MARIJUANA USE IN TEENS AND THE STRESSES OF A PANDEMIC

We have just begun National Substance Abuse Prevention Month. I will focus on several different aspects of this topic over the month. For this post, I will look at marijuana use in teens in the context of the stresses of the ongoing pandemic. The Substance Abuse and Mental Health Agency reports that marijuana is the most commonly used illicit substance in the United States, according to results from the 2018 National Survey on Drug Use and Health. An estimated 43.5 million individuals reported using marijuana during the past year. Marijuana use is widespread among young people. There also is indication in several recent Canadian studies that teen use of marijuana has been increasing during the pandemic. It is quite clear that the pandemic presents stresses and challenges for all of us. For teens, their schooling and socialization have been disrupted. They have worries about their parents, finances, future, as well as their own health. However, marijuana use can complicate issues for teens even more so than adults.

Dealing with a teen’s marijuana use often is stressful leaving parents with conflicted emotions over perceived parenting mistakes. Marijuana is one of the main drugs of choice for teens and accounts for 17% of admissions to treatment facilities, second only to opiate use. So what in fact are the use statistics?

In that recent U.S. Substance Abuse and Mental Health Services Administration survey of drug use patterns, in the 12-17 year age group the following was found:

An estimated 7.1 percent of young people in that range were current users of marijuana.

The rate of teens who use marijuana rises with age: 1 percent of 12-13 year olds, 5.8 percent in the 14-15 year range, and 14.2 percent in the 16-17 year range.

It is the most common drug found in drivers who die in accidents, sometimes in conjunction with alcohol or other drugs.

The potency of marijuana (i.e. THC levels) has been rising for over 20 years presenting greater risks and contributing to the increased incidence of emergency room visits due to marijuana.

Given the legalization of marijuana increasing in the U.S., many teens see this as permission to use the substance. However, there are concerning issues pointing to marijuana’s negative effects on the developing brains of teens. Four of these were noted by Dr. Daniel Amen, a noted neuroscience expert:

1. Marijuana increases risk of depression and suicidal behavior. The use of marijuana before age 18 significantly increases the risk of developing depression, suicidal thoughts, or suicidal attempts in a 2019 review of 11 studies.

2. Marijuana impairs cognitive function. Memory, learning, and attention all are affected negatively by marijuana. There is research consistent with the conclusion that teens who use marijuana frequently have declines in IQ, perform more poorly in school, and are more likely to drop out. They have higher rates of unemployment later in life and more dissatisfaction with life.

3. Marijuana disrupts the brain’s maturation process. Dr. Amen noted that heavy marijuana use in teens interferes with brain development damaging the formation of the brain’s white matter which contributes to speed of communication in the brain. There have been findings of higher incidences of impulsivity in teens who started smoking marijuana prior to age 16.

4. Marijuana reduces blood flow to the brain. The effect of low blood flow occurs frequently in the hippocampus, a brain area involved in memory, mood, and learning. On neuroimaging studies low blood flow has been seen with attention deficit disorder, depression, suicide, bipolar disorder, schizophrenia, and more.

Certainly, the effects of the use of marijuana on teens brains and behaviors is not benign despite what legalization advocates have to say. It is never too early to begin discussion with your young person about the issues noted here. Particularly during the pandemic, the time is now. There are various interventions to include meditation/relaxation strategies, learning new skills, exercise, proper diet and nutrition, as well as proper sleep all of which can assist in helping the teen manage the pandemic. However, if that is not working and you suspect marijuana abuse by your teen, there are professional treatment alternatives.

In an article on the effects of marijuana and the teenage brain, Dr. Michael Kaliszewski noted that if you suspect your teen is suffering from marijuana abuse, you should seek professional help. Treatment plans should be customized to address your teen’s unique abuse patterns and any related medical, psychiatric, and social problems. People with marijuana use disorders, especially adolescents, often also suffer from other mental health issues such as anxiety and depression. It is most effective to approach such a dual diagnosis with an integrated intervention, which allows a person to be treated for both their mental illness and substance abuse at the same time.

Although outpatient treatment programs are convenient and will allow your teen to stay in school, some adolescents will benefit more from inpatient treatment. Treatment will likely include cognitive behavioral therapy, an important tool that identifies and changes your teen’s attitudes and behaviors related to substance abuse and other co-occurring problems.

For now, recognize the risks and do not dismiss them. If you would like more information on managing 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 additional information about the authors and book, please consult our website at www.manageyourhealthandstress.com.

It is never too late to change your thoughts and thus 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

SIX STRATEGIES TO HELP YOUNG PEOPLE MANAGE STRESS IN A PANDEMIC

It often is noted that college students face many challenges resulting in stress-related physical manifestationn including sore throats, cough, flu, and upper respiratory problems. It also has been noted that first year drop out rates have been as high as 20%.  In surveys done in past years of more than 153,000 freshman done through UCLA's Higher Education Research Institute, results noted 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.  Of course, that all was pre-pandemic. Now students face all the challenges of social distancing, classes moved online, restrictions on socialization, on-campus living, and of course the risk of contracting COVID-19. In the past, I noted how some colleges try to help with stress reducing activities such as massage therapy and yoga.   While almost everyone agrees that the college freshman year presents many challenges, I continue to wonder if enough time and effort is spent to assist younger people to manage stressors in a capable manner.  There are many 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. Like so much of our world today, these can be taught, discussed, and encouraged through the online venues we use so often now. For more information on stress management strategies, 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 more information about the book and authors, please visit our website at www.manageyourhealthandstress.com. For now, here are 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 final 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 (yes, even during a pandemic). 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 and all college students 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-affirmations 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. There are numerous ways to engage in exercise and physical activity even in a pandemic.

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. During a pandemic, the young still at least will engage one another on social media. However, they can use face time apps as well as the Zoom program likely used in their classes to do all sorts of social and educational activities. There still is some opportunity for limited in person interaction with proper precautions taken.

So let's go back to the struggling, stressed college student facing final exams.  I would suggest that a formalized stress management program early in the first year would cut into the 20% drop-out rate noted above. Given the pandemic, I would recommend the extension of this program to all college students. 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

DO YOU HAVE HIGHER RISK OF DEPRESSION AND SUICIDE IN THE PANDEMIC?

We currently are in National Suicide Prevention Month. Under normal circumstances, estimates are that approximately 8-11% of people over the age of 12 suffer from moderate to severe depression.  During the pandemic, there is evidence that the rate of serious depression has increased. A US Census Bureau survey found that 44% of Californians reported levels of anxiety and depression commonly associated with diagnoses of generalized anxiety disorder or major depression. The signs of serious depression are many and include:

1. Prolonged sadness or irritability

2. Sleep and appetite disturbances

3. Loss of energy

4. Less interest in pleasurable activities

5. Feelings of guilt and worthlessness

6. 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. As we all know, the COVID pandemic has resulted in high unemployment, worries over health, and financial chanllenges. So it is no wonder that rates of depression are rising. 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.  

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 annual economic burden of depression is $83 billion and the majority of this cost (62% or $52 billion) is due to lost workplace productivity.  It is not uncommon for depressed workers to have poorer on the job performance.  

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 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, even during a pandemic.  You do not need to continue to suffer. There is help. The National Suicide Prevention hotline number is 800-273-8255.

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

For additional information on these and related conditions, please consult my website at www.successandmindset.com

Good luck on your journey.

Dr. Paul Longobardi

WOULD LAW ENFORCEMENT OFFICERS BENEFIT FROM STRESS REDUCTION STRATEGIES?

It is impossible to ignore the frequent ongoing violent interactions between law enforcement personnel and the people of the communities they serve, often African American and Latino communities. There have been fatal shootings and encounters between citizens and police officers.  I came across my post from almost four years ago and realized unfortunately that not too much has changed from then. Now, most people would agree that the work of law enforcement is stressful.  They have shifting work schedules, disturbing crime scenes, emotional and upset victims and community members, among other challenges.  Officers lose sleep and frequently suffer from depression, anxiety, and the physical manifestations of stress.  They are required to deal with difficult emotional states on a daily basis. They have one of the highest rates of suicide on the job of any profession.  Is it any wonder that the life expectancy for retired police is only 10 years on average? Yet, the more that they are stressed, the more likely they are to respond aggressively or with intimidation to volatile situations, putting themselves and others in danger.  Is there any help for this situation? For me, the answer to the question posed in the title of this post is a resounding yes.  Stress reduction strategies such as mindfulness, progressive muscle relaxation, and yoga are being used to reduce the harmful effects of stress. For additional information about stress, 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 additional information about the book and authors, please visit our website at www.manageyourhealthandstress.com. In an article by Jill Suttie titled "How mindfulness is changing law enforcement" in the online publication Greater Good: The Science of a Meaningful Life, she described applications of mindfulness with police officers in El Cerrito, California.  She noted that a team of a police officers and a facilitator from the UCLA Mindful Awareness Research Center conducted mindfulness practices, such as mindful breathing and body scanning (also components of progressive muscle relaxation training and yoga).  The presentation of scientific findings was critical to acceptance by law enforcement officers.  Mindfulness has a strong scientific basis.  There are numerous studies showing that it can decrease stress, pain, anxiety, and depression in many groups.  The application of mindfulness on the job has been shown to help employees reduce stress, improve communication, increase job safety, and improve job performance.  There have been studies in which police officers who went through mindfulness training in their first year of training experienced less depression.  Other studies with mindfulness and officers have shown reduced perceived stress, burnout, anger, sleep disturbance, and improved physical and emotional health.   By regulating officers' reactions to stress, mindfulness assists police in increasing the consideration of options even when under a degree of threat and without responding with automatic behaviors to include intimidation or violence.  Through mindfulness, as we become more aware of our emotional responses to situations, we can consider more possible options as to how to respond.  For police officers, this can include increased listening, caring, respect, and restraint. For many in law enforcement, this is in stark contrast to the dominant culture of restraining, dampening, or ignoring emotions.  One of my professors used to say that "there's no such thing as unexpressed resentment".  What he meant was that we can not ignore our emotional states. They will find a way to expression whether for good or to our detriment. Mindfulness training can help police officers, as well as the rest of us, to be more self-aware, lessening our human tendency to restrict choices under stress.

Such approaches are not a panacea for curing all the problems for American law enforcement officers. However, stress reduction strategies can assist in helping improve the well being of our communities as well as officers, as a result of greater openness to communication between the groups.  As I have written on many occasions, stress is a choice.  While acknowledging there are challenging situations, your ability to be more aware of your thoughts, emotions, and physical manifestations can help you make better choices while under stress.  That would be a good thing for all of us, community members and law enforcement.  

Good luck on your journey.

Dr. Paul Longobardi

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

CAN YOU OVERCOME YOUR FEARS DURING A PANDEMIC?

The answer to the question posed in the title is yes. Let’s look at this in some detail. Living through the challenges of the pandemic affect all of us in some ways, more for some people than for others. Yet, we all strive for success in our businesses and in our lives.  However, there are times such as these when fear gets in our way.  It is a part of our "inner game" in contrast with our "outer game".  These are times when often we are faced with something we have never done. For many, it’s coping with the changing nature of businesses. For others, it’s how to adapt to changed home life, finances, and the education of our children. Coping with changes can bring out our inner voices. The inner voices are those messages we say to ourselves when we think that we don't meet expectations. They begin to surface.   Why try?  I can't do it.  These words and the beliefs behind them leave us vulnerable to crippling doubt, anxiety, indecision, and lack of action.  In short, they leave us vulnerable to fear and stress.. The manifestations of stress are multiple including cognitive, physical, emotional, and behavioral. Stress has many negative effects on us. For more information about stress, 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 more information about the book and authors, please visit our website at www.manageyourhealthandstress.com. For now, consider that your inner game needs to be just as strong as your outer game to reach the next level of success in your business and life. When you hold yourself back it is time to look at your inner voices and beliefs, your mindset. Identify the limiting thoughts which are getting in the way. As I have said on many occasions mindset is the key element for success in meeting challenges in business and life.   Use it to your advantage. Get really honest with yourself about whether avoidance, sabotage or perfectionism are happening. Figure out the underlying belief, the root cause, to break free from your self-imposed obstacle to success. 

Usually one of four main fears stops many of us from saying yes to growing our business and lives. The inner critic, those limiting beliefs, and your fears contribute to performance anxiety, perfectionism and poor management of your focus and energy. These main fears include fear of failure, fear of making mistakes, fear of disapproval and fear of success. F.E.A.R. is often considered an acronym. It means False Evidence Appearing Real. It is not what needs to be done to manage your life and business. The fear comes from how you look at it. Others had already done what you are facing. Now it is your turn. Fear, worry and doubt will take you out of life if you allow it to do so.  You will know if you are ready to take action and do things differently.

Here are five steps to quiet the inner voices and defeat your fear.

1. Figure out what is the underlying reason you are holding yourself back. You need to figure out what is happening. It may be old experiences, memories or messages we heard repeatedly which cause us to stay where are instead of taking a risk or trying something new.

2. See if you can come up with alternative ways of looking at things. List as many different points of view as you can think of. Choose the one you like best. Try it on and see how it feels.

3. Focus on the reason why you want to reach your goal. Connect with your purpose. A lack of purpose and meaning in life is one of the primary reasons for the malaise so many people suffer. Take some time to think about yours, even in a pandemic with all its challenges.

4. Visualization. It is a powerful tool. Imagine yourself taking action. As you are doing this your brain is making changes preparing you for taking action. Many successful people take the time to see themselves doing that which they fear and visualization is helpful in overcoming fear and getting things done.

5. Finally, focus on the small steps right in front of you. The small actions you take today will take you to your goal.  As you take action, you overcome the doubts and fears holding you back. 

Identify, challenge, and replace the limiting beliefs you have and interrupt the little voices in your head holding you back.  Remember, 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

SEVEN TIPS ON MAINTAINING FOCUS AND REDUCING STRESS IN A PANDEMIC

There is no doubt that people are experiencing increased stress during this pandemic. The stress is manifesting itself in many ways including mental health challenges such as anxiety and depression.  In this post, I will discuss the importance of maintaining focus as it affects your well being.  The correlate is that the lack of focus contributes to increased stress.   For more information about stress, 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 more information about the book, authors, and stress, please visit our website at www.manageyourhealthandstress.com. In today's fast moving world with threats to your health, finances, and social world,  maintaining your focus is one of the biggest personal challenges. We lose much mental energy due to mental overwhelm and information overload. This sense of overwhelm and inability to keep up with the daily flow of information, interactions, and distractions is a significant cause of stress and decreased wellness for many people. Why is your mental energy not as focused as you would like right now?  In working with thousands of patients and clients over four decades, see if any of the following apply to you: easy distractibility; negative thoughts and self-talk; excessive self-criticism; perfectionism; unrealistic multitasking; low self-esteem; information overload; procrastination; poor sleep and diet; lack of exercise? Imagine how greater focus could increase your energy and productivity and reduce your stress level.

Consider some of the following tips to help you maintain more laser focus:

1. Stop multitasking  If you are easily distracted as you try to concentrate on a project, you are not alone. Mental distractions create energy dissipation. Think of all the distractions throughout your typical day: a phone rings, an urgent email pops up, somebody interrupts your train of thought, etc. A common response is to multitask, but multitasking doesn't work. Our brain cannot do parallel processing if it requires conscious awareness. Multitasking is really rapid task switching. The more complex and unfamiliar the tasks are, the longer it is going to take to switch between them. Multitasking causes distractibility and interferes with the completion of either task. 

2. Create awareness and use mindfulness. We can experience more focus if we become aware and give our full attention to the present moment. As we cultivate awareness, we gain a state of clarity. Similarly, when we are truly present and aware, our perception is heightened. We notice things we wouldn't otherwise. We experience more insights. We respond to situations as they arise without stress or worry generated by mental distractions. To experience this mental clarity, consider the use of mindfulness, meditation, or progressive muscle relaxation.  Close your eyes, turn off any sound, and be still and quiet for a few moments. Neuroscience research suggests the brain needs about two seconds to deactivate the current circuits and enable an insight to emerge into conscious attention.

3. Identify, write down, and challenge your disruptive and disturbing thoughts. When you feel hampered by persistent negative thoughts, write them all down and set the time when you will review the list. Writing thoughts down decreases their negative influence on the mind. When your scheduled time comes, review the list and determine which thoughts actually have any truth to them.  Globally judgmental statements about yourself such as "I can't do this; I never do things right" deserve to be challenged and changed.    

4. Break down your projects into achievable pieces.   Decide why you are doing the project or task in the first place.  This  provides motivation and momentum to move forward.  Break your project into well-defined goals that will serve as the milestones for your work. Use SMART goals: Specific; measureable; achievable; realistic; time limited.   Make them big enough to really stretch your comfort zone. We often underestimate what we can achieve.  Visualize your outcome.  The power of visualization often is underestimated in terms of mental focus.  See the outcome occurring for you.  Identify the cost of your goal.  Set deadlines for each goal.  Schedule portions of your day when you can accomplish a piece of the overall project and achieve a milestone.  For now, breaking down your goals into achievable pieces helps maintain a focus which reduces stress.  

5.  Be willing to accept uncertainty. How comfortable are you with uncertainty? What stops some people from pursuing their dreams and their mission is fear of the unknown. Interestingly, uncertainty can actually add to our motivation.  When we take risks, we face uncertainty and unknown likelihood of reward. The anticipation of uncertain rewards has been linked to increased production of the neuromodulator dopamine, which is responsible for a more focused attention and more pleasurable experience. A degree of uncertainty helps keep interest, motivation, and excitement going.  

6.  Celebrate your victories.  Don't wait for the next holiday to start a celebration. Celebrate victories large and small during your day.  If you wait for only a major accomplishment, you may lose motivation, interest, and focus.  We all should be able to celebrate something each day.  Look for your accomplishment and celebrate it.  It helps keep your mindset in a more positive frame by doing so.  I'm grateful to trainer Blair Singer for this perspective.  

7.  Find people who help elevate you.     Sometimes, all we need to do to get energized is to talk to certain people.  It often is said that you should try to be around people who are doing what you want to do or are where you want to be.  Most likely these will not be people who drain your energy and focus but rather encourage or stimulate you to increase your energy and focus.   As you take more personal responsibility for your energy it likely will have the effect of attracting more people with positive energy into your life. With some practice and conscious choice, you will be that person with the focus and personal energy around whom others want to be. 

Think about what one improvement you can make today to maintain your focus and productivity better.

Good luck on your journey.

Dr. Paul Longobardi

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

DOES YOUR TEEN HAVE ANXIETY IN THE PANDEMIC AND WHAT CAN YOU DO?

Even when we are not in a pandemic, 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. During the current pandemic, estimates of the presence of clinically significant anxiety in adolescents are increasing.

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. With all the anxiety driven by the pandemic and associated issues for teens, 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. Generation Z (16-20-year-olds) individuals log on average 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 even if it is face to face such as on Zoom, exercise, engage in social activities taking COVID precautions, read and even do homework are happier than those who spend most of their time on technology devices or watching 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. I realize there are challenges to doing so in a pandemic but face-to-face contacts can be beneficial.

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 have written about this in other posts including the pressures leading some parents to define youth in terms of their achievements. 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. They certainly have had enough challenges lately with cancellations of social events and sports at school, having to learn via online means, etc.

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 have added 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. Of course, now such activities are not permissible during the pandemic. However, the fear around contracting a potentially fatal illness and/or spreading it to loved ones causes increased anxiety. It is recommended to reduce teens’ exposure to the negative news cycles on television and online. Limit the exposure to pandemic news. This also is good advice for adults. Talk to them about taking what control they can by observing healthful practices such as wearing masks, keeping social distances, and frequent hand washing. In addition, teach them stress-management techniques to soothe anxiety. I have written about these in other posts but they can include diaphragmatic breathing, progressive muscle relaxation, mindfulness training, or using yoga or meditation.

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. During this time of pandemic, there is a tendency to overeat at the same time many teens and adults have reduced activity levels.

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 someone new they meet 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 I 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. However, I would recommend using the widest range of nonpharmacological approaches first unless your teen appears to have severe and disabling levels of anxiety. 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

MIGHT SILENCE HELP YOU AND YOUR CHILD'S BRAIN DURING THE PANDEMIC?

As we all stay home more these days either from work or school, there is a likelihood of more noise in the home than usual. So what you say? Well, there is a scientific literature studying the effects of noise pollution on cognitive performance and emotional well being. It has been found that noise is detrimental to performance at work and school. Noise also has an effect on decreasing motivation and increasing errors. The cognitive functions most affected by noise have been shown to be attention, memory, and problem solving. Even worse, studies also have shown that children exposed to homes or classrooms near airplane flight paths, railways or highways have lower reading scores and are slowed in the development of cognitive and language skills.

So is there any hope for us in a noisy world? Yes, there is more than you might think. In a recent article, author Rebecca Beris wrote how “Science Says Silence is much more important to our brains than we think” (https://www.lifehack.org/377243/science-says-silence-much-more-important-our-brains-than-thought ). There appear four ways in which silence benefits our brains:

1. Silence may help regenerate brain cells. In studies with mice in 2011 in the journal Brain, Structure and Function, the authors were studying different types of noise and silence. While silence was considered a control condition, it turned out that when mice were exposed to two hours of silence per day they developed new cells in the hippocampus. This is the area of the brain having much to do with memory and learning. So you say these are mice and I can’t spend two hours per day in silence. Alright, it will get even better.

2. The brain internalizes and evaluates information during silence. Several years ago, in Frontiers in Human Neuroscience, author Joseph Moran noted that even when the brain is resting, it integrates internal and external information. It helps you think in imaginative and novel ways.

3. Silence relieves stress and tension. Studies have shown that noise has an effect on our brain of increasing the levels of stress hormones. It is thought that the amygdala, an area associated with emotion and memory formation, is activated during noisy periods and releases stress hormones. If you live in a noisy environment, you likely will experience chronic stress activation. In fact, children exposed to chronic levels of noise develop a stress response that helps them to ignore the noise. However, what is of concern is that the children not only ignore noise but also things to which they should be paying attention, such as speech. Silence has an opposite effect. It releases tension in the brain. Here’s an even better part. In a study in the journal Heart (Larsen and Galletly, Heart, 2006, April 92{4}, 433-434). it was noted that two minutes of silence can be even more relaxing than listening to so-called “relaxing” music. This was based on changes observed in blood pressure and blood circulation in the brain. Now I think we all can carve out two minutes of silence per day for our cognitive and emotional well being.

4. Silence replenishes your cognitive resources. When you are in a place of lower sensory input (noise) your brain can recover some of the cognitive functions mentioned earlier such as attention, memory, and problem solving.

So silence is a safe, low cost, and effective way to enhance our brain function as well as relieve stress and tension. Since most of us live in a very noisy world, consider the benefits of silence for you and your children. Just two minutes can help. If you want more information about stress management, please acquire 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 see our website at www.manageyourhealthandstress.com.

Best of luck on your journey.

Dr. Paul Longobardi

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

HOW ARE YOU DOING WITH THE STRESS OF THE PANDEMIC?

Alas, as we all know, some days do not start out well as there are many frustrations which occur in life. Need I name them?  With the pandemic, we have hand washing, masks, social distancing for starters. There are worries about contracting the virus. There are issues around employment and finances as well as understandable concerns about children returning to school. Because of the social restrictions, more people are at home. There have been documented increases in domestic violence and alcohol use. Get the picture?   So how do you deal with these upsets?  You can let them take you to a level of distress where you declare, "This day is awful", or my favorite, "I'm so stressed".  When this happens, your day will spiral downward.  But it does not have to be this way.  You can make a conscious choice to be less upset and happier. A lot of this choice has to do with what thoughts you think when upsetting events occur.  I remember watching a television program where the interviewer was speaking with an Army Captain in Afghanistan about how he managed to control his reaction to stressors, such as getting shelled with rockets.  The Captain pulled out a laminated card he kept in his pocket and read his Rule #1: My thoughts cause my feelings, control my thoughts and control my feelings.  Yes, you can turn a potentially bad day into a good one.  Dr. Shawn Achor, author of "The Happiness Advantage", noted that “Studies show that when you’re positive, you’re 31% more productive, you’re 40% more likely to receive a promotion, you have 23% fewer health-related effects from stress, and your creativity rates triple.”  So what can you do?:

Catch your bad mood quickly. I tell this to my patients and clients all the time. It is easier said than done. Even harder is to identify the source of your distress rather than globally saying "I feel bad, awful, etc.". The faster that you even notice that you have a bad mood, the quicker you can do something about it. This happened to me recently. I realized I was feeling frustrated and checked myself. I noted that I was upset because "I'm behind on several projects". What else might you say to yourself about this which would be even more upsetting? How about, "I never get anything done, I'll never catch up, I'm not very capable"? As you can imagine, the latter statements are thoughts which will drive more upset and distressing emotions. We have discussed how to challenge these overgeneralized and untrue thoughts 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 details about the authors, book, and stress, please visit our website at www.manageyourhealthandstress.com. However, recognizing the thought is half the battle.

Find something for which you can be thankful. Did you know that neuroimaging studies show that it is very hard to be distraught and thankful at the same time? So ask yourself what are one or two good things going on at this time? In my case, it was that I was making some progress on opening over a week's worth of mail and was looking forward to seeing family members on Zoom a little later. This helped restore perspective on what otherwise looked like a bad day.

Take an action. This will help interfere with and disrupt the negative trend. As I noted, I was making progress on opening, sorting, and discarding over one week's mail. I was able to record a victory, albeit a small one. Speaker/trainer/author Blair Singer, in his book "Little Voice Mastery", says we do not celebrate the small victories in our daily lives often enough.

Do something different. Change your routine even a little. Take a walk properly distanced, listen to music, learn something new (how to work Zoom is not a bad idea these days). Or, take some deep breaths. This suggestion is particularly relevant during the restrictions associated with the pandemic. As neuroscientists know, breathing helps activate areas of our prefrontal cortex involved in positive, pleasant emotions.

Re-evaluate your expectations. If you set unattainable expectations, you're headed for a bad day. If I expect that I will complete multiple chapters on several books, review all correspondence, open over one week's mail, handle multiple administrative tasks, all in the course of a half day, than I'm likely doomed to failure. It would be better for me or you to write down several short and attainable goals for the day. If you meet or exceed them, good, you will feel better. Again, be sure to celebrate your small or partial victories. If you want more information on goal setting, please see my teacher Raymond’s Aaron’s excellent book “Double Your Income Doing What You Love”. Using his MTO system, he teaches you how to set each goal at three levels—Minimum, Target, and Outrageous—so that you can begin to move ever closer to fully creating, and then living, the life of your dreams.

Learn from your day. Use the three part formula for helping to reduce future bad days and learn from them. First, note what went well. Second, note what did not go so well. Third, decide on what you can learn from the event and make a plan to build on the positives. Either avoid or know how to deal better with the stressors which triggered your negative thoughts and feelings. I use this formula all the time with myself and with my patients and clients. It really helps.

While you can not control upsetting things happening in your personal and work life, you can control how you choose to respond to them.  Stress is a choice and so is happiness.  

Change your thoughts and change your results. Good luck on your journey.

Dr. Paul Longobardi

For information and posts on these and related topics, go to my website at www.successandmindset.com

FOUR INFLUENCES ON HOW MUCH PANDEMIC STRESS YOU CAN MANAGE

How much stress can you manage? You can answer that for yourself.  However, some people take on far too much responsibility and stress and are long overdue for a stress related health crisis. Certainly, many of the COVID-19 pandemic challenges are major stressors. These include isolation from others, work, business, and finance issues, limited recreation, and of course worries about contracting the virus itself. All of these forces got me thinking about how we manage our own life demands, whether large or small. How much stress is too much?

We all know that each of us is unique with a set of life experiences which may help or hinder us in managing life stresses.  In fact, we go into great detail on this 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 other information on stress, please see our website at www.manageyourhealthandstress.com. But for our purposes here, there are other factors which affect our vulnerability to stress. These include our personality, hardiness, self-efficacy, and core beliefs about events (attributions).  

Type A & Type B Personality. Over 40 years ago, cardiologists Friedman and Rosenman described two personality types with differing proneness to risk for heart attack. The person with a Type A personality is competitive, wants to be recognized, seeks development and advancement, looks to achieve goals and tends to rush in order to finish tasks. Does this sound like anyone you know? On the other hand, the person with Type B personality was opposite to that of the Type A person. It's not that the Type B person has no motivation but rather is described as calm, relaxed and non-competitive. In a longitudinal study with males, the cardiologists found that there was far greater incidence of heart attack in the Type A group. Individuals classified as Type B managed stress better than Type A persons. Many stress management programs include components to help individuals become more calm and relaxed, such as the Type B group.

Hardiness. It is well known that part of the negative stress response involves a feeling of loss of control over your world, whether personal, work, or health as during this pandemic. People described as "hardy" have been found to have three characteristics: 1) Control - you see yourself in charge of your world and not the reverse; 2) Commitment - you confront problems and won't stop until you solve them; and 3) Challenge - you see change in your life not as a threat but rather as a challenge. In studies of people divided into "hardy" and "non-hardy", results have shown that the hardy groups were less frequently ill and responded to stressors in a more positive way. These factors influence our immune system which can affect your risk for complications of COVID-19 virus. Do you employ the three C's in your world in coping with life's stressors?

Self-Efficacy. This term was used by Dr. Albert Bandura whose work I studied as a graduate student. Self-efficacy refers to a person's tendency to perceive a sense of mastery in a stressful situation. Instead of saying "I can't handle this", the self-efficacious person has a history of experiences leading them to feel able to confront stress situations more positively and say "I am able to handle stress and I can handle this one as well". This all has to do with your internal beliefs. If you have low self-efficacy, you are more likely to have more negative feelings under stress and manage events less well. Can you see how having a sense of self-efficacy might help you during the stresses of a pandemic world? Would you describe your view of self in stress situations as one of self-efficacy?

Core beliefs. These are similar to the concept of self-efficacy but more broad in terms of your life. Core beliefs are your more general beliefs about your likeability and capability in many areas of your life. Your beliefs enable or limit you. They create a negative reaction to stress or limit the negative reaction. If your view of you is one of self-doubt and self-deprecation, you will have a more difficult time dealing with a challenge such as an illness, relationship problem, or work demand. Are you able to question your negative or limiting beliefs? If so, you will manage your stressors more positively.

We all have a capacity to change.  Numerous studies have shown that even under the most stressful circumstances, the physiological manifestations of stress (hypercortisol levels, for example) can be changed by manipulating the psychological context of the stress and the attributes given it by you.  These include personality, hardiness, self-efficacy, and core beliefs. So how much stress is too much?  As you can see, it is not a simple answer and varies by individuals.  However, you can handle more than you might have thought using some of the ideas above.  How well are you doing?  Stress is a choice. You may not be able to avoid a stressful event but you can change your response to it in a more positive way.  

Good luck on your journey.

Dr. Paul Longobardi

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

HELPING YOUR CHILD THROUGH THE PANDEMIC WITH MINDFULNESS STRATEGIES

In recent years, there has been growing discussion about and awareness of the benefits of activities such as yoga, meditation, and deep breathing exercises. These are all strategies which help us calm ourselves and focus on the present moment.  Most frequently, the discussion has centered around workplace issues. There is a body of research showing that the above exercises lower stress, reduce anxiety, improve sleep and general health, and reduce depression and pain.  Meditators have been shown to have increased brain activity in areas known to induce calming effects, such as the anterior cingulate cortex.  Calm breathing triggers the parasympathetic nervous system which reduces stress through slowing heart rate and lowering blood pressure.  But for all this work, less attention had been paid to the potential positive effects of mindfulness strategies for children.  That is changing with articles such as in Time Magazine for October 3, 2016, titled "The Mindful Classroom" by Mandy Oaklander, as well as multiple online articles such as "Why Children Need Mindfulness Just As Much as Adults Do" by Carolyn Gregoire of the Huffington Post .   Being mindful essentially is the ability to sustain a focused awareness on the present moment. Mindfulness practice has been shown to increase our abilities to focus and attend.  It may be as effective for children as it is for adults.  Research is accumulating to demonstrate that mindfulness has positive effects for many challenges children confront.  One current challenge is managing their reactions during a pandemic. It is clear that education for children has been disrupted severely. Children also have to worry about missing friends, getting too close to other children, as well as the challenges for the adults in their lives. These are highly stressful events leading to increased anxiety. Children increasingly face stress and this can affect their health including as adults.  In Gregoire's article, reference was made to a University of Florida study that found that "stressful events can impact a child's health and well-being almost immediately, and can contribute to the development of physical and mental health problems and learning disabilities".  

For more 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 more information about the book, authors, and stress management, please visit our website at www.manageyourhealthandstress.com. Most research on mindfulness with children has been done in school settings.  There is evidence that youngsters as young as four years who practice the skills have reduced test anxiety and fewer ADHD symptoms.  There also has been noted improved sleep quality and math scores.  Various authors have suggested that the positive effects can include social skills such as improved compassion and kindness. There have been benefits in studies with children with ADHD in reducing disruptive behaviors. Mindfulness programs achieve incremental benefit when the teachers and/or parents also engage in such training. I was so engaged this past weekend while my six-year-old grand daughter was visiting. She proceeded to practice relaxation strategies with me, including listening to calming music, diaphragmatic breathing, and using visualization to go to what she described as “happy places”. She uses these approaches to help sleep as well as reduce stressful moments. To give an idea of ways you can involve your children in mindfulness, here are five of Sarah Rudell Beach's from her post titled "8 Ways to Teach Mindfulness to Kids" in the Huffington Post for September 22, 2014:

1. Listen to the bell. An easy way for children to practice mindfulness is to focus on paying attention to what they can hear. You can use a bell or a set of chimes. Tell your child that you will make the sound, and they should listen carefully until they can no longer hear the sound (which is usually 30 seconds to a minute).

2. Practice with a breathing buddy. For young children, an instruction to simply “pay attention to the breath” may be hard to follow.  One way is for each student to grab a stuffed animal, and then lie down on their back with their buddy on their belly. They focus their attention on the rise and fall of the stuffed animal as they breathe in and out.  Other ways include placing one hand on the chest and one on the belly to allow the child to follow and focus on their breathing. Another is involving your psychologist grandfather in the process.

3. Make your walks mindful. Go on a “noticing walk.” As you walk in the neighborhood, notice things you haven’t seen before.  A favorite of my grand daughter when she was younger was to do the exercise "I spy with my eye something . . ." and then encourage her attention.  You also can designate one minute of the walk to be completely silent and simply pay attention to all the sounds you can hear.

4. Establish a gratitude practice. Gratitude is a fundamental component of mindfulness, teaching children to appreciate the abundance in their lives, as opposed to focusing on all their material possessions.   

5. Practice mindful eating. The exercise of mindfully eating a raisin or a piece of chocolate is a staple of mindfulness education, and is a great activity for kids. 

In other posts, I have written about what I perceived to be the potential power of teaching youth how to overcome limiting thoughts.  If we can combine that with teaching mindfulness strategies, we can raise a new generation of children well able to manage their stresses, manage a pandemic, be happier, and get along better with others.  

Good luck to all on the journey.

Dr. Paul Longobardi

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

WEIGHT MANAGEMENT AND STRESS DURING THE PANDEMIC

Some time ago, before the pandemic, a friend had gone to a weight management class through their membership in a large Health Maintenance Organization (HMO).  The friend mentioned how much time in the class was spent on discussion of stress as a cause of overeating and stress reduction strategies as part of an overall weight management program.  That interaction reminded me how large a role stress plays in overeating and weight management. Lately, I’ve been thinking about that as our pandemic related lock downs and restricted activities have combined with stay at home eating (or overeating). More people are less active, and many are eating more ultra-processed foods than they might otherwise. Add the anxiety that comes with a deadly pandemic and you’ve got an ideal situation for weight gain. In a poll of more than 1,000 U.S. readers of WebMD, nearly half of the women and almost one-quarter of the men said they’d gained weight “due to COVID restrictions.” A separate poll of 900 international readers found more than half of men and about a third of women reporting weight gain. Among WebMD readers, 70% in the U.S. and 35% internationally cited “stress eating” as a cause of their weight gain. Furthermore, alcohol use has increased as well with impacts on our weight. One report showed that sales of alcoholic beverages went up 55% in the early days of the lockdown. Drinking tends to make you gain weight. With alcohol you have many empty calories. And alcohol loosens our inhibitions, including those related to eating. Finally, alcohol interferes with your sleep. While you may fall asleep quickly, you probably won’t sleep soundly. The next day, you can’t stop eating says Kristin Kirkpatrick, dietician at the Cleveland Clinic. In fact, I have seen cartoons and posts on social media such as Facebook stating how we all may need weight reduction programs when the pandemic finally ends. While those posts are offered in some jest, there also appears to be truth as well.

But, you say, why is this happening to me?  Doesn't stress cause you to have less of an appetite?  Well, yes in the short run but more long term or chronic stress actually increases your appetite.  Most of us overeat when we feel a lot of pressure. This happens because of our fight/flight response.  This is when our body goes into survival mode. A major reason for this response is hormonal.  When your brain detects the presence of a threat, no matter if it is a tiger or bear or finances or a pandemic,  it stimulates release of chemicals that include adrenaline and cortisol.  You become more alert, ready for action and able to withstand an injury. In the short-term, adrenaline helps you feel less hungry as your blood flows away from the internal organs and to your large muscles to prepare for “fight or flight.” Once the threat is done, cortisol, sometimes referred to as the "stress hormone", lingers and signals your body to replenish your food supply as well as store fat and glucose (sugar).  Now in the days of fighting or running from saber toothed tigers, you would have used much energy and calories. However, in modern society,  sitting at desks or on couches worrying about your stressors does not expend much energy at all. Yet, your neuroendocrine system acts as if you used up many calories and encourages you to replenish those calories, even though you don't need to do so. .Levels of cortisol rise during times when you feel tense. This can turn your overeating into a habit. Because increased levels of the hormone also help cause higher insulin levels, your blood sugar drops and you crave sugary, fatty foods.  Alas, excess cortisol also slows down your metabolism, because your body wants to maintain an adequate supply of glucose for all that hard mental and physical work dealing with the threat.  You store extra body fat because your stomach has an ample supply of blood vessels and cortisol receptors to make the whole process flow more efficiently. The downside is that excess belly fat is unhealthy and difficult to eliminate. The fat releases chemicals triggering inflammation, which increases the likelihood that you will develop heart disease or diabetes. For more information about how stress affects you and what to do about it, 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 more information about the authors, book, and stress, please see our website at www.manageyourhealthandstress.com.

So what happens when you feel anxious?  You get a surge of adrenaline and feel fidgety and active.  You may engage in "emotional eating".   Overeating or eating unhealthy foods in response to stress or as a way to calm down is a very common response even when we are not in a pandemic. In a survey on stress by the American Psychological Association,  40% of respondents reported dealing with stress in this way, while 42% reported watching television for more than 2 hours a day to deal with stress. Anxiety can also make you eat more “mindlessly”, i.e. without paying attention to what you are eating, how it tastes, how much you've eaten, or your feelings of fullness.  And you will gain weight.  You also will crave fast foods, sometimes called comfort foods as consuming sweet foods often satisfies our brain's reward systems. Comfort foods, e.g chips and ice cream, are high in the fat and sugar which cortisol craves to help you replenish supposedly lost calories.  Also, poor sleep driven by worries and stress and alcohol contribute to fatigue, lower blood sugar, and disrupted functioning of ghrelin and leptin, chemicals which control appetite.

So what can you do to maximize proper weight management even when you are stressed and living through a pandemic? Here are some ideas:

Get your proper exercise. Don't skip your workouts. Exercise can decrease cortisol and trigger release of chemicals that relieve pain and improve mood. It can also help speed your metabolism so you burn off whatever you may have eaten. I know that fitness centers have been closed until very recently. However, you can walk around the block properly socially distanced and/or with a mask as needed.

Engage in stress reduction strategies such as yoga, meditation, mindfulness, progressive muscle relaxation. All of these strategies encourage you to focus on your own immediate reality, pay better attention to your physical self, and reduce worry and anxiety.

Get your proper rest and sleep. Avoid overeating in the evening, consuming stimulating beverages such as coffee, and use stress reduction strategies as discussed above.

Be more aware of what you are eating. Sometimes referred to as mindful eating, pay attention to what you are eating, slow down eating, attend to the feelings of fullness, and avoid emotional overeating. One way to reduce emotional overeating has been to focus on the future rather than on the present when inclined to eat comfort foods. Research has shown that when focusing on the future people make healthier choices in foods.

Find Rewarding Activities Unrelated to Food. Take a walk, read a book, increase your socialization with family and friends even if by Zoom. These can help you relieve stress without overeating. But you say that you don't have time with all your stressors. Making and taking the time to do so will help you relieve stress, think more clearly, feel happier, and be less likely to overeat.

Check yourself for proper mindset. As I always say, become more aware of what you say to yourself about yourself. If you have too many thoughts like "I can't handle my stresses", "I'm overwhelmned by this pandemic", "I'll never get out from what challenges me", then it's time for a mindset do-over. Challenge the above thoughts and remind yourself how many times you in fact have handled stressors. Remember that help is available in many forms. Keeping negative thoughts in your mind also will result in your reaching for "comfort foods" with all the additional problems that will cause.      

Remember that your response to stress including a pandemic is a choice.  It is not preordained. Overeating is not inevitable in the face of life pressures of life or a pandemic.  Take control of your life.

Good luck in your journey.

Dr. Paul Longobardi

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

MIGHT STRESS REDUCTION STRATEGIES ASSIST POLICE OFFICERS?

In recent years, and particularly in the last several months, a troubling focus in our society has been on problematic and frequently violent interactions between law enforcement and the communities they serve, particularly African American communities.  There have been fatal shootings of citizens under questionable circumstances, protests, and calls for defunding police departments.  Most people would agree that the work of law enforcement is stressful.  They have shifting work schedules, disturbing crime scenes, emotional and upset victims and community members, among other challenges.  Officers lose sleep and frequently suffer from depression, anxiety, and the physical manifestations of stress.  They are required to deal with difficult emotional states on a daily basis. They have one of the highest rates of suicide on the job of any profession.  Is it any wonder that the life expectancy for retired police is only 10 years on average? Yet, the more that they are stressed, the more likely they are to respond aggressively or with intimidation to volatile situations, putting themselves and others in danger.  

Is there any help for this situation? For me, the answer to the question posed in the title of this post is a resounding yes.  Stress reduction strategies such as mindfulness, progressive muscle relaxation, and yoga are being used to reduce the harmful effects of stress.  In some recent articles, there has been study of the application of stress reduction strategies for police officers. For example, there have been applications of mindfulness with police officers in El Cerrito, California.  A team of a police officer and a facilitator from the UCLA Mindful Awareness Research Center conducted mindfulness practices, such as mindful breathing and body scanning (also components of progressive muscle relaxation training and yoga).  The presentation of scientific findings was critical to acceptance by law enforcement officers.  Mindfulness has a strong scientific basis.  There are numerous studies showing that it can decrease stress, pain, anxiety, and depression in many groups.  For a fuller discussion of stress reduction strategies, 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 additional information about the authors, book, and stress management, please visit our website at www.manageyourhealthandstress.com.

The application of mindfulness on the job has been shown to help employees reduce stress, improve communication, increase job safety, and improve job performance.  There have been studies in which police officers who went through mindfulness training in their first year of training experienced less depression.  Other studies with mindfulness and officers have shown reduced perceived stress, burnout, anger, sleep disturbance, and improved physical and emotional health.   By regulating officers' reactions to stress, mindfulness assists police in increasing the consideration of options even when under a degree of threat and without responding with automatic behaviors to include intimidation or violence.  Through mindfulness, as we become more aware of our emotional responses to situations, we can consider more possible options as to how to respond.  For police officers, this can include increased listening, caring, respect, and restraint.  For many in law enforcement, this is in stark contrast to the dominant culture of restraining, dampening, or ignoring emotions.  One of my professors used to say that "there's no such thing as unexpressed resentment".  What he meant was that we can not ignore our emotional states. They will find a way to expression whether for good or to our detriment. Mindfulness training can help police officers, as well as the rest of us, to be more self-aware, lessening our human tendency to restrict choices under stress.

Such approaches are not a panacea for curing all the problems for American police officers. Many other issues such as knowing the community they serve, reducing racial/cultural stereotypes and biases, and learning strategies to de-escalate situations, among others, are critical. However, stress reduction strategies can assist in helping improve the well being of our communities as well as officers, as a result of greater openness to communication between police and the community groups they serve.  

As I have written on many occasions, stress is a choice.  While acknowledging there are challenging situations, your ability to be more aware of your thoughts, emotions, and physical manifestations can help you make better choices while under stress.  That would be a good thing for all of us, community members and law enforcement.  

Good luck on your journey.

Dr. Paul Longobardi

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

WHY IS EXERCISE GOOD FOR YOUR BRAIN DURING THE PANDEMIC?

Many of us have been less active during the lockdown and stay-at-home phases of the COVID-19 pandemic. That lessened activity can result in reduced fitness and increased weight gain, neither of which is good for your health. While we often hear that exercise improves the body, less often do we hear of the positive effects of exercise on the brain. Physical activity strengthens both the body and brain.   Current guidelines from the World Health Organization (WHO) and the U.S. Centers for Disease Control (CDC) recommend that most adults do 150 minutes per week of moderate intensity aerobic physical activity and twice-weekly muscle strengthening.  Many activities count such as brisk walking, gardening, walking the dog, etc.  Many people are aware of cardiovascular training but are less aware of the need for muscle strengthening as we age.  That strength training helps build muscle and bone, which protects against injury.  But you say that you don't like lifting weights.  Don't worry.  You can do other strengthening forms of exercise such as yoga, tai chi, and Pilates.  

Now here's the bad news.  Only 20% of Americans get the requisite 150 minutes per week, more than half of all baby boomers (people born between 1946 and 1964) report doing no exercise at all, and over 80 million Americans over age 6 are completely inactive from an exercise perspective.  We have heard the consequences of this inactivity and they are not good.  People with very low levels of physical activity are at higher risk for a variety of diseases to include heart disease, diabetes, cancer, and Alzheimer's Disease. Prior to development of these diseases, your inactivity can worsen arthritis symptoms, increase lower back pain, and lead to depression and anxiety.   Stress, to include that of the pandemic, worsens both your mental state as well as your physical health. So what can be said about your brain and exercise?   There is research linking exercise to reduced depression, better memory, and increased learning. Exercise is one of the better ways to prevent or delay the onset of Alzheimer's Disease.

In other posts, I have noted several promising lines of research.  For example, in CNN Health News, author Morgan Manella noted recent studies showing that higher levels of physical fitness in middle-aged adults were associated with larger brain volumes five years later, particularly in brain areas having to do with memory such as the hippocampus (Kilgore, Olsen and Weber, 2013, Scientific Reports).  In a study published in the online journal Neurology (Wiley et al), the authors found that older people who exercised regularly experienced a slower rate of mental decline. Why does exercise affect brain structure and function for the better?  While scientists are not completely sure, it has been shown that exercise improves blood flow to the brain, feeding the growth of new blood vessels and even new brain cells.  This is considered due to the effect of the protein BDNF (Brain Derived Neurotrophic Factor).  BDNF stimulates the growth of new neurons and repairs and protects brain cells from degeneration.  This is exciting because for so many decades it was thought that when brain cells (neurons) die, that's the end. However, we are learning so much about how you can preserve and increase your brain functioning through exercise.  By the way, speaking of preservation, there is research showing that moderate intensity exercise may slow down the aging process of cells.   So what are you waiting for?  Lace up those athletic shoes and get going.  Even in a time of COVID, take a brisk walk (appropriately socially distanced), get out into the garden, get some light weights or find other strengthening strategies.  These will help preserve your brain, improve your mood, and reduce your anxiety and perceived stress. Exercise is but one effective way of reducing stress in these times. For more 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 more information about the book, authors, and stress, please visit our website at www.manageyourhealthandstress.com.

If you haven't been active in quite some time, consult your primary care physician as to an appropriate level of exercise at which to begin.  As always, don't let mind clutter get in your way such as "I'm too old", "I have no time", or "It's too late". These are all falsehoods you tell yourself and convince yourself are true. Challenge them and get on with improving your health and well being.  

Good luck on your journey.

Dr. Paul Longobardi

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

HOW IS THE STRESS OF THE PANDEMIC AFFECTING YOUR SLEEP?

The COVID-19 pandemic has disrupted lives in so many ways. Health worries, financial/job worries, school worries, relationship worries all are stressors. These stressors easily can interfere with your proper sleep. Sleep problems are not new for Americans.  Estimates are that 27% of adults report trouble falling asleep or staying asleep.  We spent an estimated $41 billion on sleep aids and remedies in 2015.  While there is no definitive answer as to how much sleep any one person needs, sleep experts tell us we need enough sleep to stay awake and alert the next day without caffeine.  For most of us, we don't function well with less than seven hours.  With continued sleep shortages, you can harm your health through depression, heart disease, obesity, and Type 2 diabetes.  Of course, the most frequently prescribed aids are sleeping pills and I will not be discussing these. Rather, there are several sleep issues of a non-pharmacological type discussed recently.  In an article in the Monitor on Psychology for February 2016 titled "Young and sleep deprived" by Karen Weintraub, she reported research indicating that adolescents need 8-10  hours per night but on average get less than seven hours a night.  Adolescents go to sleep later than older adults but have to get up early for school systems which not infrequently start at 7:30 or 8 AM. This interferes with their normal metabolism.   Of course, school hours have undergone major changes given the closure of various school districts during the pandemic. Among diverse recommendations when schools reopen have concerned start times. Moving start times for school have been shown to help with increased attendance rates, decreased disciplinary action, improvement in academic performance, decreased sleeping during class, and increased attention.  These are significant factors related to the well being of our youth.  There appears much research to support the recommendation to push back school start times by as much as 75 minutes.  The message appears clear that the later the start time, the more positive outcomes occur.  Note that all this occurs without any pharmacological sleep aids.

For adults who would like to sleep better and reduce reliance on pharmacological aids, there is Cognitive Behavior Therapy for Insomnia (CBT-I), a form of behavioral treatment that focuses on changing habits that disrupt sleep.  The treatment has been mentioned in various consumer magazines such as in the February 2016 issue of Consumer Reports magazine, titled "Get more ZZZs, naturally".  There was a review of CBT-I in the journal Annals of Internal Medicine several years ago indicating that the treatment helped people sleep on average 26 more minutes per night and reduce their need for medications.  It also was noted that the American Academy of Sleep Medicine recommended CBT-I over sleep medications as a treatment of first choice for chronic insomnia.  I have been using CBT-I principles for many years for referred patients with insomnia as part of their total presentation, whether anxiety, depression, or post traumatic stress disorder (PTSD). In fact, it almost always is worthwhile to address sleep problems. While many providers think sleep problems will remit if the anxiety or depression is treated, that is not always true. There needs to be a focus specifically on sleep problems.  Of course, I always recommend that you consult first with your primary physician to rule out any physical causes of your insomnia. So what is involved in CBT-I?   As mentioned, CBT-I  has a goal to improve sleep habits and behaviors. The cognitive part of CBT-I teaches you to identify and modify beliefs that affect your ability to sleep. For example, this may include learning how to control or eliminate negative thoughts and worries that keep you awake. The behavioral part of CBT-I helps you develop good sleep habits and avoid behaviors that keep you from sleeping well.

There are various techniques some or all of which you may need depending on your condition. These include: 

1.  Stimulus Control Therapy. This is a technique I have used frequently and is a part of CBT-I.  This method helps remove factors that condition the mind to resist sleep. For example, you might need to set a consistent bedtime and wake time and avoid naps, use the bed only for sleep and sex, and leave the bedroom if you can't go to sleep within 20 minutes, only returning when you're sleepy.  You need to be very motivated for this one but it will help you get better control of the sleep/wake cycle.  I remember one patient who got up 25 times the first night after not falling asleep within 20 minutes.  That was the highest number I ever saw but improvement for the patient came rapidly over the next week.

2.  Sleep Restriction. This is a strategy in CBT-I. Lying in bed when you're awake can become a habit that leads to poor sleep. This technique decreases the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.  The trick here is not to take naps the next day as your progress then is completely undermined.

3.  Sleep Hygiene. This method of therapy involves changing basic lifestyle habits that influence sleep, such as smoking or drinking too much caffeine late in the day, drinking too much alcohol, or not getting regular exercise. It also includes tips that help you sleep better, such as ways to decrease your activities an hour or two before bedtime

. 4. Sleep Environment.  These are ways you create an improved sleep environment, such as keeping your bedroom quiet, dark and cool, not having a TV in the bedroom, and hiding the clock from view.  You also may need to stow away your cell phone or laptop to minimize interruptions.  The light they emit also is known to interfere with sleep.

5. Relaxation Training. This method helps you calm your mind and body. Approaches include meditation, imagery, progressive muscle relaxation (PMR) and others.  I have written in other posts about such techniques as they reduce stress reactions and they can be very helpful here as well.  I have used PMR extensively in assisting with sleep improvement often in combination with the other techniques above. For more discussion of such approaches, 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 more information about the authors, book, or stress management, please visit our website at www.manageyourhealthandstress.com.

6.  Biofeedback. This method allows you to notice physiological signs such as heart rate and muscle tension and shows you how to change them. Some sleep specialists may have you take a biofeedback device home to record your daily patterns.

7.  Paradoxical Intention. Paradoxical intention, courtesy of famous therapist Victor Frankl,  involves avoiding any effort to fall asleep. In fact, it really involves trying to stay awake.  Have you ever been somewhere, maybe even a meeting, where you are worrying that you need to stay awake but continue to fall asleep?  Paradoxically, worrying that you can't sleep can actually keep you awake. Letting go of this worry can help you relax and make it easier to fall asleep.

Whatever method or strategies you employ, good sleep is critical to your health, productivity, and well being.  Per the research with adolescents, adjust your sleep cycle depending on whether you are an early or late riser so as to get enough sleep.  Also, consider cognitive behavioral strategies as a first treatment for insomnia before resorting to medications.  You may be amazed at the power you have over this process.

As always, change your thoughts and change your results.  Sleep well my friends.

Dr. Paul Longobardi

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

EIGHT STRATEGIES FOR FATHERS TO MANAGE THE STRESSES IN THEIR LIVES

Father’s Day soon will arrive. It is on June 21 this year. For so many people including fathers, this year has been more challenging than many with the addition of the COVID pandemic. Many fathers have been laid off, creating financial challenges as well as frustration in the home. It is well documented that alcohol use and domestic violence rates have increased during the last three months. Stress can increase to the point where pressures build and symptoms emerge, e.g. headaches, explosions of anger, depression and discouragement, sleeplessness, or just living with emotional pain. Eliminating stressors in your life is not possible. However, how you handle them is critical to your well being and that of your family. If you need more information broadly on stress management, 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. If you want more information about the book, authors, or stress, please visit our website at www.manageyourhealthandstress.com. For some of this post, I drew on Wayne Parker of liveabout.com from his article on A Father’s Guide to Managing Stress at Home. Here are eight strategies for fathers (mothers and youth too!) to use to better handle the stresses in their lives:

1. Set aside some family downtime. Despite all the work and busyness of the average day, make some time for your family. For the younger children, telling bedtime stories and reading to them can be a way to relax and reduce stress. For the older children, asking about their day and really listening also can induce more calmness. As was mentioned in the article noted, family rituals like family prayer, cuddle time in bed with the family and Saturday morning breakfasts can be important times for both building relationships and reducing stress. In a time of COVID, playing games together and/or engaging in projects around the home also can be ways to interact meaningfully with your family.

2. Make time to talk. It is common that stress at home is the result of failed communications. So make sure you talk with your partner and your family regularly. You might want to plan a weekly family night so you can deal with problems before they happen. A family therapist has said that the best advice for strong marriages was to set aside 30 minutes each night after the children so that the parents can talk together – no television, no smartphones, and no computer – just talk.

3.Remember good nutrition and regular exercise. As we write about in our book and spend parts of two chapters, make time for healthy eating and physical activity. Proper nutrition will give you good fuel to burn and exercise makes your body more efficient. Eating junk food and sitting in front of the television or computer all day will tend to make you tired and irritable. This will result in increased personal and family stress levels.

4.Make time for you. In addition to all your family obligations, be sure to look out for yourself too. Find a favorite hobby, activity, or volunteer endeavor in which to participate as it allows you to grow and builds you well being. Just watching television, surfing the internet, or catching up on social media for the evening does not help you. Find what you like to do and what relaxes you. If you can involve other family members, all the better. In a time of COVID restrictions, read a book you have been putting off. Begin to learn a new skill just for you.

5.Get some physical activity. In our book we write about the power of exercise and physical activity as a stress reducer. Your body releases endorphins and they naturally improve your mood. So go out and work in the yard or work out at home or just take a walk even if COVID restrictions prevent your access to a gym. The more activity you do the better you will handle stressors.

6.Find ways to improve yourself. In the article noted above, author Stephen Covey referred to this as sharpening the saw. If we do not take time to learn something and/or improve ourselves, we become dull and less productive, like the wood cutter who never took time to sharpen the saw. Take time to improve yourself in some way in four areas: mental, spiritual, emotional/social and physical. Covey says that spending one hour in these pursuits will be a powerful investment in the other 23 hours of the day.

7.Learn to say no. I have worked with so many individuals who have a difficult time saying no. They overcommit, feel pressured, and experience stress symptoms. Many of the stress factors in our family come from over-programming our time and lives. Consider prioritizing by saying no to the less important activities. To do that effectively, you have to define what is important and commit to that, and then say no to everything else. The article refers to world renowned Pastor Joel Osteen, a favorite of mine, who has a church in Texas to which 40,000 parishioners come weekly (pre-COVID restrictions). Pastor Osteen has found that he has to say no to weddings and funerals, and to any other events on Wednesdays and Sundays. Obviously, Sunday is the day he preaches. Wednesday is his day with God and his family first. He is a great example of practicing what he preaches and putting first things first. Consider doing something similar for yourself.

8.Laugh and find the humor in life. I have found this one of the best ways to handle stress and anxiety. So many of our felt stresses come from taking ourselves and our situation too seriously. Yes, there are indeed some serious life events. There clearly is nothing funny about the dangers of COVID-19. However, so many times just finding an outlet to laugh can help. I sometimes find it hilarious to watch a rerun of the television comedy 227. My wife and I watch it and feel better for doing so. Years ago, writer Norman Cousins literally cured himself of a life threatening cancer by putting himself on a diet of old comedy shows. Like exercise, laughter triggers powerful positive endorphins in the brain. So take some time to laugh. It’s not frivolous. Consider it part of your prescription for a less stressful life.

If you should need help, reach out and get it. Talk to a trusted minister or counselor. Take advantage of an Employee Assistance Program (EAP) at work. Find a father’s support group. Find a mental health professional. Don’t take it out on yourself in the form of stress related symptoms. Certainly don’t take it out on your family.. Regular outbursts, abusive behavior, loss of control, unchecked depression or anxiety, substance abuse, all are signs that you may need emotional help.

Your family is a precious asset in your life and you are valuable to them. Don’t allow poorly managed stresses to interfere with that. Consider the eight strategies described above. Good luck on your journey.

Dr. Paul Longobardi

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

ARE YOU AT RISK FOR PTSD AS A RESULT OF THE PANDEMIC?

We all are aware of the human toll in our country taken by the Coronavirus 19 pandemic. We have over 1.6 million cases and over 100,000 deaths as of this writing. The traumatic nature of this pandemic for so many people has high likelihood of resulting in an increase in diagnoses of Post Traumatic Stress Disorder (PTSD). According to Dr. Daniel Amen in a post titled “The next wave of the pandemic: PTSD”, the human brain is wired to remember traumatic experiences. In some people, this biological reality may lead to post-traumatic stress disorder (PTSD). In fact, mental health experts anticipate that PTSD, which currently affects over 8 million American adults, could become the next healthcare crisis.

So who is at risk for PTSD during this pandemic? Some groups are more at risk than others. Dr. Amen noted the following groups:

COVID-19 SURVIVORS Fearing that you may die is traumatic. A 2018 study showed that being critically ill can lead to symptoms of PTSD in as many as 27% of patients surviving a stay in the intensive care unit (ICU). For people with COVID-19 who survive an ICU stay, risk is even higher. I noted in another post that a 2020 study of more than 700 COVID-19 patients in China found that a very high 96% had symptoms of PTSD during quarantine. Because COVID-19 is so contagious, people in ICUs couldn’t see family or friends, leaving them completely alone during this frightening time.

PEOPLE WHO HAVE LOST A LOVED ONE Suffering the death of someone you care about can trigger devastating long-term psychological consequences. Dr. Amen cited research in The American Journal of Psychiatry showing that the unexpected loss of a loved one increased the chances of the onset of PTSD, as well as other mental health issues, such as depression and panic disorders.

HEALTHCARE WORKERS We certainly have heard much about our heroes, healthcare workers. Physicians, nurses, EMTs, and other frontline responders put themselves in harm’s way by caring for those who are sick and dying. It is likely they soon will confront another risk—PTSD. Dr. Amen cited a 2020 report in the journal Psychological Medicine which called PTSD the “second tsunami” of the COVID-19 pandemic and noted that healthcare workers are in occupations that are already at risk for the condition. Research in the Canadian Journal of Psychiatry on the SARS outbreak in 2003 showed that 10% of healthcare workers experienced high levels of PTSD following that pandemic.

PEOPLE WITH A HISTORY OF TRAUMA OR OTHER MENTAL HEALTH ISSUES If you have suffered trauma in your childhood or as an adult, the psychological distress of the pandemic may compound the effects and lead to PTSD. Dr. Amen observed that people who already struggle with anxiety, depression, bipolar disorder, or other mental health conditions may be more vulnerable to developing PTSD.

ANYONE WHO PRACTICED SELF-ISOLATION A 2013 study in Disaster Medicine and Public Health Preparedness investigated the psychosocial responses of children and their parents to quarantine and isolation measures in a pandemic. The researchers found that 30% of children in quarantine met the criteria for PTSD as did 25% of their parents. Considering that most of the nation was encouraged to self-isolate during the pandemic, this could translate into millions of people experiencing PTSD in the wake of the coronavirus pandemic.

So what is PTSD? PTSD is a pathological 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.

What are common symptoms of PTSD? Dr. Amen noted that there are many signs and symptoms associated with PTSD. Common symptoms include anxiety, distressing memories and flashbacks, nightmares, trouble sleeping, hypervigilance, being easily startled, and difficulties concentrating. Also, avoiding people, places, or things that are reminders of the trauma is also common among those with PTSD. Suffering from PTSD also makes people more likely to have suicidal thoughts and behaviors.

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. Most recently, I have been working with victims of severe wild fires for whom intrusive reminders occur regularly and elicit emotional overreaction. 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 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 amygdala signals fear and threat, the prefrontal cortex can not control it. 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 is some hope as well as 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. Enhancing overall brain health can make a big improvement, as can some forms of psychotherapy (cognitive processing therapy, prolonged exposure therapy), some virtual reality therapies, as well as EMDR (Eye Movement Desensitization and Reprocessing) therapy.

Realize that there are treatments available for PTSD. Second, consider the above and whether you or someone you know might be suffering from such a problem. Depression and anxiety are common occurrences with PTSD and can affect well being in life and at work. Stress is a common factor in PTSD. For more 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 additional information about the book, authors, and stress, please visit 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

MENTAL HEALTH AWARENESS MONTH AND DEPRESSION

May is Mental Health Awareness Month throughout our country. More people are becoming aware of the potential negative effects of anxiety and depression. I saw an article on May 23, 2020 in the Los Angeles Times sports section titled “A poke check to mental health stigma” by Helene Elliott. In the article, she discussed the increased awareness and outreach of some of the toughest professional players, hockey players. She noted the warrior culture of denial of pain and suffering of any type and how that is beginning to change. She highlighted several former NHL goaltenders talking about their struggles and advocating for mental health awareness and treatment. Most of us in Los Angeles remember former Laker basketball player Ron Artest (Metta World Peace) thanking his psychologist for helping him handle his mental health challenges. But isn’t depression rare? Not so.

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.   Risk for depression is worsened by stressors. We discuss this 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 authors, book, and stress, please visit our website at www.manageyourhealthandstress.com. For now, note that 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.   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 recommendations were published in the Journal of the American Medical Association several years ago. 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.  

You can change your life but you must take action.  Change your thoughts and change your results. If you believe that you or a loved one is suicidal, please call the National Suicide Prevention Hotline at 800-273-8255.

Good luck on your journey.

Dr. Paul Longobardi

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

HOW CAN WE HELP MEDICAL STAFF HANDLE THE MENTAL HEALTH CHALLENGES OF THE PANDEMIC?

Throughout my long career as a psychologist, issues of emotional and mental health always have taken a back seat to medical issues until it is impossible to ignore them. For example, in working with NFL players with possible chronic traumatic encephalopathy (CTE) stemming from repeated concussions, the focus was on cognitive issues, i.e. concentration, memory, learning, etc. However, the hidden problems were in the areas of emotional and mental health. So many of the players suffer from anxiety and depression along with other challenges. Now we continue in the era of the COVID-19 pandemic. Many front line medical staff daily face herculean challenges in performing their work while being concerned about their own health and that of their families. In a recent article in the Los Angeles Times dated 2/3/21 titled “Health Workers Anguish” by Soumya Carlamangla, the author reviews the increasing psychological distress experienced by frontline medical workers. She noted the rise of the new ritual born of the pandemic: death by Face Time. In this ritual, families are allowed access mostly by Zoom to seeing their dying relative as they are not allowed into the room. I myself went through this ritual three weeks ago as our niece’s 63 year-old beloved husband expired as 15 of us were on the Zoom call offering words of remembrance and comfort to one another and to her. Medical workers are going through this on a daily basis. The Times author noted various stories of the emotional trauma, exhaustion, and despair experienced by the medical workers. There are indications of likely higher rates of burnout in these workers as well as ongoing anxiety, depression, and post traumatic stress disorder. As was noted in the article, experts in trauma note that we have no way currently of estimating the incidence of these traumatic emotional effects as most models of disaster assume a much shorter time line than is occurring in this pandemic. As noted, burnout always has been a risk for frontline medical workers but likely will be seen more often now and in the future. Symptoms of burnout include:

Sense of failure and self-doubt.

Feeling helpless, trapped, and defeated.

Detachment, feeling alone in the world.

Loss of motivation.

Increasingly cynical and negative outlook.

Decreased satisfaction and sense of accomplishment.

Activities you used to enjoy are no fun any more.

It is known that supporting workers with mental health services is not only an ethical obligation for employers, it’s also a bottom-line issue. More than 60% of workers say their mental health affects their productivity, according to a survey by Mind Share Partners, a nonprofit that works with companies to improve mental health resources. Also, in 2019 the World Health Organization estimated that depression and anxiety cost the global economy $1 trillion per year in lost productivity. Given the emotional toll of the pandemic, that price likely will be much higher this year.

Front line medical staff are suffering from mental health issues. How do we know this? Some information we have comes from studies of the medical staff in China, who already have gone through such challenges. In one survey of 1,257 physicians and nurses during the height of the COVID-19 pandemic in China, it was found that about 50 percent of respondents reported symptoms of depression, 44 percent reported symptoms of anxiety and 34 percent reported insomnia. Medical professionals are already at risk for many of these conditions at baseline—medical occupations have among the highest rates of suicide—yet it has been noted that physicians typically are unlikely to seek help.. Most are just so busy that they do not have the time or flexibility to go see a therapist. However, there also remains a stigma still attached to psychological problems leading many to defer or decline psychological treatment.

Given these problems, what can be done to structure more responsive interventions and means of assistance to frontline medical staff? This was a challenge faced by the Second Xiangya Hospital, a facility in Wuhan, China months ago. They too found that medical staff were reluctant to access group and individual psychological interventions. In fact, it was observed that individual nurses showed excitability, irritability, unwillingness to rest, and signs of psychological distress, but refused any psychological help stating that they did not have any problems. Rather, many staff worried more about families, difficult patients, and lack of protective equipment and their own feelings of incapability when faced with critically ill patients. Many staff mentioned that they did not need a psychologist, but needed more rest without interruption and enough protective supplies. Finally, they suggested training on psychological skills to deal with patients' anxiety, panic, and other emotional problems and, if possible, for mental health staff to be on hand to directly help these patients. Therefore, different interventions were offered. These included the hospital providing a place for rest where staff could temporarily isolate themselves from their family. The hospital also guaranteed food and daily living supplies, and helped staff to video record their routines in the hospital to share with their families and alleviate family members' concerns. Second, training was arranged to address identification of and responses to psychological problems in patients with COVID-19. Third, the hospital developed detailed rules on the use and management of protective equipment to reduce worry. Fourth, leisure activities and training on how to relax were properly arranged to help staff reduce stress. Finally, psychological counselors regularly visited the rest area to listen to difficulties or stories encountered by staff at work, and provide support accordingly. They found that these interventions were well received and staff reported lessened worry and stress.

To support health care workers, experts need to intervene to help protect their mental health, not just their physical health. This was done in China as we have seen above and we should follow their lead. Some universities, like University of North Carolina Chapel Hill and the University of California, San Francisco, have been leaders in this effort, deploying their psychiatric workforce as volunteers. What is needed are approaches that are comprehensive and multifaceted. There is a need for preventive measures (stress reduction, mindfulness, and educational materials), in-the-moment measures (hotlines, crisis support), and treatment (telepsychiatry for therapy, and medication if needed). For additional information about stress, 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 additional information about the book, authors and stress, please see our website at www.manageyourhealthandstress.com. Such interventions acknowledge that mental health treatment is not just something that happens urgently or in crisis, but rather is something that needs to continue and be available long into the future. When all the cheering of frontline medical staff diminishes, there likely will be an increase in mental health conditions to include anxiety, depression, and post traumatic stress disorder. This is our professional and societal challenge.

Good luck to all on our collective journey to wellness.

Dr. Paul Longobardi

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

WHAT ARE THE EFFECTS OF ISOLATION FOR YOU IN A COVID WORLD?

We’ve been hearing a lot lately about social distancing. Even more drastic have been the stay-at-home orders in many states resulting in prolonged periods of separation from other than immediate family members. There is increasing concern about the psychological effect of isolation on us and the risks for our mental health. But what about loneliness? Isn’t that inevitable given our restrictions into our homes? Well, not necessarily. First, let’s clarify terms. Solitude, isolation, and loneliness are similar terms, but they have distinct meanings. Solitude is the state of being alone. Isolation is a lack of social relationships or emotional support. Loneliness is a craving for social contact. It is often linked to feelings of sadness and emptiness. Spending time alone is not inherently bad. Solitude can be a healthy, rejuvenating experience. It can allow people to reconnect with their needs, goals, and feelings. Some people require more solitude than others. Introverts, for example, enjoy spending lots of time alone and can feel drained through social interaction. Meanwhile, extroverts often need more social interaction to feel fulfilled. Circumstances that feel isolating or lonely to one person may be healthy for another.

But why is it so hard to be in social isolation? One of the reasons that living in isolation is difficult is because we humans are social creatures. Many people that have lived in isolated environments – such as researchers stationed in Antarctica – report that loneliness can be the most difficult part of the job. Loneliness can be damaging to both our mental and physical health. Socially isolated people are less able to deal with stressful situations. They're also more likely to feel depressed and may have problems processing information. This in turn can lead to difficulties with decision-making and memory storage and recall.

So what do we know about isolation? Actually, there is a surprisingly large amount of information about the effects. Much of it comes from studies of a range of life experiences, such as prisoners in solitary confinement, research participants in Antarctica and arctic explorers, as well as astronauts in space.

Multiple studies have documented a link between isolation, loneliness, and physical health issues. Loneliness may be as bad for your health as smoking 15 cigarettes a day. Some of the many health effects of isolation and loneliness include: Higher levels of stress hormones and inflammation; Heart disease, including high blood pressure and coronary artery disease; A heightened risk of developing a disability; Increased vulnerability to chronic illnesses such as Type 2 diabetes. Social isolation may even increase your risk of premature death. A 2015 study found social isolation increases a person’s risk of death by about 30%.

What about the effects of isolation and loneliness on your mental health? Isolation can increase the risks of mental health issues such as depression, dementia, social anxiety, and post traumatic stress disorder. Isolation and mental health issues can also interact with one another in a feedback loop. For example, a person might develop depression because of intense loneliness, then feel even more isolated because of their depression. Extreme isolation can have catastrophic effects on mental health. As noted earlier, we are social animals who need human contact to thrive—and sometimes even to survive. Studies were conducted decades ago showing that infants who didn’t get enough physical contact failed to thrive and died. Inmates held in solitary confinement, especially for extended periods of time, may experience hallucinations and insomnia. A research team at McGill University discovered that after just a few hours, isolation can lead to a distorted perception of time, high levels of anxiety, and even hallucinations. Case studies of prisoners kept in solitary confinement also indicate that a lack of human contact can lead to a cognitive breakdown. However, many of us experience isolation and loneliness in other forms as we go about our day. We live alone, have a small social network, and infrequently participate in social activities such as volunteering or religious services. Without enough social interaction, you may be at risk of: Cognitive decline; The onset of Alzheimer’s Disease or dementia; Depression. Social isolation can also interfere with daily functioning. It can disturb sleep patterns, disrupt focus, and affect both logical and verbal reasoning.

But it is possible to overcome isolation. I recently saw an article in the Los Angeles Times for 4/30/20 by Deborah Netburn titled “The psychological toll of isolation”. In the article, the author discussed research findings on the effects of quarantines for other pandemics. Factors noted that lessened the impact of isolation/quarantine included keeping isolation as short as possible, ensuring those isolated and in quarantine know why they must stay isolated, thanking them for their sacrifice, and making sure everyone has access to supplies they need (think toilet paper, sanitizers, etc.). Other research findings noted the importance of maintaining social connectedness to maintain emotional and physical health. Authors cited in the article observed how staying socially connected can mitigate the effects of social isolation and help us find purpose and meaning in our lives.

As in many events, your mindset and views on the challenges of social isolation have much to do with your reactions to it. Consistent with cognitive behavioral therapy, it’s worth considering how your thinking influences your feelings and the actions you take. Are you telling yourself that you can’t stand isolation or stay-at-home orders? Is that really true? Telling yourself that likely increases your level of upset. Perhaps you might reframe that thought into “I don’t have to like this isolation but I can stand it and may come out even stronger”. Related to resilience, one of the experts mentioned a potential positive aspect of isolation, termed salutogenesis. It’s the reward which comes from dealing with a stress and feeling more self-sufficient, observed in studies of Navy personnel in the Arctic. The whole idea here is to develop the mindset that “If I can deal with this, I can deal with anything”, a rather healthy belief and mindset. At the same time, let’s not forget our old friends to assist with stress reduction such as exercise, meditation, proper sleep and diet, engaging in enjoyable activities. Combine these with a proper mindset and social connectedness and you will be well equipped to deal with the challenging effects of distancing and isolation in a COVID world. However, if you need more information about stress management, 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 more information about the book, authors, and stress, please visit 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