Category Archives: behavior therapy

Loneliness can kill you…Part 1

According to new research from the journal Nature, Human Behavior published on January 3, 2025, loneliness and social isolation lead to molecular changes that, in my simple terms, seem to set the body up for serious problems – increased risk for dementia, depression, cardiovascular disease, diabetes, stroke, and early death.  The researchers’ recommendations include routinely asking about loneliness and isolation, the way a health professional asks about sleep habits, alcohol use, and drug use.

If you are lonely on an ongoing basis, this is for you.

Loneliness can strike through no fault of one’s own.

Losing your spouse, for example, or a best friend, will almost inevitably lead to a long stretch of deep loneliness during the initial year or so of grief, and can continue beyond, as the bereaved person struggles to outsource some of that emotional, intellectual and spiritual intimacy to other relationships. In a healthy marriage, you share all sorts of confidences with a spouse that you simply might not share with anyone else – fears, dreams for the future, spiritual insights and struggles, and the warmth of shared memories that are no one else’s but the two of yours.  Somehow, some of that must be extended to others, and depth built over time. It an absolutely monumental task to parcel out these small slices of the immeasurable depth of a healthy marriage.

Moving, alone, to a new city, for a new job, can be exciting, but the reality can include aching loneliness when everyone at the new job goes home to their lives and you go to your apartment and try to figure out how to build a life. Developing the big, and small, connections that make a place feel like home can be daunting, and for most people, it takes longer than they had ever anticipated.

Loneliness hits other people, too. Those who are living primarily second-hand, separated by screens and trying to substitute electronic connections for human ones, are often intensely lonely. Some people interact with others in person, but the conversations are shallow, guarded and therefore nearly empty of connection and meaning. This type of loneliness can be even more painful, because it seems inexplicable; how can a person live with family or a partner and yet feel deeply lonely?

So, what to do? Unfortunately, the impetus is mostly on the lonely people to do something differently.

Here are some suggestions I would give to a client in such a situation.

  1. Go to church or synagogue. If you are grieving, try to go back to your own – but if that’s painful, go somewhere else, at least for now. If you are new to the area, just find a place that seems like a possibility. Then go to the hospitality time afterwards. Introduce yourself, and invite people to tell you about the faith community. Do not stand around with your cup of coffee and wait for people to notice you. Set a goal: perhaps that you will introduce yourself to three people, get their names, and ask a little about this community. See what happens. Try to focus on the other person; make the conversation a chance to get to know them and about their community – not about you. If it goes fairly well, go back the next week, greet those three people (and anyone else you met) by name if you can, re-introduce yourself without taking them forgetting your name personally, and see if you can meet a couple of other people. Within a month, you will have some acquaintance with a dozen or more people and have a solid idea if this community offers activities for education, worship and service for you to join.
  2. Even if you usually like to do things solo join at least one activity – one exercise class, one art class, one talk at the local bookstore, etc. – on a regular basis. Get to be a regular. Greet other people.
  3. Volunteer in your community. Do this with others. Doing good solo is beautiful, but if you’re not getting out of your head and focused on others in an interactive way, you are missing part of the point.
  4. Be friendly but don’t try to bully people into being your friends. For example, if you are new to the area, don’t wear out your welcome with the neighbors who came over to introduce themselves on moving day.
  5. Please do not use alcohol or other substances, or resort to hanging out having drinks as a way to cut loneliness.
  6. Be patient and keep trying! Think of these steps as experiments. Track what happens over time; be willing to change to a different experiment if the first one isn’t working after a month or so.

As you can see, the remedies for loneliness all include getting out of your head and into the world. Focusing on others, in small ways (such as greeting them and showing interest) to big ones (such as volunteering), is a critical part of overcoming loneliness. This can be really hard, because loneliness tends to make people even more withdrawn, more insular – it is a self-perpetuating problem unless you boldly step out, even with small but courageous steps, into focus on others.

More about connecting with others in Loneliness can Kill You, Part 2, coming soon.

Stress…And a Lesson From Cognitive Behavioral Therapy for Insomnia

Cognitive Behavioral Therapy for Insomnia (CBTi) helps people with insomnia via examining and, where appropriate, helping them change their behaviors and thoughts surrounding the issue of sleep.  One important factor we explore are called “Sleep Safety Behaviors.” These are habits which people believe are helpful for sleep.  Some sleep safety behaviors are in fact very helpful, such as avoiding screens for a couple of hours before bedtime, using soft, warm light sources in the evening, and avoiding upsetting discussions before bedtime. Other sleep safety behaviors are counter-productive, but if a person is convinced that they are helpful the anxiety around giving them up ends up disrupting the process of falling or staying asleep. The objective is to have positive habits around sleep, not unhelpful sleep safety behaviors. It is not as easy or obvious as it might sound.

For example, many people use alcohol as a type of sleep safety behavior. They believe it helps them relax and unwind, and seem to either not know, or disregard, that it actually is a sleep disruptor. Alcohol-fueled sleep usually involves waking up in the middle of the night as the effects of alcohol wear off. It also disrupts the quality of sleep. However, the person convinced that they “need” a drink to sleep may become so anxious about going without the drink that they have difficulty falling asleep, which they attribute (wrongly) to the absence of alcohol.

In the same way, don’t most people have some sort of “stress safety behaviors” to cope with stressful situations or extended times of stress? Some are helpful and constructive, and others are terribly unhelpful and even destructive.  Some are fairly neutral until taken to excess; an ounce or so of chocolate as a snack is one thing; a pound is another. Odds are, you know someone who clings to a stress safety behavior even though it is clear as day that it is unhelpful and even harmful. You may have encountered the futility of trying to convince the person that the extra drinks, the avoidance, the angry outbursts to vent over and over, merely get in the way.

Imagine a person for whom life has delivered a set of one-two punches – illness, a hurricane or two, unexpected car repairs. There are all sorts of paperwork and bills to tackle, and after a long day of work it is all too much. He takes an evening off to binge watch a favorite series, and then, the next day, everything is one more day behind, one more day piled up, and even more overwhelming – too much to be tackled, again, after a long and wearying day. Surely there is a half a season or so of something that will distract from the looming piles of paper.

Perhaps the person doesn’t binge-watch. Perhaps she enjoys a glass of wine, or two, or three, or, heck, why leave only one glass in the bottle? She adds poor sleep and the three days it takes for the full effect of alcohol to leave the brain to the problems still piling up on the table. Perhaps he gets caught up in a vortex of videos about things he cannot afford – certainly not at this moment – and adds envy and resentment to the problems at hand.

Odds are, too, you know people who have some good “stress safety behaviors.” Those habits reinforce resilience. You might notice some people seem to surf through the ups and downs of stressful times without falling apart or adding to the trouble at hand. If you are that someone, that’s wonderful; stick with it. If you know some people like that, but are not one yourself, perhaps you might give some positive stress safety behaviors a try.

If I were making an official list of Stress Safety Behaviors (which I am not at the moment), I’d probably include these:

Sleep: getting regular and adequate sleep – not feast or famine approaches to the weekly rotation, where you pretend you can “get by” on four hours during the workweek and really make it all up to your brain with a long sleep on Saturday.

Move regularly and adequately. Exercise, appropriate to your overall health and physician’s guidance, is essential. The machine needs regular movement to function properly.

Limit exposure to negative influences. Don’t feed your envy, your insecurities, or your bad habits.

Minimize exposure to media and people that encourage you to compare yourself to other people.  Do you think it’s a coincidence that so many magazines and websites feature articles about improving oneself – and a surfeit of advertisements for products that will, in theory, improve those things?

Treat Sabbath time seriously. Set aside one day each week for renewal. Pray, rest, read, enjoy time with family and friends, play, create.

Journal. There are lots of ways to journal. There’s the quick “5 things you’re grateful for” at bedtime journal. There are prayer journals and journals that are brief paragraphs on the events of the day. Maybe it’s that annoying journal assignment your therapist gave you. The act of writing – more than just “thinking about it” – brings more of your brain into the process. This way, for example, you benefit more from noticing good moments during the day, recollecting them in the evening, writing them down, and seeing your words on the page.

Positive stress safety behaviors are simple, common sense…but they can appear to be just one more thing to keep you from getting things done. If you think, for example, that a short walk is just a waste of time, that you’d be better off using those fifteen minutes for the big mess at hand, well, that might be true if that were, in fact, what would happen. But if the thing that would actually happen was a big sigh or a venting of angry frustration and the welcome distraction of a text message from a friend – well, then, the short walk to breathe deeply, move quickly and focus yourself for action might be less of a time-waster than it seemed.

If you’ve taken a look at the task manager window on your computer, you know there are dozens of programs running even though you may be only engaged in one. Start clicking on random programs to turn them off and watch the warnings pop up that this will interfere with the proper functioning of the computer. It’s the same with these sleep and stress safety behaviors. The people who do these things do them consistently, even when things are smooth and rolling along just fine.  These habits operate like a background program, always running. They keep the system working properly but without a big fuss. Turn off, or pause, those background programs and the system stops working properly, or perhaps just shuts down entirely.

Even good programs need updates. Taking that weekly break gives you a chance to notice if you need to make changes to the routine. Ignoring necessary updates usually makes the whole system a bit glitchy.

7 Things to do When Life Is Crazy

Sometimes, life just goes horribly sidewise.  This week, like most weeks, I spent time with people who have lost their homes to natural disasters, lost their job, had loved ones die, and sometimes are grappling with multiple serious problems.  The world seems crazy, you can feel like you’re going mad, and it is oh-so-easy to slide into attempts to numb the pain that are ultimately harmful.

It’s easy to advise people on what NOT to do – don’t drink alcohol. Don’t use drugs. Don’t eat a lot of junk food. Don’t let yourself scroll through social media and/or your newsfeed for extended periods of times. It’s easier, though, to “do” than to “not do.”  Anyone who has tried to break a bad habit knows that; it’s easier to “eat an apple” than to “not smoke/drink/eat a bag of cheesy poofs the size of a pillow.”

So, here are seven things to do – and keep doing – when life is crazy

  1. Say grace. Say grace when you get to sit at a table and say grace – together – when you eating a granola bar in the shade after another few hours of trying to make sense of the debris that used to be your home.  Say grace when you are out on a hike, just about out of water, and have miles to go. G.K. Chesterton famously noted he said grace when he sat down to write, to draw, etc.  A moment of gratitude shifts the focus from the mud to the mountaintop.
  2. Put the social media/news scrolling down and, instead, watch something that will make you laugh, preferably either an episode of a sitcom or a funny movie. Why? These require sustained attention, will bring a focus on characters who have ups and downs, and have the potential to make you laugh. Laughter releases dopamine – that feel-good chemistry that helps you heal.  Make it better and share that humor break with someone else. Sharing laughter with the person you love helps that sense of connection that seems strained, or even lost, when life has gone crazy.
  3. Eat food that is good for you. Ongoing extreme stress causes havoc in your body, including your brain, and getting decent nutrition is essential to your well-being, now and later.  I did the price comparison:  a precooked chicken, a bag of salad, some fruit and a little something else healthy, for example, feeds two or four people far cheaper than most or all fast food. Your brain will thank you.
  4. Listen to music that is soothing: piano or guitar, instrumental jazz, classical, baroque:  as tempting as it may be to listen to “angry” music because you feel so angry about what’s become of your life, that will only reinforce your distress.  Let peace soak into you, however slowly it may come.
  5. Check in with other people every day. Reach out to someone to see how s/he is doing. It helps us get out of our own heads, our experiences, and feel less alone.
  6. Get outside, preferably in the morning, for natural light exposure. You don’t need to bake in the sun; just get out there. Take a walk if you can.  Early natural light helps the brain regulate the sleep/wake cycle, setting you up for a healthy rhythm of melatonin production over the course of the day.
  7. Ask God to show you where He is at work in the events of your life, because when life goes crazy, the fog can make God’s loving presence hard to detect. Ask for the grace to notice the helping hands, the kind words, the moments of clarity.

I’m sorry if life has gone crazy. It is scary, and lonely, and disorienting when disaster strikes. If you find that you are sinking, reach out for help:  call your local helpline (in Pinellas County, FL the number is 1-888-431-1998, for the new Care About Me program that helps match those in crisis with an appropriate mental health provider).  Call a friend, a family member, or, if you are feeling unsafe and considering suicide or plan to harm yourself or others, go seek immediate help via 911 or go to an emergency service location.  When life has gone crazy, it is natural to feel frightened, confused and even helpless, but remember that none of us were designed to “handle it all.” We are, in fact, designed so that our strengths are distributed so that each has something to offer but none has every gift and ability.  Please reach out for help if you feel you are sinking.

Random Life Lessons

Here, on a beautiful autumn day, are a few life lessons I’ve picked up on the way…perhaps one will be useful to you.

Walking in the morning, before sunrise, can lead to being stopped by law enforcement, who, upon getting a look at me from the front (wrinkles and rosary beads) say things like, “Oh. I thought you were a kid out breaking into cars.”  Wearing a reflective vest and a skort, instead of baggy gym shorts, has solved that problem. Either that or I have succeeded in looking old from behind. The lessons: be reflective and dress appropriately to the task at hand.

Don’t save special stuff for special occasions.  Eventually someone else will just throw your treasure away or it will end up, sad and dusty, on a thrift store shelf. Use it up, whether it’s that fancy cocoa mix someone gave you at Christmas or your grandmother’s crystal. Drink sweet tea out of a fancy goblet.

Not from personal experience (see a prior post about this issue) If you change your hairstyle and/or color on a regular basis, you might not be the best candidate for a tattoo. The same goes if you try to destroy or at least hide any photos of you from five or more years ago because you can’t believe you left the house looking like that.

If there is something you really want to do, and it’s realistic for you, then pick a reasonable time frame (say, one year) and reverse engineer backwards all the way to tomorrow. If you want to achieve “X” – your G.E.D., your master’s degree, a marathon, writing your first book – there will be something specific that you do and/or don’t do tomorrow that is different than yesterday. Then the next day, you will, again, do/not do something different because you have this goal. If it’s your G.E.D., and you want to pass by one year from now, then the first thing to do is look up where to go for information. Then call the place. Then go. Then decide what you will give up to make time to study. Then do that: give up some of that time to study. Learn how to study (a lot of people get to college without knowing how to study; no shaming). And study again and again. Enlist people who will encourage you because it will be hard and discouraging and there will be people who try to pull you off course.

Don’t spend time around people who discourage you when you are trying to become a better person. If you have thought things through, and realized you must change some habit or adopt a new plan for life, and wise people agree it is a good move, then be very skeptical about the motivation of people who try to interfere.

Unless you have doctor’s orders to the contrary, odds are that alcohol is not your friend. Remember when Pinot told you what a great dancer you were at your cousin’s wedding?  Or how some kind of brown liquor helped you straighten out that miscommunication with your in-laws? Yeah, not your friend. Besides, alcohol is eager to share bad things: disrupted sleep, increased risk of cancer (it’s a major factor in a number of types of cancer), dementia, prematurely aging skin and who knows what else. Disclaimer: I don’t drink and I’m not in recovery, which means this one comes from 1) observing life and 2) reading the medical research.

Be wary of people who think it is funny to scare animals. A guest who tries to frighten your cat because it’s “funny” when the cat’s fur stands on end needs to go away and not visit again. This is a red flag, no matter how “nice” you thought this person was. They exert power by terrifying others; is that nice? No. If a five-year-old could easily explain it, I shouldn’t have to say another word.

The above does not include the person who is willing to make an absolute ass of themselves trying to scare a squirrel, bunny, rat, lizard, etc., out from under their parked car so they can leave without killing it. 

Try, if you can, to be patient with people who act as if they didn’t need to let you know about something they wanted you to know about because they put it on social media. Give yourself permission to explain that you don’t spend time looking for something you ought to know on social media. Unless you do, in which case you have bigger problems, perhaps, than missing one person’s newscast.

And, in closing, bear in mind that one person’s life lesson is not necessarily yours…but then again, maybe it could be.

Why Ask Me That? Third in a series on questions in the therapy room

Someone who is struggling with anxiety just wants to feel better. It’s understandable; anxiety feels awful. The physical symptoms, so often hovering just below full-blown fight-or-flight; a mind that won’t rest, a brain that hops from topic to topic like a rabbit in a vegetable garden. Add to this the fear that so many people have when they come to therapy:  will the therapist tell me I’m crazy?

No; no, I won’t tell you that, but I am probably going to annoy you with a lot of questions that may seem to be irrelevant to your suffering. My paperwork asks about your history, decade by decade; your losses; job satisfaction; health issues; your alcohol and drug use; your prescribed medications; your exercise and sleep patterns. I ask about screen time, social memberships, supportive relationships. I ask a lot of questions, and I can tell who thinks those questions are irrelevant by who leaves them unanswered, handing me incomplete paperwork and acting surprised when I follow up on the many blank places.

All these questions are important, and here’s a short discussion on just a few aspects and the explanation.

Your sleep patterns, and any difficulties, can both contribute to, and be worsened by, anxiety, stress and depression. If you need more, or better sleep (and most people do), figuring some ways to improve your quality and quantity of sleep can help across many categories of your life: focus, memory, energy, stress level, and mood. When these improve, relationships can often improve, as you might expect when you can pay attention and be less cranky.

If you have major health conditions that are not properly managed, these may contribute to problems with sleep, anxiety, or mood. For example, poorly managed diabetes, besides being physically very dangerous, impacts focus and mood. I would refer you to your physician to see if there are problems that require medical attention.

Social isolation is a recipe for loneliness and depression. Social media use tends to make this worse – something that seems weirdly contradictory. Lonely people eventually withdraw, and this creates more loneliness, isolation and possibly anxiety and depression. We need to explore ways to enter back into activities with others.  From my guidance counselor days: children who are isolated suffer. If you ask a child if s/he has friends, and then ask him/her to name those friends, and there is a flash of hesitation, you know you are dealing with a child suffering social isolation. Just so, adults who cannot identify some supportive relationships and what is good about those relationships is an adult who is emotionally isolated.

I ask questions that make sense to me; if they don’t make sense to you, please ask why I’m asking. Thanks!

Why Ask Me That? Part 1 of a Series on Questions in the Therapy Room

“It’s a lot of paperwork.” 

Yes, I agree, it is. And all that information is helpful and useful for me in what I presume is a shared project: making positive change in some aspect – or many aspects – of that client’s life. 

The number of people who simply skip sections, as if they were optional, or not relevant, is significant. This gives the opportunity to have some conversations about those questions, and their relevance.

For example:

If someone routinely shortchanges their sleep, health problems will develop. In the short term, irritability (which tends to mess up personal and work relationships), less efficient short-term memory (ditto), distractibility (ditto) and impulsivity (mega-ditto) are possible contributors to whatever the primary complaint may be.  So maybe we should address that, too!

If you are extremely extroverted and are working remotely and living alone, you have created a perfect petri dish for restlessness, depression, and dissatisfaction. Those are psychological and emotional factors that create problems across domains. Deliberately arranging adequate real interactions with others will be essential to meeting that basic need.

If you don’t have five or six people who you can identify as part of your social support system, such as friends, family, a mentoring colleague, etc., there may be a heightened risk for depression and anxiety.  That doesn’t mean you confide personal problems with all those folks; you might have someone who provides support and encouragement in career-related areas, some people you can pray with, people who you play sports or exercise with and enjoy lighter conversations.

There are no questions on my paperwork that are not rooted in helping the client and me have a grounded understanding of the client’s strengths, struggles, and emotional resources for making positive change. Just ask me.

What’s in your backpack?

I was speaking with someone reluctant to make any sort of commitment to a small change in the routine. Things were not going well for my friend, and the future seemed murky. With no clear picture of “where the journey is heading,” taking any first step seemed imprudent, my partner in conversation asserted; it would be better to wait until the “where” is sorted out in life before making a concerted effort in any direction.

One reasonable response to that is, there is no “standing still” in life: attempting to stand still just means things around you will change while you pretend you can hold your position.  See how that works for you standing in the ocean. Maybe that seems trite; the whole “you never step into the same river twice” trope that is, as it happens, absolutely true.

Another way of looking at my friend’s dilemma is this: no matter where my journey is going, some items always go in the backpack. I may not always need the water purification straws, or the sleeping bag rated for freezing weather, but I always need underwear and socks. I always need a spare pair of contact lenses and sunscreen. I always need a small Bible. I always need chocolate and my thyroid medicine. Even without knowing where, or when, I’m going, some things can go into the backpack.

No matter where your life journey is taking you, wouldn’t it be helpful to have a better quality of sleep? More physical energy?  A firmer sense of what your values are, and why, and what the implications are for daily life? A little less messiness in the closet or refrigerator or your car? Less weird clutter and mysterious crumpled papers in that one drawer? Some better thinking habits, whether it’s taking on a phobia or developing your capacity for focused attention?

Even if you’re feeling really stuck – a lot of pressures, an unhappy job situation, the first year or so into significant grief – perhaps there is one small thing you can do first– something you can “put into the backpack” – without a clear picture of where you hope to be heading. And, as you’re putting those essentials into your pack, perhaps the mystery of the next few steps on the journey will begin to come into focus.

Happy trails –

Life-Changing Hacks

Confession: I really dislike the term “hack.” It sounds awful, like a data breach somewhere, drenching the dark web with the personal info of thousands of people. It also used to mean someone whose work was poorly done and usually rushed, or the work itself. Somehow it became slang for “something you can do to make things easier/simpler/better.”

So be it, then.  In the spirit of openness (in which I score extremely high in personality tests), here are seven “hacks” for a happier life:

  1. Spend at least 15 minutes a day sitting in silence. For me, it is prayer time. This is a powerful early-day practice. If you are religious, this is a good time to sit with Scripture, a devotional book if you use one, and a small notebook in which to write a brief response as part of your prayer. For some people of faith, opening with a short Scripture reading and sitting silently in a contemplative mode of prayer is better.

If you are not religious, use it as quiet meditation time, focusing on breathing in a way that feeds relaxation and focus.

Why it works:  The research on the benefits of such a meditative practice is robust: brain health, heart health, reduced depression and anxiety symptoms. For people of faith, it becomes an opportunity to listen and reflect on God’s presence in their lives and how they are called to live. Taking a few moments to formulate your thoughts and write to God can help anchor you into the experience. The act of writing – words of gratitude, questions, fears – helps with focus and invites you to be in dialogue.

  • Go on a news fast.  If something horrible that actually requires your attention happens or is imminent, like a hurricane or other disaster, you’ll find out about it. Otherwise, just skip the news for a week, or two, or more. Then titrate your dosage:  15 minutes a day, checking into two or three varied sources.

Why it works:  repeated exposure to what are often the same events, or people discussing those events, has the neurological effect of repeated distressing experiences and amplifies your stress level. By quickly reading, rather than watching and listening, you will be better able to glean information without being overly stimulated emotionally.

  • Once a week, avoid all electronics except:
    • Live interaction with loved ones at a distance
    • Shared experiences with family or friends such as watching a movie together, which you can then discuss over a meal.

Why it works:  you will necessarily be spending more time in the real world, either resting, being creative, or otherwise having your life rather than passively observing others’ lives.

  • Go outdoors every day, preferably in the morning.

Why it works:  Morning daylight helps with brain chemistry; it contributes to a better mood and improved sleep by getting your melatonin system set properly.  It is also a good time of day to get your beneficial Vitamin D exposure (check with your physician) and to take in the benefits of exposure to nature: the sky, the sights, sounds and smells of plants, the sight and sounds of animals.

  • Clean up your diet.  Experiment with giving up highly processed junk foods. If you are a “one toe in the water” type, pick one change at a time and stick with it. Add a small change a week. If you are a “cannonball into the pool” type, go all in: get rid of the chips, the fast foods, the super-sweetened snacks.  See how you feel after a couple of weeks, after the worst of the withdrawal has passed and your tastebuds start to recover.

Why it works:  junk food is addictive, hijacking your dopamine system; it leads to erratic moods both because of the direct up and down of dopamine and the very complex relationship between the gut and the brain. The research here is abundant and easy to find; simply put, you’ll feel better. Your energy level should be more stable, helping you feel more energetic and, without that brain/body overstimulation from processed snacks in the evening, you may even sleep better, which leads to number 6:

  • Be religious about sleep.  If you are a 7-hour-a-night person, get those 7 hours; if you are a 9-hour person, get the 9.  Since you will be consuming less electronic media you should be able to squeeze out the time.

Why it works:  Sleep is essential. It is when your brain, and the rest of your body, does a lot of its clean-up and repair work. Your brain uses sleep to sort out information, store memories, and do important work such as using your new, improved, healthier diet to rebuild your stress-and-junk-damaged hippocampi, amygdala, etc.  Try to go to bed and get up at around the same time every day. If you are skeptical, then be scientific about it: do this as a four-week experiment and then assess the outcome.

  • Be committed to a daily exercise routine appropriate to your health requirements.  Your physician can give you info on recommended guidelines and any limitations or considerations you need to bear in mind.  There is no one routine for everyone, but unless you are on doctor’s orders to remain resting and sedentary, there is something you could do in this area. You may have to start slow; you may have to scale back because you are burning out; you may need to add variety so you are addressing cardiovascular health, strength, flexibility and balance.

Why it works:  Well, look at the data!  We are engineered to move, not to sit for hours.  Regular exercise is good for physical and mental health, can help with social well-being for those who exercise with or around others, afford time in nature, and help with sleep and digestion. 

So, there you go.  Seven simple hacks for a happier life.  Most of them cost nothing; even healthier eating could start with a money-saving switch of water in lieu of sugar- or artificially-sweetened prepared beverages. So – all simple, all potentially free. Since it doesn’t cost anything – what’s the harm in giving it a one-month trial run?  If one month of free, simple changes could mean more well-being in multiple areas of life, that seems like a great bargain – cheaper than coming to therapy and paying me, or someone else, to tell you the same thing.

I could tell you, but you’re not going to like it: Anxious Youth

As you know, this column isn’t intended as psychotherapy or professional advice. It’s information and entertainment, and, I hope, the spark for some conversation with someone who can help with a problem. The problem here is anxiety in all its forms.

According to the Anxiety and Depression Association of America, about 31.9% of youth have some sort of anxiety disorder.  This would include diagnoses such as generalized anxiety, separation anxiety, panic disorder, and trauma disorders. It’s hard to believe this is accurate; if it is, then as a culture, things have gone horribly wrong. 

We know a lot about what works, and what doesn’t work for anxiety.  Isolation, the vortex of doom the internet can be, the misguided or malevolent support of random strangers online, endless social networking, and a sedentary, sleep-starved, junk-fed existence don’t work.  Overscheduling doesn’t work. Avoidance doesn’t work. Irresponsibility doesn’t work. So do the opposite.

Get off the devices except for schoolwork.

Get enough sleep. Go to bed at a set time, get up at a set time. Every day, even weekends.

Cut down on activities.

Read real books. Learn about other people’s interior lives via good fiction (that’s a primary reason that we read classic literature in school; to understand more about how other people think, feel, and respond to life’s events). Then talk about them. That means parents should read them, too.

Get physical activity.  A healthy young person needs at least two hours of activity a day, and ought to be standing, moving around, and active a big chunk of the rest of the time.  

Learn useful skills.  For example, everything it will take to manage one’s own money, car and home.

Socialize in person, often while doing something purposeful (whether that’s a sport, volunteering, or other activity).

Spend a lot of time in nature. If it can’t happen just about every day, plan a four- or five-hour chunk on the weekend.

Have chores and responsibilities for young people.  No, “school is not their job” and therefore nothing else is to be done around the house. How are they going to learn necessary life skills? Plus, who wants a spouse or roommate who thinks going to work covers them for any contribution to home and family life?

Learn mindfulness meditation skills, to slow down the stress response and “step back” from anxiety-provoking thoughts. This facilitates the cognitive restructuring of cognitive-behavioral therapy, in which new ways of thinking and behaving are identified and rehearsed.

…and try cognitive behavioral therapy (CBT), preferably with at least one parent learning, too, to be coach and to help the parent. Anxious parents tend to teach their children fear-fueled ways of thinking and behaving, and anxious parents are apt to facilitate avoidance.  Avoidance is like jet fuel for anxiety. Find a licensed mental health professional who will work with you as a family to teach the skills. Keep in mind that CBT will work much better if the other parts of life are in healthy, working order – proper sleep, nutrition, exercise, etc.

To expand on an earlier point: parents, often your anxiety feeds your child’s anxiety. If you are behaving as if the world is a terrible, dangerous place, do not be surprised if your child responds the same way.  Making changes together to have a healthier, less anxious lifestyle will help the whole family.

I could tell you: Bryce Canyon Therapy

I could tell you, but you’re not going to like it…there’s no way to defeat fear without going through it

I am afraid of heights.

Not, “Eew, a little squeamish standing on the observation deck at the Empire State Building” afraid of heights. I mean, heart-pounding, sweaty-handed angst when faced with the open stairs in your typical outdoor, three-story-ish observation tower. I come by it honestly; I apparently took a few hard tumbles down long flights of stairs as a toddler. Hence the reality that “falling can and does happen, and it’s bad,” is hardwired in.

The thing of it is, avoidance works perfectly if by works you mean, never feel that afraid. It also means missing out on things, standing around at the bottom of things feeling slightly foolish when everyone else goes up and looks out over scenic vistas that I will see as a thumbprint on their cell phone screens.  The only way to reduce it, or at least have the experience that fear will not be what kills me, is to go through it.

Enter our long-planned, long-saved for vacation earlier this year to Utah, where we joined a small group tour hiking and camping and taking in five of the national parks: Arches, Bryce Canyon, Capital Reef, Canyon Lands and Zion.  The first day, we set up camp nearby and drove over to Bryce Canyon to see the canyon at sunset and see the trail we would take on the next morning just past sunrise – a narrow path down the cliff walls, through the varying terrain of the bottom, and back up the narrow path along the cliff walls.  I spent half the night in turmoil, crying with fear, and woke up knowing if I did not do that hike, I would regret it for the rest of my life. Meanwhile, of course, my amygdala were trying to convince me that the rest of my life would be short because I would certainly fall off a cliff and die.

I did hike the trail, sometimes in tears, sometimes trying to melt into the cliff face away from the edge (sorry, everyone who had to pass me; I disobeyed the rules of foot traffic on that).  By the end of vacation, I was navigating through elevations with much less fear. I am not a fan of heights, and probably never will be, but I know I can feel afraid and still do reasonable things.

Sharing this tale with friends, one shared that he, too, is afraid of heights and that’s why he decided to apply to and go through jump school in the military (as in, jump out of perfectly good airplanes). He didn’t expect it to cure his fear of heights – it didn’t – but it did do what he hoped, which was convince him he could handle scary things, something he wanted in his pocket before being deployed to war.

The purpose of this rambling set of tales is to illustrate what’s happening when we therapists annoyingly insist people face their fears, even one small step at a time, if the fear is keeping them from doing the normal, necessary things of life and/or barring them from their goals. Whether it’s elevators, public speaking, or driving over bridges, only taking the small, often agonizing steps forward works. Thinking about it, waiting until you’re magically not afraid, or postponing only convince your emotional, instinctive brain parts that the situation in question merits that level of fear. In other words, avoidance doesn’t reduce fear, it increases it. Every time I started up an observation tower, freaked out and sat down on the steps and then crept back down before reaching the top, I didn’t accomplish anything except making my fear worse.

So when, as the therapist, I encourage you to plan out, with me, and begin taking small steps towards conquering the fears that block you from living as enthusiastically as you’d like, I am not being mean or insensitive. I am not failing to understand how gut-wrenching fear can be. I get it. Really. As in fear-sweat drenched, heart-pounding, climbing that narrow path in and out of Bryce Canyon on a hot day getting it.