic condition. For more information about the book, authors, and stress, please visit our website at www.manageyourhealthandstress.com. These tips/strategies include the following:

1. Change stress producing situations, when possible. For example, it is well known that people reduce stress to the extent that they manage their time well and don’t let themselves overcommit and become overwhelmed by events. If you improve your organization skills and learn problem-solving skills, you reduce your likelihood of allowing yourself to become excessively stressed and then worsening your diabetic condition.

2. Initiate relaxation procedures. You can try yoga, meditation, mindfulness, deep breathing, or progressive muscle relaxation (PMR). Our favorite is PMR, in which you practice tensing and relaxing major muscle groups in sequence while combining pleasant visual imagery and proper breathing. In fact, a study published in the journal Diabetes Care showed that just five weekly sessions of a relaxation therapy can reduce blood sugar levels significantly.

3. Learn about cognitive behavior therapy (CBT) and its benefits. In addition to learning to relax, CBT assists you in evaluating your problematic, catastrophizing, and often overgeneralized thoughts leading you to feel tense, frustrated, and upset. You can learn to react differently to the challenging events in your life through re-evaluating your thoughts and thus your emotions. As we always say, "Change your thoughts and change your results".

4. Use your social support network. Talk to a trusted friend or confidante about your concerns. Talking about problems can help lessen the stress associated with them. Don't have a social support network? Maybe this is a good time to develop one. Also, you can speak with your spiritual leader or other members at your place of worship. If nothing is working, consider talking with a mental health professional.

5. Maintain healthy eating, sleep, and exercise routines. Exercise can help lower blood sugar, so a stressful phase is not the time to stop your program. Exercises in groups, e.g. aerobics, water aerobics, dance or yoga classes could be a lot of fun and help maintain accountability and comraderie.

6. Develop relaxing routines, such as starting a hobby, taking walks, or joining a class you like. You can attend pleasant activities such as the theater and movies. These activities will contribute to a more pleasant outlook on life as well.

7. If the above still is not working, know that there are antianxiety medications available which may help. You may need the medication for the short term only as some of the medications have addictive potential. See your medical care provider.

It is very clear that diabetes is a condition possibly initiated by but at least worsened by the presence of stress. The areas of glycemic control and self-care management both are negatively impacted by stressors. It is important that you and your children take control of your health and one way to do this is by managing effectively the stresses in your life.

Good luck on your journey.

Dr. Paul Longobardi

For additional information on these and other topics, please see my website at www.successandmindset.com

DOES STRESS WORSEN DIABETES AND DEPRESSION?

November 27, 2019 Paul Longobardi

We still are in Diabetes Awareness Month and facing Thanksgiving challenges to our diets, pertinent to persons with diabetes and pre-diabetes. At the same time, we are entering the holiday season in which depression increases in vulnerable individuals. About 23.5 million Americans nationwide have diabetes, and about 14.8 million Americans have major depressive disorder in a given year, according to research statistics. However, matters soon may be getting worse. Estimates are that 55% of adults in California have either diabetes or pre-diabetes. That's up to 13 million adults in the state (2.5 million with diabetes, the rest pre-diabetic).

It has been known that a comorbidity, or co-occurrence, occurs between depression and diabetes. Some estimates have been that up to 30% of individuals with Type 2 diabetes have a diagnosable depressive disorder (Katon, Maj, & Santorius, 2010). In a study in the Annals of Internal Medicine in 2010, Dr. Frank Hu observed that depression increased the risk for diabetes, and diabetes increased the risk for depression. Women who were depressed were 17% more likely to develop diabetes even after the researchers adjusted for other risk factors such as weight and lack of regular exercise. Women who were taking antidepressants were 25% more likely to develop diabetes than their counterparts who were not depressed.

In the same study, women with diabetes were 29% more likely to develop depression after taking into account other depression risk factors. Women who took insulin for their diabetes were 53% more likely to develop depression during the 10-year study.

Certain factors such as physical activity and body mass index may partially explain the link between depression and diabetes. However, they do not completely explain the connection.

I agree with the research conclusions that the common denominator may be stress. I have written frequently about the role of stress in the initiation or exacerbation of multiple medical conditions to include diabetes. In our book on stress management (I Can't Take It Anymore: How to Manage Stress so It Doesn't Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), we discussed depression and diabetes in detail. The book is available on Amazon at https://www.amazon.com/dp/1542458056. For more information on the book and authors, please visit our website at www.manageyourhealthandstress.com.

People who are depressed have elevated levels of stress hormones such as cortisol. Elevated levels of cortisol can lead to problems with glucose or blood sugar metabolism, increased insulin resistance, and the accumulation of belly fat. These all have been noted as diabetes risk factors. Now if you develop Type 2 diabetes and have not been identified as depressed, you still are faced with the stressors associated with diabetes management such as blood sugar control and treatment for complications. This can lead to decreased quality of life and increased probability of depression. Research studies have shown that depression leads to poorer physical and mental functioning, so a person is less likely to follow a required diet or medication plan. Over time, thoughts may become more depressive such as "I'll never be healthy again"; "Why did this happen to me?"; "I'll never be happy again". These thoughts can lead you into a spiral of depression and worsen diabetic management. Treating depression with psychotherapy, medication, or a combination of these treatments can improve a patient’s ability to manage diabetes.

But what about the issue of pre-diabetics raised in the first paragraph? Do you know your status and that of your loved ones? Perhaps you indeed are pre-diabetic yourself. Symptoms of diabetes include: 1. Being very thirsty; 2. Urinating frequently; 3. Blurry vision; 4. Being irritable; 5. Tingling or numbness in your hands or feet; 6. Feeling worn out; 7. Wounds that don't heal; 8. Yeast infections that keep coming back.

Have you had a depression screening or think you may be depressed? Symptoms include:
1. No longer finding pleasure in activities that you once enjoyed; 2. Insomnia or sleeping too much; 3. Loss of appetite or binge eating; 4. Inability to concentrate; 5. Feeling lethargic; 6. Feeling anxious or nervous all the time; 7. Feeling isolated and alone; 8. Feeling sadness in the morning; 9. Feeling that you "never do anything right"; 10. Having suicidal thoughts. If you experience four or more of these symptoms for up to two weeks, please consult your primary care provider or a mental health professional. If you have suicidal thoughts, please see a professional immediately.

There is excellent care available but you have to take the first steps. As noted, evaluate your stressors in life, be aware of your mindset and the possibly depressing thoughts and limiting beliefs you tell yourself, and consult information and experts on diabetes management.

Again, your good physical and mental health are the results of choices you make. Stress is a choice. Don't make it yours. Good luck on your health journey.

Dr. Paul Longobardi

For information on these and related topics please see my website at www.successandmindset.com

HOW DOES STRESS AFFECT DIABETES?

November 20, 2019 Paul Longobardi

We are in November, National Diabetes Awareness Month. Do you or a loved one have diabetes? If so, you know that this is a disorder that causes blood glucose (sugar) levels to rise higher than normal. This is also called hyperglycemia. Type 2 diabetes is the most common form of diabetes. Also, you likely know that your body doesn't use insulin properly. Over time, your pancreas can't keep up making the extra insulin needed to process the high levels of glucose. The prevalence, or number of people with the disorder, was 29.1 million Americans in 2012, or 9.3% of the population. The incidence of diabetes is increasing and this clearly is a major medical problem across our country. Medical complications can include stroke, heart disease, kidney problems, foot ulcers, blindness, and peripheral neuropathy (lessened sensation in the feet), among others.

If you have type 2 diabetes, you know that certain foods — particularly foods that are high in carbohydrates — can greatly elevate your blood glucose (sugar) levels. However, you likely are less aware that there are numerous stress related factors, e.g. chronic work and relationship problems, reduced sleep, chronic illness, that can interfere with the ability to maintain proper blood sugar levels. According to the American Diabetes Association (ADA), emotional stress can cause blood sugar to elevate significantly. As blood sugar control is the key to successful management of Type 2 diabetes, it’s worth knowing how stress affects you and to find coping strategies to deal with your stressors.

So how does stress affect your blood sugar level? When you are under stress, stress hormones like epinephrine and cortisol are activated since one of their major functions is to raise blood sugar to help boost energy when it's needed most. Think of the fight-or-flight response. If you are confronted with a life threatening danger, you need your blood sugar level higher to handle the danger. If you are not diabetic, you have compensatory mechanisms to keep blood sugar from getting out of control. However, if you are diabetic you don't have enough insulin to keep the blood sugar at a proper level. Over time, you become at risk for the negative medical outcomes noted above. Emotionally upsetting events like relationship breakups or significant work difficulties place physical stress on your body. If you have diabetes, you are at risk to have elevated blood sugar levels. It even has been shown that some "happy" events can be stressing enough in a positive sense to effect the same problematic elevations of blood sugar levels.

It's possible to make the problem worse because, when under stress, you may sleep less, exercise less, and eat less well. You may eat unhealthfully, i.e. junk food or comfort food like candy or chips. Since exercise helps to lower blood sugar, reducing this activity under stress can make the problem worse. We discuss all aspects of the relationship between stress and diabetes in our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056. You can learn more about the authors, book, and stress by visiting our website at www.manageyourhealthandstress.com.

But for now, what can you do to reduce your level of stress in the service of managing your diabetes? One of the major strategies on which most experts agree is to help yourself become more aware of your stress level and how you feel when you are under stress. Often we fail to recognize the daily stressors such as busy times at work or holiday activities which may alter the blood sugar level. If you can begin to record stress levels and events at the time you take blood sugar levels, you soon will establish a helpful level of self-monitoring. You will be more aware of your stressors and take some action as well as recognize the need to adjust your medication if you are taking it.

Here are a few other stress reducing strategies to help you better manage your diabetic condition:

1. Initiate relaxation procedures. You can try yoga, meditation, mindfulness, deep breathing, or progressive muscle relaxation (PMR), about which I've written in other posts. My favorite is PMR, in which you practice tensing and relaxing major muscle groups in sequence while combining pleasant visual imagery and proper breathing. In fact, a study published in the journal Diabetes Care showed that just five weekly sessions of a relaxation therapy can reduce blood sugar levels significantly.

2. Learn cognitive behavior therapy (CBT). In addition to learning to relax, CBT assists you in evaluating your problematic, catastrophizing, and often overgeneralized thoughts leading you to feel tense, frustrated, and upset. You can learn to react differently to the challenging events in your life through re-evaluating your thoughts and thus your emotions. As I always say, "Change your thoughts and change your results".

3. Use your social support network. Talk to a trusted friend or confidante about your concerns. Talking about problems can help lessen the stress associated with them. Don't have a social support network? Maybe this is a good time to develop one, you might see my posts on this topic as well. If nothing is working, consider talking with a mental health professional.

4. Maintain healthy eating, sleep, and exercise routines. As mentioned earlier, exercise can help lower blood sugar, so a stressful phase is not the time to stop your program.

5. Develop relaxing routines, such as starting a hobby, taking walks, or joining a class you like.

6. If the above still is not working, know that there are antianxiety medications available which may help. See your medical care provider.

Diabetes is a serious medical condition. Managing your emotional stressors is a key part of keeping the condition in check. Your reaction to the stressors of life is a choice. Make it a healthy one.

Good luck on your journey.

Dr. Paul Longobardi

For more information on these and related topics, please visit my website at www.successandmindset.com

TRANSITION STRESS AND VETERANS

November 13, 2019 Paul Longobardi

As a veteran and a psychologist on Veterans Day, I was thinking about what to write about veterans. I have written in the past on multiple occasions about post-traumatic stress disorder (PTSD) and treat individuals suffering from PTSD in my practice. Then I came across an interesting article by James Clark from 2018 titled “For most vets PTSD isn’t the problem, transition stress is. Here’s what that means”. The author contends that while PTSD has become a much-discussed affliction, a seemingly more prevalent problem of transition stress is going largely overlooked. For a complete discussion of stress and its influence in our lives, please read our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056. For information about the book, authors, and stress, please visit our website at www.manageyourhealthandstress.com.

Now don’t get me wrong, I’m not minimizing the seriousness of the PTSD issue for many veterans. Yet, Clark’s article is based on an essay titled “Beyond war and PTSD: The crucial role of transition stress in the lives of military veterans”, by George A. Bonanno, a professor of clinical psychology at Columbia Teachers College, and Meaghan Mobbs, a PhD student at the college and a former Army officer. In that article, the authors contend that though only a relatively small percentage of recent veterans develop PTSD — somewhere between 11% and 20% for Iraq and Afghanistan War-era veterans in a given year — the disproportionate attention given to PTSD overshadows a more pervasive problem among vets. That is transition stress.

The problem all too often is that the veteran serves, whether in war or peace, and then returns to a situation with less sense of meaning, purpose, and fulfillment in their life. The military service has provided the purpose of a mission repeated and reinforced in many ways. There is clarity where you fit in the hierarchy, camaraderie, and shared experiences. I know I used to say when I got out of the military that it war harder to know the ranks of individuals in civilian organizations, sometimes contributing to less clarity of mission and vision.

The authors described transition stress as encompassing a number of issues facing transitioning military veterans, which can lead to anxiety, depression, and other behavioral difficulties. They include a loss of purpose and sense of identity, difficulties securing employment, conflicted relationships with family and friends, and other general challenges adapting to post-military life. Veterans easily can lose their sense of self, purpose, and meaning formerly provided by the military.

Further, they face challenges in re-entry into society exacerbated by what the authors call the civilian-military divide and the broken vet stereotype. The civilian-military divide refers to the increasing tendency for the all volunteer military to have become more insular so that most Americans have no idea what service, wartime or otherwise, looks like. The broken vet stereotype refers to the misperception of many civilians. A 2016 survey by Military Times found that roughly 40% of civilians think half of all post-9/11 veterans — that would be roughly 1.4 million Americans — have a mental health disorder. Veterans are aware of that perception and, to acknowledge their stress and difficulties, they often devolve to report they have PTSD and become even more stigmatized and stereotyped. The authors reported that maximal focus is on training and retraining military members but minimal focus is on helping veterans prepare for transition back to civilian life.

I was struck with this analysis for several reasons. I find in my work with clients that their lack of purpose and meaning often contributes to an existential vacuum into which despair, malaise, and many other problems fill the void. Also, the issues of transition reminded me of what I and my colleague Dr. Tony Strickland wrote about in discussing the transitions of professional athletes out of the sport. In our article titled “Is there life after sports?” in Professional Sports LIves Magazine in 2016 (Volume 5, Issue 2) we discussed several issues likely pertinent to transitioning veterans. These include their range of social support, the strength of their athlete (military) identity, and the strength of their identity outside of athletics (military). Does the military member have a life outside of the military with non-military persons? Have they made early preparations for life after sport (military)? Bonanno and Mobbs recommended that a mentorship program be initiated that would help the veteran transition back into civilian life just to help with the daily things of life and understanding the transition process. Some of the difficult things are just reintegrating with friends and families and managing those relationships. We need to do more for our veterans.

I wish a Happy Veterans Day to all. For those who have served, thanks for your service. For those in transition, be kind and patient with yourselves and seek out help. Best wishes on your journey.

Dr. Paul Longobardi

For information on these and related topics, please visit my website at www.successandmindset.com

CHILDREN COPING WITH ANXIETIES AND FEARS OVER THE WILDFIRES

November 6, 2019 Paul Longobardi

As all Californians and most of the nation knows, there has been an outbreak of wildfires during the last two weeks. These events have dominated the news. Focus has been on the courageous first responders and provision of aid to those affected. But what about the psychological consequences of such disasters? In a Los Angeles Times article for October 30, 2019, authors Sonali Kohli and Nina Agrawal wrote on “Fires heighten kids’ fears”, noting how the fires are taking a toll on students’ mental health

We know that natural disasters such as hurricanes, earthquakes, and wildfires are typically unexpected, sudden and overwhelming. For many children, there are no outwardly visible signs of physical injury, but there can be nonetheless an emotional effect. It is common for people who have experienced disaster to have strong emotional reactions.

We know that in the initial weeks after a natural disaster, many people experience distress, including anxiety, disturbing memories, sleep disturbance, nightmares, and restlessness. This is very common and is an understandable reaction to stress. Emotional reactions can be worse for children who also struggle with issues of social media, immigration issues, and the fear of school shootings. We also know that most mental health problems typically reduce over time as people get over the initial distress. However, there is usually a significant minority who will have persistent problems and whose problems may actually worsen. Often, this occurs because their coping resources have been worn down by the ongoing stressors involved in slowness of rebuilding their lives, watching their parents suffer, relocation, and financial challenges. Routines are disrupted. In fact, it is not uncommon for persistent stress reactions to come from the more ongoing long-term effects of disasters.

What are common psychological reactions to such disasters? The American Psychological Association has listed the following after the initial reactions subside:

Intense or unpredictable feelings. You may be anxious, nervous, overwhelmed, or grief stricken. You also may be more irritable or moody than usual.

Changes to thoughts and behavior patterns. You might have repeated and vivid memories of the event. It may be difficult to concentrate or make decisions. Sleep and eating patterns also can be disrupted — some people may overeat and oversleep, while others experience a loss of sleep and loss of appetite

Sensitivity to environmental factors. Sirens, loud noises, burning smells or other environmental sensations may stimulate memories of the disaster creating heightened anxiety. These “triggers” may be accompanied by fears that the stressful event will be repeated.

Strained interpersonal relationships. Increased conflict, such as more frequent disagreements with family members and coworkers, can occur. You might also become withdrawn, isolated or disengaged from your usual social activities.

Stress-related physical symptoms. Headaches, nausea and chest pain may occur and could require medical attention. Preexisting medical conditions could be affected by disaster-related stress.

Increasingly, as discussed in the article noted above, educators are employing an immediate intervention approach called “psychological first aid (PFA)”. So what is that? In brief, PFA is a supportive intervention for immediate use in the aftermath of a disaster. It was developed by the National Center for PTSD (Post Traumatic Stress Disorder) in 2006 and has since spread to many agencies, governments, and localities throughout the United States and internationally.

While it is not intended to replace professional mental health services when needed, PFA is an evidence-informed approach built on the concept of human resilience to help people—from children to adults—in the immediate aftermath of a disaster, act of terrorism, or even a personal crisis. It's designed to reduce stress symptoms caused by those traumatic events and to foster short- and long-term functioning and coping. It also connects survivors to additional services. It's understood that survivors affected by those events will experience a broad range of early reactions that can cause enough distress to interfere with coping and recovery. So what does PFA intend to accomplish? There are several goals including those in the Times article:

Safety. Restoring a sense of safety is critical. Establish a sense of safety to provide physical, psychological, and emotional comfort.

Calm and comfort and protect and listen. Survivors are overwhelmed or distraught and take their cue from others. Establish a human connection in a non-intrusive, compassionate manner. It's important to maintain a calm, non-judgmental demeanor. This is not a time to talk at children but to allow them to express themselves.

Connectedness. Provide resources and practical assistance to persons to meet their immediate needs and concerns. Connect survivors to social support networks or other sources of support, including family members, friends, and community resources. Also, direct them to professionals as needed.

Self-empowerment and teaching. Support positive coping. Acknowledge coping efforts and strengths and empower survivors. Encourage them to take an active role in their recovery. This can be an opportunity to teach children resilience by teaching them how to cope with adversity in healthy ways, such as problem solving, self-regulation, and relaxation/mindfulness.

Instill Hope. There will be a new day.

In our book on stress management (I Can't Take It Anymore: How to Manage Stress so It Doesn't Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056, we offer detailed discussions of strategies to manage your reactions to stressors. For more information about the authors and book, please visit our website at www.manageyourhealthandstress.com. However, in addition to using PFA where available, here are some steps experts recommend to help you and your children regain your emotional well being and take back control of your life. These include:

Give yourself time to adjust. Accept that this will be a difficult time but that you will get through it. Allow yourself to mourn the losses you have experienced and try to be patient with yourself.

Ask for support. Ask for support from people who care about you and who will listen and empathize with your situation. Social support is a key component to all stressful situations including disaster recovery. Family and friends can be an important resource. You can find support from those who've also survived the disaster.

Communicate your experience. Express what you are feeling however it is comfortable to you, whether that is talking with family/friends, keep a diary, or partake in a creative activity. Consider using a local support group led by appropriately trained and experienced professionals. Support groups are frequently available for survivors. Group discussion can help you realize that you are not alone in your reactions and emotions.

Reconnect with a higher power. If it is a part of your life, draw on the strength of a higher power, whatever that may mean for you. Many times there is comfort in seeking solace, strength, and support from such sources. It is common for survivors of natural disasters to return to regular worship as soon as possible.

Engage in healthy behaviors. Engage in healthy behaviors to enhance your ability to cope with excessive stress. Be sure to eat well-balanced meals and get plenty of rest. If you experience ongoing difficulties with sleep, you may be able to find some relief through relaxation techniques I've discussed in other posts. Avoid alcohol and drugs because they can be a diversion that could detract from as well as delay active coping and moving forward from the disaster.

Establish or reestablish routines. This can include eating meals at regular times, sleeping and waking on a regular cycle, or following an exercise program. Build in some positive routines to have something to look forward to during distressing times. Establishing or returning to a regular routine assists children greatly in regaining a sense of control and purpose in life.

Avoid or delay making major life decisions. Making important life decisions is highly stressful normally and even harder to take on when recovering from a disaster. Your mindset following a natural disaster has much to do with how well and quickly you will recover from the potential negative psychological consequences of a natural disaster. As always, change your thoughts, change your results.

Good luck on your journey.

Dr. Paul Longobardi

For information on these and related topics, please visit my website at www.successandmindset.com

IS ADULT ATTENTION DEFICIT DISORDER AFFECTED BY STRESS?

October 30, 2019 Paul Longobardi

October is National Attention Deficit Hyperactivity Disorder (ADHD) Awareness Month. While we think of this disorder affecting children, many adults suffer from adult Attention Deficit Disorder (ADD). Do you or a loved one suffer from ADD? There has been increasing recognition that this is not only a disorder of children. While many ADD children continue to manifest symptoms in adulthood, there are individuals who have an initial onset of the disorder as an adult. For both children and adults, the primary symptoms that define ADD include impulsivity, hyperactivity, and inattention. The National Institute of Mental Health (NIMH) estimates the one year prevalence of adult ADD at 4.1% and a lifetime prevalence of 8.1%. These are millions of individuals suffering from this syndrome. More men than women are diagnosed with adult ADD.

I mentioned hyperactivity as a symptom but this is one area that does seem to present a bit differently in adulthood. For example, the overt hyperactivity may not be as prevalent for adults. Rather, the adult may experience feelings of uncomfortable restlessness. Adults typically display some combination of the following behaviors:

Need to move; feel restless inside, fidgety

Can't sit through meetings, meals, movies

Extremely impatient

Finish people's sentences; draw rapid conclusions; interrupt others

Drive too fast, reckless

Prefer very active job

On the go; low tolerance for frustration

Talk excessively; may make inappropriate comments; interrupt others

Common symptoms of adult ADD include poor attention; excessive distractibility; problems with memory and forgetfulness; frequently losing things; trouble organizing steps in a project; chronic lateness and procrastination; trouble starting and finishing tasks; careless mistakes; and disorganization.

People with ADD cost the economy billions of dollars. The Center for Disease Control (CDC) noted that this is so because individuals with ADD have more difficulties in school, at work, and in social relationships than those without the disorder. They have higher rates of emergency room visits and automobile accidents, are at greater risk for substance abuse, and experience higher rates of job turnover. The economic cost to American society has been estimated at between $36 billion and $52 billion annually (2005 dollars).

Individuals living with ADD have a greater risk of experiencing stress such as work stress and stressful life events (e.g. bankruptcy, divorce, etc.). Stress actually can cause ADD symptoms to become worse. So what is stress? For a complete description and discussion of stress, please consult our book (I Can't Take It Anymore: How to Manage Stress so It Doesn't Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056. For information on the book and authors as well as other information on stress, please visit our website at www.manageyourhealthandstress.com. For our current purposes, stress onset usually occurs when we anticipate or perceive danger or a threat. When you subjectively feel stressed, it is usually because of a change that you don't feel able to handle. Clearly, different people have different senses of what is stressful to them. Some examples include: a long wait in a line, being stuck in traffic, a fast approaching deadline at work, a large bill to pay.

Physiologically, when you perceive a stressor, your sympathetic nervous system is activated. The "fight or flight" response is initiated and the stress hormones adrenaline and cortisol are released. Your pulse increases, blood pressure goes higher, and you breathe faster. You are able to respond quickly to get out of danger. Blood is diverted to the heart, brain, and large muscle groups, so you can think and act quickly. Once the stressor is no longer present, the parasympathetic system takes over from the sympathetic nervous system and gets your body back into its normal state.

Some adults with ADD notice that they enjoy a certain level of stress as it makes them feel motivated, ennervated, and focused. However, that activation frequently turns into feelings of being anxious and overwhelmned. This is because we are not designed to stay alert and activated for long periods of time. Yet, in today's world it is common for people to go from one stressful situation to another. Unless you are able to manage your stressors, your body remains in "fight or flight" mode. It is well established that chronic stress has numerous negative effects on physical and mental health to include increased risk for colds and flu, illnesses such as heart disease and stroke, as well as depression/anxiety and substance use and abuse.

So what can you do as an adult with ADD to better manage your stressors and reduce the likelihood of being overwhelmned? There are several steps for you to employ, most of which are relevant to stress management even if you do not have ADD:

1. Identify what causes you stress - This is usually the first step to solve most problems. Start noticing what stress "triggers" exist for you? To help, consider the following areas:

a. Physical environment. This might include the route you travel to work, distractions on the train or bus, and how you can plan to manage these with less stress.

b. Relationships. Is there tension and stress with people in your life?

c. Money. Do you have financial worries?

d. Life events. Have there been or are there upcoming or present major events, e.g. births, deaths, marriages, illnesses?

e. Lifestyle or behavioral issues. Are you having health challenges, not taking care of yourself, living a disorganized life, having problems managing your time and meeting deadlines, abusing alcohol or drugs?

2. Problem solve to find different ways to handle the problems you identified above. For example, if you are having health challenges, you can make a plan to schedule exercise, see your primary care provider, get more rest, take some time for yourself, etc.

3. Make a stress management plan and implement it. While some stressors may be out of your complete control, most are not. It is important that you plan on a daily/weekly basis to get out of activation mode and reduce your stress. Here are eight tips to better manage your stressors:

1. Exercise. There is research support for the assertion that if you engage in 150 minutes per week of cardiovascular and muscle strengthening exercise that your health benefits physically and mentally increase.

2. Get regular sleep and make it a priority. No one handles stress well burdened by a chronic lack of sleep accompanied by fatigue.

3. Eat healthy foods.

4. Reduce caffeine and sugar.

5. Avoid alcohol and cigarettes.

6. Practice deep breathing and muscle relaxation. In our book I've written about the positive effects of progressive muscle relaxation (PMR) on health. PMR combines positive imagery, proper breathing, and reduction of muscle tension.

7. Get a massage regularly. In our book, I've written about the positive effects of therapeutic massage on general relaxation as well as reduction of muscle tension and anxiety.

8. Change how you speak to and about yourself. This is a hallmark of a successful mindset approach. Much of our malaise is caused by what we say to and about ourselves rather than what actually is happening.

So, the answer to the title questions is yes. As challenging as it is to live with adult ADD, how you manage the inevitable stresses of life will either help you live with higher well being or suffer even more. What are you doing currently to manage your stressors? As I always say, how you react to stress is a choice. Make yours a healthy one. Best wishes on your journey.

Dr. Paul Longobardi

For information on these and related topics, please see my website at www.successandmindset.com

MIGHT YOU BE SUFFERING FROM DEPRESSION?

October 23, 2019 Paul Longobardi

This is National Depression Education and Awareness Month. October 11, 2019 was National Screening Day. National Depression Screening Day (NDSD), is dedicated to raising awareness and screening people for depression and related mood and anxiety disorders. NDSD is the nation’s oldest voluntary, community-based screening program that gives access to validated screening questionnaires and provides referral information for treatment. Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression, in fact, some studies show that one-third of women will experience a major depressive episode in their lifetime.

Estimates are that approximately 8% of people over the age of 12 suffer from moderate to severe depression. The signs of serious depression are many and include prolonged sadness or irritability, sleep and appetite disturbances, loss of energy, less interest in pleasurable activities, feelings of guilt and worthlessness, and occasionally thoughts of suicide. Depression is correlated with problematic medical conditions such as post-stroke recovery and diabetes management, among others. Unfortunately, many people attempt to deal with their depression through problematic alcohol or drug use.

Between 2 to 4% of workers in the US suffer from depression and up to 50% of workers with depression experience short term disability. There are significant financial costs to employers. For example, in studies from the University of Michigan Depression Center, the total economic burden of depression in 2000 was $83 billion and the majority of this cost (62% or $52 billion) was due to lost workplace productivity. It is not uncommon for depressed workers to have poorer on the job performance. Stress worsens the risk for depression. We discuss the relationship of stress and depression in our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056. For additional information about the book, authors, and stress please visit our website at www.manageyourhealthandstress.com.

So should we be doing more to screen for depression? Apparently the medical establishment has decided yes. The U.S. Preventive Services Task Force has recommended that general physicians/primary care physicians screen all adults for depression and treat those affected by it with antidepressant medication, refer them to psychotherapy, or both. The Task Force also recommended that all pregnant and postpartum women be screened for signs of depression as well as older adults. Pregnant women with depression are recommended a range of treatments including cognitive behavior therapy, an evidence based psychotherapy with demonstrated efficacy in treating depression. This policy is a departure from previous recommendations which only had recommended that physicians look for signs of depression periodically when resources to treat were in place. The new recommendations recently were published in the Journal of the American Medical Association.

So should you seek out screening for depression? Occasional sadness or the "blues" are a part of life for most people. However, if you or a loved one have been suffering from one or more of the symptoms noted earlier, it would be prudent to seek out screening. Your physician healthcare professional is in a position to use several available depression screening tools as well as assess whether any of your physical/medical conditions may be influencing your self-report. Your professional can refer you to a mental health professional, who may be a psychiatrist, psychologist, social worker, or mental health trained registered nurse. But do keep in mind that help is available and ranges from medication to cognitive behavior therapy. The treatment of depression has transitioned into the mainstream of American medical care. There is no excuse for failing to diagnose and treat depression.

Actually, depression screenings should be a routine part of your healthcare. Whether for heart disease, high blood pressure, diabetes or depression, health screenings provide a quick and easy way to spot the first signs of serious illness and can reach people who might not otherwise seek professional medical advice.

Depression screening is effective in linking at-risk individuals with treatment options. Results from a 2009 independent research study by the University of Connecticut and commissioned by Screening for Mental Health confirm this connection. The study showed that 55% of participants who completed an online depression screening and who agreed to participate in a follow-up survey sought depression treatment within three months of the screening.

To take a mental health screening, go to www.mhascreening.org or visit www.HelpYourselfHelpOthers.org to locate a mental health screening site or take an online screening.

You can change your life but you must take action. Change your thoughts and change your results.

Dr. Paul Longobardi

For information on these and related topics, please see my website at www.successandmindset.com

WHAT CAN WE LEARN ABOUT LIFE AND STRESS MANAGEMENT FROM CHRISTOPHER COLUMBUS?

October 15, 2019 Paul Longobardi

As a person of Italian heritage on Columbus Day, and always interested in life and stress management as well as leadership issues, I sometimes ponder what leadership lessons we can learn from Christopher Columbus. Well, several years ago I was fortunate enough to come across this enlightening post on the very topic from Mr. Larry Boyer. He is a regular LinkedIn Top Contributor.

More than 500 years ago Christopher Columbus set sail and reached the Americas. Was this a grand achievement for a man, a nation, humanity or generations to come? What are the lesson of personal achievement and leadership that Christopher Columbus has taught us?

Today we focus so much on the activity, the man and his deeds that we miss the deeper importance of Christopher Columbus. Did Columbus really discover America? Did someone else? After all, the continent was here long before he arrived. If he thought he discovered India did he really discover America? Was America in fact really “discovered”? What about the treatment of the natives by Columbus and those who followed him? Christopher Columbus was revered by and inspired generations for a reason that is often overshadowed by today’s critiques.

So, what are lessons learned from Columbus which we can use to help us in our lives today?

5 Leadership Lessons from Christopher Columbus

Luck favors the prepared

Be Bold. Be Different

Ignore Nay Sayers

Find people who believe in you

Let go of the familiar and safe

LESSON ONE: Luck Favors the Prepared

Was Columbus just lucky? One of the first criticisms of successful leaders and visionaries is they were just lucky to be at the right place at the right time. Anyone could have done the same thing. It’s just lucky this person did it and someone else didn't. Columbus was trying to sail to India and was just lucky he found something else instead.

What appears to be a lucky happenstance is the result of years of work and preparation. Leaders make luck happen through preparation. Columbus spent years developing his idea and going around Europe looking for financial backing. He had to believe and convince others that the world might be round. Like any great leader, Columbus spent a lot of time getting prepared for his opportunity. So, when an opportunity appears for you, be ready to both recognize it and to be able to take advantage of it. This involves planning, goal setting, prioritization, and focus. These are all key elements in managing life well and reducing stress when compared to poor planning, lack of goals, no priorities, and lack of focus. They are among the topics in our book on stress management in your life (I Can’t Take It Anymore: How To Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056. For information about the authors, book, and other topics on stress, please visit our website at www.manageyourhealthandstress.com. But let’s get back to Columbus.

LESSON TWO: Be Bold. Be Different.

Columbus had a bold idea. An idea that was different from everyone else around him and certainly different from his seafaring peers. In his day ship captains kept in sight of the shore, ensuring they would not fall off the edge of the Earth or be consumed by sea monsters. Columbus understood that if he continued to do the same thing everyone else was doing, he would at best continue to get the same results as everyone else. If you want to achieve something great it is going to have to be by doing something different than what everyone else is doing.

LESSON THREE: Ignore the Naysayers

Everywhere Christopher Columbus went people laughed at him for his idea that the Earth was round as he traveled Europe looking for support. He was sent away time after time. His peers and colleagues in the sail industry thought him to be a mad man for making such suggestions. Everywhere he went sharing his idea he was dismissed, ridiculed and marginalized. It is very easy to start to listen to the voices of the naysayers. They will always be around. Leaders who believe in their mission will ignore the naysayers and continue moving forward. It’s not just leaders who deal with naysayers. You too likely have people in your life who don’t support your goals and plans. Some of them may even be in your family. Your challenge is nonetheless to move forward with goals and dreams.

LESSON FOUR: Find People Who Believe In You

Leaders know they cannot be successful alone. They need the support of people who believe in them. Even if those people are uncertain themselves they believe enough to put themselves on the line and be part of your team. Queen Isabella and King Ferdinand of Spain were the first. And then there were the people on his crew. Each of his supporters may have had different goals and objectives than Columbus, but they were all aligned in support of him in his efforts. Undoubted some were less supportive than others. It doesn't matter. Great leaders use this support, whatever the level, to charge forward. Time and time again, I have discussed the need for a support network that contributes to your success. None of us can accomplish alone all that we want. Build your support network. There’s a chapter in our book on this process.

LESSON FIVE: Let Go Of The Familiar And Safe

Finally, perhaps the greatest lesson from Columbus’ leadership is to let go of what is familiar and safe and have the faith that you and your supporters will have what it takes to face the unknown, adapt, and move forward. Columbus literally did this in ways that we simply cannot replicate in today’s business world or personal world. However, we do know what it means to feel secure and not want to take chances with your career and finances and avoid taking risks. Those who let go and take a chance may fail at first. Getting up and moving forward, past your comfort zone, is where success lies. Leaders in life face their fears and move forward.

What have you learned from Columbus that you apply in your life today? I hope it is to be prepared, differentiate yourself, ignore the naysayers, develop your support network, and move out of your comfort zone. Yes, that can feel stressful but you can do it.

Best wishes in your journey.

Dr. Paul Longobardi

For information on these and related topics, please see my website at www.successandmindset.com

WHY DOES YOUR TEEN HAVE SO MUCH ANXIETY AND WHAT CAN YOU DO?

October 9, 2019 Paul Longobardi

Adolescence is a time of life when most mental disorders emerge. One of the most common disorders is anxiety. Recent estimates suggest that over 30 percent of teens have an anxiety disorder. That means about one of every three teenagers is struggling with anxiety that significantly interferes with their life and is unlikely to fade without treatment. It affects nearly 1 in 3 teens between the ages of 13 and 18. The number of young people experiencing anxiety is on the rise, with a 20% jump in anxiety disorders in children and teens seen from 2007-2012.

So how does teen anxiety present? The main manifestation is fear or nervousness that does not go away, even in the absence of any real threat. Teens with anxiety disorders will report that they are nervous all the time, can not relax easily, feel stressed, and are apprehensive frequently. It can be difficult to differentiate normal emotional changes in teens from a clinical disorder. Many teens without diagnosable anxiety disorders worry about what others think about them, about making friends, or fitting in with others. However, in contrast with everyday teen worries, teens with clinical anxiety disorders feel nervous all the time and their anxiety interferes with their functioning socially and at school. We discuss anxiety and stress in detail in our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056. For information about the book, authors, and stress, please visit our website at www.manageyourhealthandstress.com

For now, what is going on in the brains of teens with anxiety? Like adult brains, scientists know that connections between the limbic system involved in emotionality (particularly the amygdala and basal ganglia) and the prefrontal cortex are involved in fear and anxiety. We are learning that one of the problems for teens is that the amygdala/prefrontal cortex connections are slow to develop, continuing to develop into their early 20s. During adolescence, the brain goes through changes and the areas involved in managing emotion are in significant development during these times. This leaves teens vulnerable to stress and anxiety secondary to the changes in the areas of the brain managing emotionality. These changes are associated with anxiety, nervousness, panic attacks, physical sensations of anxiety (such as a pounding heart, shortness of breath, and racing thoughts), and a tendency to predict the worst, At its worst, anxious teens are at heightened risk for many serious comorbid problems, including depression, substance abuse and in some cases suicide.

What are other factors contributing to increased anxiety among teens? In a recent post, Dr. Daniel Amen, world renowned neuroscientist and psychiatrist, listed several areas in addition to brain changes:

1. SPENDING MORE TIME ON SOCIAL MEDIA

Teens report using the internet on an “almost constant” basis, according to statistics from Pew Research Center. And Generation Z (16-20-year-olds) logs over 4 hours a day online on their mobile phones. A growing number of studies have shown a connection between time spent on social media and feelings of anxiety and depression. Effects of this level of use include feelings of shame secondary to the incessant negative comparisons teens make of themselves to others. This can generate significant levels of anxiety. Dr. Amen suggested limiting the social media time of teens. Studies have shown that teens who limit their social media use and spend time with friends, exercise, engage in social activities, attend religious services, read and even do homework are happier than those who spend most of their time on technology devices or watch TV.

2. SPENDING LESS TIME IN FACE-TO-FACE INTERACTIONS

Dr. Amen noted that as teens spend more time on social media, they spend less time with in-person connections. As they become more anxious, teens are more likely to isolate themselves from social situations in favor of scrolling through their social media feeds. This keeps them trapped in a negative emotional cycle. He recommends spending more time with humans with the additional benefit of the brain releasing the feel-good neurotransmitter oxytocin.

3. INCREASED PRESSURE TO PERFORM

We know that high expectations are placed on teens (and that teens place on themselves) stimulating the rise in anxiety. Teens today can be under tremendous pressure to achieve, and a growing number of them say they feel overwhelmed by everything they need to accomplish. I too have written about this in other posts including the pressures leading some parents to define youth in terms of their achievements and the parents to engage in college admissions cheating scandals. I have suggested being aware of the expectations you place on your teen. Do not allow them to overschedule their time, allow them to relax. Give them positive reinforcement just for being the person they are.

4. AN INCREASINGLY FRIGHTENING SOCIETY

I also have written about this factor in past posts. Mass shootings on school campuses and the threat of terrorist attacks are adding to the sense of anxiety so many teens are experiencing. Just seeing news coverage of these events can cause intense fear and contribute to anxiety or post-traumatic stress syndrome (PTSD). Teens no longer feel safe in places that used to be safe such as school, movie theaters, or outdoor concerts. Dr. Amen recommends reducing teens’ exposure to the negative news cycles on television and online. Talk to them about being aware of their surroundings and noticing where exits are located so they can have some sense of control in case a situation arises. In addition, teach them stress-management techniques to soothe anxiety.

5. POOR EATING HABITS

We know that food is a drug that has major effects on our moods, emotions, and behavior. Teens frequently have bad eating habits—fast food, pizza, soda, ice cream, coffee—that can increase symptoms of nervousness. Additionally, eating foods such as sugar, MSG, gluten, soy, corn, and dairy, that are potential allergens, may create a metabolic disorder that can lead to symptoms of anxiety, agitation, irritability, depression, and more. These are found in the vast majority of processed foods. So teens may not make the connection between what they’re eating and the way they’re feeling.

Dr. Amen recommends to feed your teen a healthy diet of small amounts of high-quality protein, fatty fish that is rich in mood-boosting omega-3 fatty acids, and pesticide-free vegetables and fruits, and minimize refined carbohydrates and junk food.

But what if your teen still is anxious? Well, there are evidence based treatments that are effective. Teens should not have to face anxiety alone. Psychotherapy and medications can both be highly effective.

Cognitive behavioral therapy (CBT) is one of the most effective and widely used psychosocial treatments for anxiety in teens. I use it regularly in my own psychological treatment practice. In CBT, among other things, therapists help individuals with anxiety to gradually and repeatedly expose themselves to the very situations that they fear. This can help lessen the power of the anxiety situation in real life. I have heard it often said, “Do the thing you fear and the death of fear is near”. Having a socially anxious teenager imagine contacting a new acquaintance, then moving on to call the acquaintance, and then initiating a conversation with a stranger at a party can help reduce felt anxiety. This is done in combination with work on helping the teen identify, challenge, and create less anxiety producing thoughts.

Emerging research has shown that current treatments for anxiety directly modify the same amygdala-prefrontal connections we discussed earlier that are in development during adolescence and associated with anxiety.

Both CBT and medication treatment with selective serotonin reuptake inhibitors (SSRIs) may reduce amygdala reactivity and enhance prefrontal control. The treatments help these brain circuits regulate fear and keep them from overreacting to potentially anxiety-provoking situations. Although your teen’s brain is prone to anxiety because of their developmental stage, there are many ways you can help mitigate risk factors and/or access treatment options.

Good luck on your journey.

Dr. Paul Longobardi

For information on these and related topics, please see my website at www.successandmindset.com

IS YOUR COLLEGE STUDENT FAILING STRESS MANAGEMENT 101?

October 2, 2019 Paul Longobardi

We are early in the new college year. Slowly but surely the college admissions scandal is fading and attention needs to be focused on the new college freshman. Surveys have shown that stress levels are high for college freshmen. As they experience their first semester and ready themselves for mid-term exams, there are frequent physical manifestations of stress including sore throats, cough, flu, and upper respiratory problems. The challenges college freshman face are such that first year drop out rates are noted as high as 20%. There was a recent survey of more than 153,000 freshman done through UCLA's Higher Education Research Institute. Results included findings that anxiety and depression are challenges for freshmen with only about half of them reporting a high level of emotional health, the lowest rate ever. What is of note is that some colleges are trying to help with stress reducing activities such as massage therapy and yoga. So is your student failing one of the most important life courses, Stress Management 101? It’s not on most curricula but it should be.

While almost everyone agrees that the college freshman year presents many challenges, I wonder if enough time and effort is spent to assist younger people to manage stressors in a capable manner. Massage and yoga are helpful techniques. However, there are many additional strategies and techniques available as part of a comprehensive package to equip young persons earlier to develop a sense of mastery as they face stressful circumstances. For a full discussion of stress and its management, please see our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.) available from Amazon at https://www.amazon.com/dp/1542458056. For more information about the book, authors, and stress, please visit our website at www.manageyourhealthandstress.com.

For now, let me suggest six strategies/techniques which would help young people cope better and sooner so that so much psychological repair is not necessary in their adulthood:

1. Cognitive restructuring. This has to do with how we view the events in our life. Listen to the people who lament, "I'm so stressed out", or "This person/event is stressing me out". What that person is saying is that events control them and their view of their ability to cope successfully is low. In fact, it is why some psychologists advocate training primary school children in modifications of cognitive therapy. Why? I have worked with so many patients who incorporated negative/limiting beliefs about themselves as children such as "I'm incapable/unlovable/unlikeable because . . . someone said so". To be able to identify, challenge, dispute, and change these false beliefs earlier would have interdicted years of suffering and limitations in life happiness and well being and the need for psychotherapy. The young person who can develop a cognitive sense of self-mastery still will worry about mid-term exams but will neither make themselves physically sick nor create a state of anxiety or depression.

2. Relaxation strategies. As noted, some colleges are on the right path. Of course, there are available multiple strategies to include meditation, mindfulness, yoga, progressive muscle relaxation, and massage. Mindfulness and meditation approaches have been introduced in some graduate schools of business to assist future business leaders to manage their physical reactions. Might this not be as helpful at even earlier ages?

3. Time management. A source of stress for many adults is the failure to plan, prioritize, and set limits as to their work and possible interruptions. Do you take on too many obligations and fail to plan for interruptions, say yes to everything and everyone even when you don't want to? Do you then feel pressured to get done that to which you overcommitted? Good time management can help you as well as college freshmen who must juggle many school, social, and daily life activities in a newly independent life. I contend that teaching them such skills even before college would help prevent the frequent feeling of overwhelmn.

4. Self-affirmations. Acute stress can help rote memory, which is probably why so many "crammers" for exams actually do satisfactorily. However, if the task involves more complex problem solving increased stress interferes.

In the last several years there is new research indicating that self-affirmation can lessen the interfering effects of stress on problem solving. I prefer the definition that an affirmation is a statement that describes your goal in its completed state. For example, if the young person is trying to lose weight, their self affirmation might be that "I am feeling lean and powerful at my perfect body weight of 170 pounds". Creating and using self-affirmations daily can increase problem solving and goal attainment.

5. Exercise. Many observers decry the lack of physical fitness in the young. Yet, we all know that exercise and physical activity help improve general physical as well as mental health, leaving us with a sense of well being. However, less well known is that physical activity may facilitate the brain reorganizing itself in response to stress.

In recent research published in the Journal of Neuroscience, a team based at Princeton University reported that physical activity reorganizes the brain so that its response to stress is reduced and anxiety is less likely to interfere with normal brain function. Suffice it to say that the elimination of physical education in primary and high schools is not helping the ability of youth to gain the benefits of stress reduction.

6. Social support. Social support is the degree and quality of our connections with others. In the mental health field, it has long been known that even the presence of one confidante buffers to some extent the onset/degree of depression, from which many youth suffer. For the young people of today, they live in an era where frequently social interaction is defined in terms of connections on social media. Yet, without connection to real humans, there is increased risk for adverse physical and mental health outcomes. Social support moderates the effects of some of the other stress factors.

So let's go back to the struggling, stressed college freshman facing mid-term exams this week. I would suggest that a formalized stress management program early in the first year would cut into the 20% drop-out rate noted above. Perhaps even more helpful could be to consider adapting stress management strategies and programs to both primary and high school levels. In doing so, might we not cut into the hundreds of millions of dollars lost each year to stress related illness in adults in American business? Might we not improve quality of life for so many young persons and help them develop the sense of self-mastery which will facilitate their enjoyment and success in life? As the old saying goes, "An ounce of prevention is worth a pound of cure". I think this is true in stress management as well.

Good luck on your journey.

Dr. Paul Longobardi

For articles on these and related topics, please see my website at www.successandmindset.com

MIGHT YOU SUFFER FROM POST TRAUMATIC STRESS DISORDER?

September 25, 2019 Paul Longobardi

In considering the effects of stress on your personal and work lives, we need to discuss Post Traumatic Stress Disorder (PTSD) At first glance, you might think this is questionably relevant. You say, “I’ve never served in the military”. However, three things are true. One is that you do not have to be a combat veteran to suffer PTSD. Second, PTSD affects your brain. Third, you may be working with or living around someone with PTSD. In our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056, we discuss all aspects of stress. For more information about the book, authors, and website, please visit our website at www.manageyourhealthandstress.com. For now, let’s look at PTSD in more depth.

So what is PTSD? PTSD is a pathological anxiety disorder resulting after exposure to a traumatic event. An estimated 8% of the U.S. adult population matches the criteria for PTSD with women more likely to develop symptoms than men. While PTSD cases commonly involve combat or assault experiences, there is a wide range of events capable of triggering PTSD symptoms. Trauma events frequently associated with the development of PTSD include the following:

Physical, emotional, or sexual abuse

Combat experiences

Terrorist attacks

Natural disasters such as tornados, floods, earthquakes, or fires

Life-threatening accidents, such as automobile accidents, airplane crashes, or boating accidents both experienced or witnessed

Violent crimes, both experienced or witnessed

As you can see, there are a wide range of non-military events associated with the onset of PTSD. Unfortunately, given the frequency of violent shooting events as well as natural disasters, there is increasing risk of the development of PTSD. There is growing research around the topic of even vicariously witnessing traumatic events as well. With the explosion of violent traumatic events in the news of late, there is more interest and concern about the impact of these on people not directly accosted.

So what are common symptoms of PTSD? There are four:

Intrusion: Recurrent recollections of the event

Numbing: Emotional distancing from surrounding people and events

Avoidance: Fear and avoidance behavior

Arousal: Agitated state of constant wakefulness and alertness

What happens in the brains of people with PTSD? Suffice it to say, there is no use telling them to get over it because PTSD changes the brain's structure.

Extensive neuroimaging studies on the brains of PTSD patients show that several regions differ structurally and functionally from those of healthy individuals. The amygdala, the hippocampus, and the ventromedial prefrontal cortex play a role in triggering the symptoms of PTSD. Together, these regions impact the stress response mechanism in humans. Consequently, PTSD victims, long after their experiences, continue to perceive and respond to stress differently than someone who does not suffer the results of trauma.

What happens in the brains of people with PTSD? Suffice it to say, there is no use telling them to get over it because PTSD changes the brain's structure.

Extensive neuroimaging studies on the brains of PTSD patients show that several regions differ structurally and functionally from those of healthy individuals. The amygdala, the hippocampus, and the ventromedial prefrontal cortex play roles in triggering the symptoms of PTSD. Together, these regions impact the stress response mechanism in humans. Consequently, the PTSD victim, long after their experiences, continues to perceive and respond to stress differently than someone who does not suffer the results of trauma.

The most significant neurological impact of trauma is seen in the hippocampus. PTSD patients show a significant reduction in the volume of the hippocampus. This area of the brain is responsible for memory functions. It helps us record new memories and retrieve them later. The hippocampus also helps us distinguish between past and present memories.

PTSD patients with reduced hippocampal volumes lose the ability to discriminate between past and present experiences. They have extreme stress responses when facing situations that only slightly resemble something from their traumatic past. I have treated numerous patients who were victimized by physical and/or sexual abuse whose responses were overdetermined to current situations, often benign, as though the current situation was the one which had traumatized them initially. This can occur decades after the initial traumatic event.

Severe emotional trauma causes lasting changes in the ventromedial prefrontal cortical region of the brain. This area is responsible for regulating emotional responses triggered by the amygdala. Specifically, this region regulates negative emotions like fear. PTSD patients show a marked decrease in the volume of ventromedial prefrontal cortex. This explains why people suffering from PTSD tend to exhibit fear, anxiety, and extreme stress responses even when faced with situations not connected, or only remotely so, to their experiences from the past.

Traumatic events appear to increase activity in the amygdala. This region of the brain helps us process emotions and is also linked to fear responses. PTSD patients show hyperactivity in the amygdala in response to stimuli that are somehow connected to their traumatic experiences. Sometimes, they show hyperactivity even to stimuli not associated with their trauma.

Hyperactivity of the amygdala also is positively related to the severity of PTSD symptoms. To a large extent, this is a result of the hypoactivity of the hippocampus and the dysfunction in the ventromedial prefrontal cortex in controlling the amygdala. The excessive reactivity of the amygdala helps explain some of the major signs of PTSD - startle responses to the most harmless of stimuli and frequent flashbacks or intrusive recollections.

However, there are promising treatments for PTSD and these treatments have been shown in some studies to correlate with brain changes. We certainly now know that the brain can regenerate more than we thought in the past. Some drugs and behavioral therapies have been shown to increase the volume of the hippocampus in PTSD patients. Two of the evidence based behavioral therapies approved by the Veterans Administration in the treatment of PTSD include cognitive processing therapy (CPT) and prolonged exposure therapy (PE therapy). First developed to treat the symptoms of PTSD in sexual assault victims, CPT focuses on the impact of the trauma. In CPT, the therapist helps the patient identify negative thoughts related to the event, understand how they can cause stress, replace those thoughts, and cope with the upsetting feelings. PE therapy has been shown to be effective in 60% of veterans with PTSD. During the treatment, repeated revisiting of the trauma in a safe, clinical setting helps the patient change how he or she reacts to memories of traumatic experiences, as well as learn how to master fear- and stress-inducing situations moving forward. There is some experimental work using virtual reality to treat PTSD. Currently, sertraline and paroxetine are the only drugs approved by the Food and Drug Administration (FDA) for the treatment of PTSD. All other medications for PTSD are used off-label and have only empirical support and practice guideline support

So, if you or a loved one suffer from PTSD, or if you work with someone who appears to suffer from such a stress related disorder, get help as it is available. There is no reason to suffer needlessly. There is hope and you can change. However, as usual, change starts with a mindset which recognizes that change is possible.

No matter what has happened, you can change your thoughts, your life, and your response to stress.

Good luck on your journey.

Dr. Paul Longobardi

For in formation on these and related topics, please visit my website at www.successandmindset.com

HOW DOES COPING WITH DIABETES AFFECT YOUR MEMORY?

September 18, 2019 Paul Longobardi

As I discussed in a recent post, there is evidence that coping with diabetes lowers quality of life and increases risk for depression, including in youth. Also, there are numerous findings that stress exacerbates, and may trigger diabetes. We reviewed that topic in the chapter on stress and diabetes in our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056. For more information about the book, authors, and stress, please visit our website at www.manageyourhealthandstress.com. But how does diabetes affect memory? It is known that there are serious negative consequences of uncontrolled or untreated diabetes, including an increased risk for heart disease, blindness, and kidney failure. Well, you may be less aware that diabetes puts you at higher risk for memory problems, Alzheimer’s Disease, and other types of dementia. There increasingly is scientific research connecting abnormal insulin levels to cognitive decline and Alzheimer’s disease.

As you may know, diabetes is a medical disorder that occurs when the body’s blood sugar levels are chronically too high. The condition develops when the body either does not produce enough insulin (Type 1), the hormone that regulates blood sugar levels, or does not use insulin efficiently (Type 2) .

Prediabetes is a condition often seen as a precursor to type 2 diabetes. This condition is having blood sugar levels that are higher than normal but not high enough to be diagnosed as diabetes. The Centers for Disease Control (CDC) estimate that over 100 million Americans have diabetes and prediabetes (30 million diabetes and over 80 million with prediabetes). Therefore, the cognitive risks of diabetes warrant your concern and attention.

Studies using brain imaging have shown that diabetes is associated with decreased blood flow to the brain which is connected to memory problems. Even the hippocampus, an area of the brain important to memory, is noted to be smaller in individuals with diabetes. These findings are true even for people with prediabetes.

So how can you lower your risk for diabetes and memory loss? In a recent post from the Amen Clinics, Dr. Daniel Amen, world renowned expert on brain conditions, offered ten ways:

1, Eliminate sugar and artificial sweeteners. Refined sugar causes blood sugar levels to elevate, and the artificial sweeteners are linked to a higher risk of dementia.

2. Limit high-glycemic, low-fiber foods (cookies, cake, and pretzels).

3. Eat smart carbohydrates that are high in fiber and low-glycemic (vegetables, fruits, and protein-rich carbs like quinoa).

4. Eliminate sodas and sugar-laden energy drinks and instead choose still or sparkling water.

5. Drink decaffeinated tea and coffee to boost metabolism and lower the risk of diabetes.

6. Eat small quantities of high-quality protein and some healthy fat (such as avocado, walnuts, or olive oil) with every meal to stabilize blood sugar levels.

7. If you’re overweight or obese, do not crash diet. Instead, lose weight gradually as you develop healthy habits that will last a lifetime.

8. Make physical exercise—and especially strength training—a part of your daily routine to help balance blood sugar levels. In one study, women who did strength training reduced their incidence of diabetes by 30% compared to women who did no strength training. Exercise also is a great stress reducer as we discussed in our book.

9. Spice up your cooking with cinnamon, which has been shown to lower fasting glucose levels, improve insulin sensitivity, and reduce HbA1c (a test that measures your average blood sugar levels over the past 2-3 months)

10. Supplement your diet with a high-quality multivitamin/mineral, as well as:

vitamin D (low levels have been linked to memory problems, including Alzheimer’s disease)

omega-3 fatty acids EPA/DHA (help maintain proper insulin signaling)

chromium picolinate (can aid in insulin regulation)

alpha-lipoic acid (improves overall blood sugar management)

Diabetes is a condition which can disrupt your life in so many areas, i.e. medical, cognitive, emotional. But that does not have to happen. Eat right, exercise, attend to your emotional health, and engage in stress reduction practices. You will have taken major steps to improve your health and that of your friends and loved ones.

Good luck on your journey.

Dr. Paul Longobardi

For information on these and related topics, please see my website at www.successandmindset.com

ARE YOU AT RISK FOR DEPRESSION OR SUICIDE?

September 11, 2019 Paul Longobardi

This is National Suicide Prevention Week. Estimates are that approximately 8% of people over the age of 12 suffer from moderate to severe depression. The signs of serious depression are many and include:

Prolonged sadness or irritability
Sleep and appetite disturbances
Loss of energy
Less interest in pleasurable activities
Feelings of guilt and worthlessness
Thoughts of suicide.

Risk factors for suicide include mental health conditions such as depression, substance use problems, bipolar disorder, personality traits of aggression, mood changes and poor relationships, as well as conduct disorders and anxiety disorders. Other risk factors are serious physical health conditions including pain and traumatic brain injury. Environmental risk factors are access to lethal means including firearms and drugs and prolonged stress, such as harassment, bullying, relationship problems or unemployment. Other environmental risk factors include stressful life events, like rejection, divorce, financial crisis, and other life transitions or loss. Historical factors include previous suicide attempts or family history of suicide as well as a history of childhood abuse, neglect or trauma. We discuss the relationship of depression to stressful life events in our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.) available on Amazon at https://www.amazon.com/dp/1542458056. For information about the book, authors, and stress, please visit our website at www.manageyourhealthandstress.com.

Regarding suicide, in 2017, there were over 47 thousand recorded suicides, up from over 42 thousand in 2014, according to the CDC's National Center for Health Statistics (NCHS). On average, adjusted for age, the annual U.S. suicide rate increased 24% between 1999 and 2014, from 10.5 to 13.0 suicides per 100,000 people, the highest rate recorded in 28 years. In that year of 2017, suicide claimed the lives of 5,016 males and 1,225 females between 15 and 24 in the United States. The youth suicide rate — 14.6 per 100,000 — appears to be the highest it’s been since the government began collecting such statistics in 1960.

Depression is correlated with problematic medical conditions such as post-stroke recovery and diabetes management, among others. Unfortunately, many people attempt to deal with their depression through problematic alcohol or drug use.

So should we be doing more to screen for depression and suicide? Apparently the medical establishment has decided yes. The U.S. Preventive Services Task Force has recommended that general physicians/primary care physicians screen all adults for depression and treat those affected by it with antidepressant medication, refer them to psychotherapy, or both. The Task Force also recommended that all pregnant and postpartum women be screened for signs of depression as well as older adults. Pregnant women with depression are recommended a range of treatments including cognitive behavior therapy, an evidence based psychotherapy with demonstrated efficacy in treating depression. This policy is a departure from previous recommendations which only had recommended that physicians look for signs of depression periodically when resources to treat were in place. The new recommendations recently were published in the Journal of the American Medical Association.

So should you seek out screening for depression? Occasional sadness or the "blues" are a part of life for most people. However, if you or a loved one have been suffering from four or more of the symptoms of depression noted earlier and/or have multiple risk factors for suicide, it would be prudent to seek out screening. Your physician healthcare professional is in a position to use several available depression screening tools as well as assess whether any of your physical/medical conditions may be influencing your self-report. Your professional can refer you to a mental health professional, who may be a psychiatrist, psychologist, social worker, or mental health trained registered nurse. But do keep in mind that help is available and ranges from medication to cognitive behavior therapy. The treatment of depression has transitioned into the mainstream of American medical care. There is no excuse for failing to diagnose and treat depression. You do not need to continue to suffer. There is help.

You can change your life but you must take action. Change your thoughts and change your results.

Good luck on your journey.

Dr. Paul Longobardi

For information on these and related topics, please see my website at www.successandmindset.com

HOW DOES COPING WITH DIABETES AFFECT QUALITY OF LIFE FOR YOUTH?

September 4, 2019 Paul Longobardi

Well, it’s time for school again. For many youth, that includes going away to college, often for the first time. There are numerous adjustments new college students need to make and the transition can be stressful. This can include the stress of having diabetes. We discussed in great detail the connection between stress and diabetes in our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056. For information about the book, authors, or other information on stress, please visit our website at www.manageyourstressandhealth.com.

So, does your student have diabetes? If so, there are even more challenges for those students. This is the conclusion drawn in a study in the Journal of the American Osteopathic Association.

The investigators found that people who worked at or attended universities had high levels of diabetes distress. This was defined as a condition of feeling worried and frustrated about living with diabetes associated with fewer self-care behaviors, suboptimal glycemic control, and lower quality of life.

Dr. Elizabeth Beverly, Ph.D., associate professor of family medicine at Ohio University Heritage College of Osteopathic Medicine and lead researcher on this study, noted that distress with diabetes occurs to everyone at times, often stimulated by major life events or change. She observed that going to college qualifies as a major life event and she recommended that we anticipate distress in students with diabetes and offer support.

In the study itself, investigators surveyed 173 people with type 1 diabetes mellitus and type 2 diabetes mellitus who worked at or attended a university. High levels of diabetes distress were reported by 27% of those with Type 1 and 30% of those with Type 2 diabetes. Study participants who reported high diabetes distress also indicated a lower quality of life. The study investigators also found that 19% of those with Type 1 diabetes and 17% of those with Type 2 diabetes screened positive for severe depression.

However well the student has been managing while living at home, new environments can significantly disrupt their self-care plan, especially when it comes to diet and managing blood glucose. As noted by the study authors, for students moving away from home, where routines are set, getting access to the right foods may prove difficult. Living with diabetes requires daily management and remains a chronic, progressive disease that can lead to decline over time.

Heightened diabetes distress stems from the uncertainty of being able to effectively maintain one's health in the face of major life changes or disease complications. It is well known that there can be severe consequences of not managing diabetes, including loss of eyesight and limbs.

As lead study author Dr. Beverly observed, the best intervention for combating uncertainty is information This can include referring patients with high distress for diabetes education. Patients can speak to diabetes educators and dieticians to problem solve barriers to better eating habits, learn about treatment options, or get mental health care from a mental health clinician knowledgeable of this area. In a large public mental center at which I worked years ago, we did just this for patients with severe and chronic mental disorders who also had diagnoses of diabetes. .

Dr. Beverly gave examples at Ohio University where provision is made for sharps containers for storing needles and refrigerators for insulin in dorm rooms. Hypoglycemia treatment kits can be found throughout campus. Faculty is also flexible with test schedules and absences that result from health complications. Students with diabetes can qualify for accommodations under the American Disabilities Act. However, they have to self-identify as having diabetes in order to have access. Just this past week, as I began a new semester teaching graduate students in psychology, one of the class members provided me with a list of accommodations around her diagnosed diabetic condition, to include ones just mentioned above. Clearly, more universities are recognizing that there is need to support students to facilitate improved health and academic outcomes.

In the chapter on stress and diabetes in our book noted above, we offered several stress reducing strategies to assist in managing diabetic conditions. In brief they are:

Change stress producing situations where possible. For students, this might include better time management and avoid becoming overwhelmed by over commitment to activities and people. Learning problem solving skills can help as well.
Use some form of relaxation therapy. It could be meditation, yoga, progressive muscle relaxation. Studies have shown that even five weekly sessions of relaxation therapy can reduce blood sugar levels significantly.
Learn to re-evaluate your thoughts and reduce your stress levels. If your problematic, overgeneralized, and catastrophic thinking is leading to stress and upset, get some help to change those thoughts.
Use your social support network. If you don’t have one, create one. In college, there are lots of opportunities to connect to others.
Maintain healthy eating, sleeping, and exercising routines. Among other things, exercise can help lower blood sugar.
Develop relaxing routines such as taking walks, taking up a hobby, or getting into a school activity or group which you enjoy and facilitates relaxation.

University is an exciting time of life for any young person. It is important that we support youth to include those with diabetes in making the most of the experience. It is possible to maintain control of our health and stressors.

Good luck on your journey.

Dr. Paul Longobardi

For information on these and related topics, please see my website at www.successandmindset.com

ARE YOU GRIEVING OR ARE YOU DEPRESSED?

August 28, 2019 Paul Longobardi

There has been much loss over the last several years in the news. With the rise in mass shootings, many individuals have died. Left to mourn are relatives, other loved ones, and friends. However, we all have experiences of death and loss in our lives. In the last month our own family has started to cope with the loss of our beloved niece secondary to pancreatic cancer. Also, I have been working clinically with several clients who experienced the death of loved ones. The times elapsed since the death event have ranged from one month to one year. In all cases, the individuals have asked me a question I've heard repeatedly: "How long should grief last before I return to my normal self?" In each case, I have explained that there is no established time line for when you should be "over" grieving. Usually, the follow-up question is: "Am I experiencing more than grieving, am I depressed?" Now that is a question which is not always easy for mental health professionals to answer, namely, the distinction among grief, complicated grief, and depression.

So just what is grief? Grief is a natural response to loss. It’s the emotional suffering you feel when something or someone you love is taken away. The more significant the loss, the more intense the grief will be. Most people associate grief with the death of a loved one. This is often the most frequent cause of grief. However, there are other losses which can cause grief, such as: divorce; loss of health for self or loved one; loss of job; loss of financial stability; retirement; miscarriage, among others. The more significant the loss, the more intense or severe the grief. Though everyone grieves differently, grieving is a normal process. Yet, it can worsen your quality of life and sometimes involves more serious symptoms when it lasts for a long time. This often is referred to as Complicated Grief. Estimates are that 10-20% of people who suffer from grief go on to suffer from Complicated Grief, a more long lasting and severe form of grief. Studies of complicated grief even have indicated brain changes in several areas (nucleus accumbens and amygdala) having to do with reward and avoidance centers in the brain.

Symptoms of grief can include: an intense pain when you think of your lost loved one; a heightened focus on reminders of your lost loved one; an overall feeling of numbness; a feeling of bitterness when you think about your loss; a loss of purpose or motivation; a loss of trust in friends, family, and acquaintances; an inability to enjoy life. People experiencing grief frequently suffer sleep and appetite disturbances as well as feelings of regret, guilt, or lessened worth depending on the circumstances.

The above symptoms and the profound sadness associated with grief can look a lot like the sadness clinical depression brings. The similarity can create a dilemma for mental health professionals: When should someone experiencing the loss of a loved one be diagnosed as depressed? In our old diagnostic manuals, no one was diagnosed with major depression, a major clinical mood disorder, within two months of the death of a loved one. That has changed with the latest edition of the manual making it easier to diagnose and treat a grieving person with depression.

So I go back to the original title question. Are you suffering from grief or depression? In both forms of sadness, you can experience a loss of interest or pleasure in activities you normally enjoy, as well as changes in sleeping patterns, difficulty concentrating, fatigue and other symptoms. However, there are distinctions. Someone who is grieving typically focuses his or her thoughts on the person who has passed away and experiences intermittent waves of pain rather than the constant pain typical of depression. Research also indicates that in most cases the depression-mimicking symptoms associated with grief tend to lessen over time with the help of family and friends. The support and assistance of family/friends as well as the individual's responsiveness to the support often are contrasted with the isolation and withdrawal of individuals suffering from clinical depression.

In my clinical experience, mindset or beliefs about the loss event have much to do with differentiating between what will remain a grief process and what will turn into a chronic depression. I find that most people are in a crisis at the time of the loss. How they give meaning to it for and about themselves and their lives is crucial. People with more absolutistic thoughts/beliefs about the situation and their lives are at higher risk for clinical depression. For example, I have worked with numerous clients who have suffered the loss of a loved one and said: "I'm sad, I think about them, I miss them". That is grief. Other clients state: "I can't go on with my life without my loved one, I can't trust any more, I can't enjoy my life anymore". These are the clients at risk to be headed for or maybe already in clinical depression. I remember a particularly sad case some years back. A family had brought in their 70 year old grandmother following the murder of her 25 year old grandson approximately six months earlier. She reportedly was sad, withdrawn, not sleeping or eating well. In speaking with her, she told me that she no longer could get close to anyone, particularly the grandchildren, nieces, and nephews, for fear she would lose them too. I only had this one meeting as the family did not return with her despite my recommendations. I learned about six months later that she had died in her sleep. While I can not say with any certainty, the old phrase "died of a broken heart" came to mind complicated by her beliefs about this very sad event for her. My point here is that the beliefs we adopt in resolving our feelings about the losses leading to grief influence whether the reaction remains grief or turns into clinical depression.

In any event, there is help available. Use the support of family and friends. Take care of yourself. Allow yourself gradually over time to re-engage life under the changed circumstances at your pace. If your sadness persists and interferes with your participation in life, consider obtaining professional help. You may need assistance with a clinical depressive disorder for which therapy and/or medications can help. As always, your mindset and beliefs will be critical. If you would like to know more about how stress can interfere with your life, please see our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056. For other information about the book, authors, and stress, please visit our website at www.manageyourhealthandstress.com.

Good luck on your journey. May all your thoughts be helpful ones.

Dr. Paul Longobardi

For information on related topics, please see my website at www.successandmindset.com.

WHAT ARE THE MENTAL AND PHYSICAL HEALTH EFFECTS OF SEXUAL HARASSMENT?

August 23, 2019 Paul Longobardi

Sexual harassment has stayed in the news recently. Allegations of sexual harassment have been leveled at many celebrities of late to include singer Placido Domingo, and a Yale medical professor. The Philadelphia police commissioner has resigned amid sexual harassment allegations. And, of course, there has been the case of the late Jeffrey Epstein dominating the news. It seems that every week there are stories about prominent individuals accused of such behavior. These are only the more well known individuals. Sexual harassment charges and behaviors occur frequently. The majority of the attention has focused on the alleged perpetrators. But just what are the effects on the victim?

First, let's clarify the range of sexual harassment. Sexual harassment can take many forms. Sometimes, it’s just a single sexist comment, an off-color joke, or a comment about how good someone looks. These one time incidents, though annoying, probably won’t have a long term effect on the victim. However, there are some harassment victims who are subjected to humiliation, unwanted advances, inappropriate touching, oft repeated lewd comments, and rape. For these victims, the harassment can take its toll on the person's mental and physical health.

Second, how prevalent is sexual harassment? Most estimates indicate that approximately 33% of women and up to 16% of men have experienced some form of sexual harassment in the workplace. These are lower end estimates. Some surveys have suggested that incidence rates can go as high as 70% for women and 45% for men. Of course, sexual harassment can and does occur in any venue, not just work.

Third, while victims of sexual harassment can experience strained relationships, they are at increased risk for numerous health and psychological effects. Here are some key effects:

1. Negative change in worldview

What are the effects of experiencing street harassment or inappropriate comments at school or in the workplace? What is it like to be groped, ogled, objectified, left to be uncomfortable? Experiences like this are not simply unpleasant at the time, but often inform a woman’s worldview for years to come. They change the way women behave and effect their sense of safety and security in their world. The negative experience continues long after the incident itself in how victims relate to others, plan for events, dress, and view themselves.

2. Depression

Many victims of sexual harassment suffer from chronic, long term depression. They have self doubt, frequently blame themselves, feeling responsible for what happened. I have treated numerous individuals with depression who have histories of sexual harassment and abuse in their backgrounds. They have pent-up hostility, often having been pressured to maintain silence and "not make a big deal of it". They often are accused of being overly sensitive and are re-victimized.

3. Post-traumatic stress disorder

Many studies have found a link between experiences of sexual harassment and symptoms of post-traumatic stress disorder (PTSD), which includes re-experiencing the trauma and avoiding people or things that may remind the victim of the harassment.

4. Blood pressure

In a 2008 study in the journal Social Science Medicine, authors Kriegera, Chena, Waterman, Hartman, Stoddard, Quinn, Sorensen, and Barbeau questioned 1200 Boston union employees about sexual harassment in the workplace and gave them a health exam. Researchers discovered that victims of sexual harassment, 23 percent in all, experienced elevated heart rates and other physiological effects such as stress which can lead to cardiovascular disease. Sexual harassment may trigger the same type of physiological reactions as stress, which is thought to raise the risk of cardiovascular disease. I've written about this link in past posts on stress and cardiovascular effects.

5. Sleep problems

When victims of sexual harassment experience mental and emotional problems, it often leads to such problems as loss of appetite, headaches, weight fluctuations, and sleep disturbances. Sleep disturbances can in turn lead to other serious health problems, such as hormonal imbalance, an increased risk of high blood pressure as mentioned above, and a weakened immune system. The sleep problems in part may be because victims experience stress and anxiety and this affects sleep habits.

6. Suicide

Sexual harassment can increase the risk for suicide. This is due to the effects of depression, anxiety, and the changed world view of victims. Studies indicate increased suicidal behavior following sexual assault. However, in surveys up to 15% of women who had experience sexual harassment, including unwanted sexual touching, reported making suicidal attempts within the past six months.

It is clear that sexual harassment has enduring psychological and health effects for many victims. The high incidence of such behaviors necessitates continuing interventions in schools and workplaces. We need as well a fundamental shift in the way we treat women and model appropriate behavior for young men in their relationships with women. For victims of sexual harassment, if you think you are suffering from the effects noted above, reach out and get assistance. There is no need to suffer without help. In our recently published book on the topic of stress (I Can't Take It Anymore: How to Manage Stress so It Doesn't Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available through Amazon at https://www.amazon.com/dp/1542458056, we discuss the many aspects of stress in our lives. If you would like more information about the authors and the book, you can go to the book website at www.manageyourhealthandstress.com.

Good luck on your journey.

Dr. Paul Longobardi

For information on these and related topics, please see my website at www.successandmindset.com