This is Thanksgiving week … the week some of us are very thankful that we don’t live in the same city as our relatives. So I’m calling in the experts.

My friend, Elisha Goldstein, who writes the “Mindfulness and Psychotherapy” blog on Psych Central, offers readers like myself, who are having difficulty with a formal meditation practice, several quick tips for mindful living that can be implemented throughout the day. He writes in his post, “Hectic Life? Quick Tips for Mindful Living” that “even without the time and place in life to set up some formal practice, from the minute you get up in the day to the moment you lay your head on the pillow there is opportunity to engage mindfulness as a way of life, opening you up to greater focus, calm, and peace.”

That means, in between the turkey/mash potatoes/cranberry sauce plate and the pumpkin/pecan pie plate, you can squeeze in a little sanity break, and ask yourself if it’s really going to benefit you to comment on your brother’s fourth glass of Merlot (plus the sedatives he’s stashing in his trousers, of course).

For this week’s “Mindful Monday,” I thought I’d list some of the easy mindfulness practices Elisha offers in his blog:

1. RAIN.

In his blog “Difficult Emotions: One Approach You’ll Want to Try,” Dr. Goldstein writes:

In the mindfulness circles the acronym R.A.I.N has floated around to support people in dealing with difficult emotions. It has been found in Tara Brach’s book Radical Acceptance, Jack Kornfield has said it, and you will find it the upcoming Mindfulness-Based Stress Reduction Workbook that I have co-authored with Bob Stahl, Ph.D (February, 2010). Here is a sneak peek:

“R” is to recognize when a strong emotion is present. “A” is to allow or acknowledge that it is indeed there. “I” is to investigate and bring self-inquiry to the body, feelings, and mind, and “N” is to non-identify with what’s there. This non-identification is very useful in that it helps to deflate the story and cultivates wise understanding in the recognition that the emotion is just another passing mind state and not a definition of who you are. Just like seeing a movie, standing back and watching the actors play out their dramas, by non-identifying with your story and seeing it as impermanent, this will help assist in loosening your own tight grip of identification. Utilizing R.A.I. N. as a practice can help you bring space to be with things as they are and grow in deeper understanding of what drives, underlies or fuels our fears, anger, and sadness.

Turning into our emotions can feel a bit foreign since most of us live in such a pain denying culture. Isn’t it time to begin acknowledging stress, anxiety or pain rather than suppressing, repressing, or all-too-quickly medicating it? Can we learn to view these challenges as a rite of passage instead of running away from them?

2. STOP.

Another tip to weave mindfulness into your daily schedule: before work, during lunch, before you walk into your home in the evening, or after you get the kids to bed at night. Writes Goldstein in his post “Stress Got You Down?”:

Creating space to come down from the worried mind and back into the present moment has been shown to be enormously helpful to people. When we are present we have a firmer grasp of all our options and resources which often make us feel better. Next time you find your mind racing with stress, try the acronym S.T.O.P.:

S - Stop what you are doing, put things down for a minute.

T - Take a breath. Breathe normally and naturally and follow your breath coming in and of your nose. You can even say to yourself “in” as you’re breathing in and “out” as you’re breathing out if that helps with concentration.

O - Observe your thoughts, feelings, and emotions. You can reflect about what is on your mind and also notice that thoughts are not facts and they are not permanent. If the thought arises that you are inadequate, just notice the thought, let it be, and continue on. Notice any emotions that are there and just name them. Recent research out of UCLA says that just naming your emotions can have a calming effect. Then notice your body. Are you standing or sitting? How is your posture? Any aches and pains.

P - Proceed with something that will support you in the moment. Whether that is talking to a friend or just rubbing your shoulders.

3. Walk.

Walking is an easy way to incorporate mindfulness into your day. Heck, even walking to the frig to grab some milk provides 60 seconds of reflection time. So why not squeeze out the mindfulness potential? In his post, “4 Ways to Walk (Mindfully) into Mental Health,” Dr. Goldstein lists four ways we can apply the simple act of walking to mindfulness.

Appreciation - If you are fortunate enough to have the ability to walk, try and remember, it took you over a year to learn how to walk and these legs are often the unsung heroes that take you to and fro day in and day out. Thank your legs for all their efforts.

Grounding - Bring your attention to the sensations of your feet and legs as the heel touches the ground, then the base of the foot, then the toes, and then they lift. You can actually say to yourself, “heel, foot, toes, lift.” This is a way to connect to the action of walking in the present moment.

Open Awareness - Walk slightly slower and begin to open your awareness to all your senses one by one. Sight, sound, taste, feeling, smell. See what is around you, listen to the sounds, taste the air or whatever is in your mouth, feel the warmth, coolness, or breeze on your cheeks, smell the air. Then stop for a moment and see if you can take in all of the senses.

Mantra - As I mentioned in an earlier blog, you can also recite some sayings while taking a few steps. For example, take a few steps and during an in breath say to yourself, “breathing in, I have arrived, breathing out, I am home” or “breathing in, I calm my body, breathing out, I relax”. Or make up your own sayings.

4. Shower.

I actually use this one a lot. Because when the kids were young, my time in the shower was, honest to God, the only time I had to myself. So I was not so green and blasted the hot water for a good five to minutes, pretending I was under a tropical waterfall in Hawaii. In his post, “Turn on the Shower and Reduce Your Stress Today,” Dr. Goldstein writes:

What would happen if instead of thinking about all the plans you had to catch up on while you were in the shower, you took a pause, and then brought your nose to the smell of the soap…and again, just exploring the scent of it with your nose… What would happen if you then brought your attention to just feeling the sensation of the warm water against your skin and the feeling of goose bumps that might be there from the contrast of coming in from the cold? Oh… then the mind drifts back again about who you need to call at work, why are you doing this stupid practice, the upcoming meetings, when you need to pick up your kids, what you need to buy for dinner, as you begin to speed up and the tension mounts. What would happen if you noticed this, said to yourself “there goes my mind again”, and then brought your attention back into the shower where you were right now. How might your experience be different? How might your mood be different when getting out of the shower? Would you be more or less reactive with your family, roommates, or whoever you came in contact with next?

Recently, the Chicago CBS affiliate interviewed her briefly for a story about the signs of suicide, after the suicide of Chicago school board president, Michael Scott. Scott was among officials subpoenaed this summer in a federal investigation of admissions practices at Chicago’s selective enrollment high schools. He also was the subject of a Chicago Tribune investigation into a land deal and his key role on Chicago’s Olympics committee. He was found dead on Monday by a self-inflicted gunshot wound.

This time of year, many of us will be gathering to give thanks for what we do have in our lives — family, friends, and the ability to try and provide a better world for our children, and our children’s children. Efforts like Kathryn’s give us all renewed hope, and I give thanks that folks like her are in the world, spreading the word about the significant impact depression and suicide have on so many.

Watch the video Suicides Can Come Without Warning (preceded by a 30 sec. commercial)

Learn more about the International Foundation for Research and Education on Depression (iFred)

(Full disclosure: I sit on iFred’s advisory board, and I lost my best friend to suicide in my first year of graduate school.)

But I don’t.

Because I want her to like me. It’s part of being a stage-four people-pleaser.

I didn’t realize the extent to which I was holding back until, the other day, when I mentioned to my therapist something that I had told Dr. Smith–the psychiatrist that I see every four to six weeks–about positive thinking just not cutting it when you plummet to such a low depression.

My therapist asked me to back up and tell her more about that. Because either I hadn’t said anything about that to her in the last month or so or else she had missed it.

I stewed on that for a few days: Did I omit my frustration with self-help books and cognitive-behavioral techniques or maybe not express how depressed I have really been? And I realized that I divulge more to my psychiatrist about the status of my depression and anxiety than I do with my therapist.

Why? 

When I’m sitting on my doctor’s couch, I believe the most significant culprit to my bad mood is my illness. I’m somewhat like a diabetic going in to get her insulin levels checked.

However, when I perch myself across from my therapist, I feel more accountable for my moods … that I if I am unable to implement cognitive-behavioral adjustments, and thereby some find relief, that I am somehow to blame. Moreover, if I’m pulled back into addictive and destructive thoughts and behavior, I have gotten there by choice.

It’s nothing she says that makes me feel that way. She’s a wonderful therapist.

It’s just the nature of therapy versus psychiatry. By far, the easiest part of my recovery is taking my prescriptions and getting blood work done once a month or so. The real warfare takes place at the battlefield of my mind, where I must adjust my thoughts constantly, sometimes as much as ten times a minute, so that they don’t steer me into a dangerous and sticky place. My therapist is my coach, my captain, in that challenge. And so when I feel like the negative intrusive thoughts are winning 10 to 0 and it’s only halftime, I feel as though I must have, in some way, let her down.

Crazy, really, isn’t it?

But I’m not alone. According to a 2005 study published in the “Journals of the British Psychological Society,” of the study’s 85 respondents, 54 percent withheld significant information from their therapist, 42 withheld information related to depressive symptoms and behaviors. Nearly 75 percent said they did so out of shame. Like me, they wanted their therapists to think well of them.

But John Grohol of PsychCentral has some great perspective from a therapist’s perspective in his blog post called “Why Would You Lie to Your Therapist?”:

If you lie to your therapist, especially about something important in your life or directly related to your problems, then you’re wasting your and your therapist’s time. If you tell your therapist all about your depression, but leave out the fact that your mom just passed away last month, that’s an important, valuable piece of information that would be helpful for the therapist to know in order to help you better. If you tell your therapist you have low self-esteem or always feel insecure about yourself, yet leave out the fact that you purge after eating almost every meal, again, you’re only impeding your own recovery and treatment.

These are plain and simple lies, called lies of omission. And they prevent a person from moving forward in treatment.

I believe the reason many people leave out this kind of information is the same reason we have trouble mentioning embarrassing things to our family doc — we’re embarrassed by what we need to say, and feel the doctor might pass some sort of judgment on us. Whether it’s a rational fear or not doesn’t really matter, does it? One of the reasons many people seek out psychotherapy in the first place is to help combat irrational thoughts and fears, so in that context, it makes sense many of share this fear of being judged or embarrassed.

And yet, if you do nothing else in therapy, you should find some kind of way to share this sort of pertinent information with your therapist. It doesn’t have to be in the first session. But it does have to happen at some point.

Your therapist won’t judge you, and they won’t be embarrassed by what you tell them. They won’t criticize you for not sharing this information with them sooner. All they will do is use it to find a way to better help you and help you move forward.

The solutions should be familiar to our regular readers — self-help techniques (most of which you can find online; but you can also find them in self-help books, freely available at your local library); self-help support groups (such as the ones we host here at Psych Central); an employee assistance program, or EAP (if you still have some connection with a job); and a host of ways of seeing professionals at reduced costs out-of-pocket.

For instance, in some communities, there are community mental health centers that will see you for a mental health concern on a sliding scale fee — the fee is based upon how much money you make. If you’re making $0, they will still ask for a small amount (usually $10 to $20 per session). If your mental health concerns are affecting your ability to work or live your life, this is money well spent. Some private therapists also will see clients on a sliding scale, but their fees usually won’t go as low as a community mental health center’s.

There are also other great tips in the article, and yours truly is quoted in it, so it can’t hurt to check it out! We also covered this topic two years ago, Finding Low-Cost Psychotherapy, so you may also want to read our take on it.

Read the full article: Patient Money - How to Find Mental Health Care When Money Is Tight.

I have a vivid memory of walking around the neighborhood with Mark’s brother at night. The adults were sitting shiva and he had to get away. Suddenly he grabbed a fallen branch and wailed it on the trunk of a tree. Raw anger.

This family did heal. Before support groups or national days of recognition they talked about the conflicting emotions pain, anger, guilt. The same tape kept playing in everyone’s head:
If only… If only… They used therapy, the love of family, friends and good works, to find their way through. They found a way to forgive. 

Today is National Survivors of Suicide Day. Around the country there will be gatherings, rallies for awareness and support.

If you suspect someone you care for is thinking of suicide tell them out loud that you are worried for them and ask if they have thought of harming themselves. Get over your fear of offending them and imagine if they are dead tomorrow, will you regret not asking? If the answer is yes, then follow the guidelines provided by the American Foundation for Suicide Prevention. You won’t regret it.

via WBFO Surviving After Suicide of Family Member

Quebec woman Nathalie Blanchard poses on the beach in a Facebook photograph that convinced her insurance company that she was no longer depressed.

Nathalie Blanchard, a 29-year-old IBM employee from Quebec, took a long-term sick leave from her job after being diagnosed with major depression. Her doctor told her to try & have fun, and to take a sunny vacation to get away from her problems. She did just that while she received monthly sick-leave benefits from Manulife.

And she posted her vacation photos on her private Facebook profile.

But recently, the monthly payments stopped. So, Blanchard contacted her insurance company to see why she was no longer receiving her benefits:

When Blanchard called Manulife, the company said that “I’m available to work, because of Facebook,” she told CBC News this week.

She said her insurance agent described several pictures Blanchard posted on the popular social networking site, including ones showing her having a good time at a Chippendales bar show, at her birthday party and on a sun holiday — evidence that she is no longer depressed, Manulife said.

But can a series of photographs really demonstrate that someone is no longer depressed?

Blanchard confirmed that she’s happy “in the moment” that the photo is taken, but “before and after, [she has] the same problems”.

According to CBC news, the insurer has confirmed that they do indeed use Facebook to investigate their clients, but the company claims that it wouldn’t “deny or terminate a valid claim solely based on information published on websites such as Facebook”.

Claude Distasio, a spokeswoman for the Canadian Life and Health Insurance Association, tells CBC News that insurance companies “must weigh information found on…sites” like Facebook.

But how much weight should something like a photograph taken in a sunny locale carry? I think it’s fairly obvious to say that even folks grappling with major depression smile once in awhile. Sure, I personally struggle with anxiety, but I’m calm sometimes — placid, in fact, if you catch me at the right time. People dealing with agoraphobia are probably going to find themselves out in public on a good day. Does a photograph of an agoraphobic in a public area demonstrate that agoraphobia is no longer a problem? How about a photo of an insomniac, sleeping soundly? Making mental health judgment calls based off a mere photograph — a single, isolated, and brief moment of time — is a slippery slope.

Take a look at your own Facebook profile picture. Does it accurately portray your mood at the moment it was taken? How about your long-term disposition? Look at it analytically from an outsider’s perspective. If you suffer from a mental illness, is there evidence of that illness in the photograph? Is a photograph a valid measure of anything other than a visual record of a moment?

Currently health care in this country is focused on illness rather than health, on procedures and face-to-face interventions rather than on coordination and prevention, and on fragmented, specialty-driven care rather than on a primary care-driven delivery system. There is a solid evidence base that shows that a health system centered on primary care costs less and has better outcomes on a population basis than one dominated by specialty-driven care.

For behavioral healthcare, this kind of system reform poses significant opportunities and challenges, specifically in the scaling up of the evidence-based integration of mental health and substance use treatment and prevention into primary care. Thus, it is through system reform—replacing a fragmented, specialty-dominated system with a more effective and efficient primary care-driven one—that national health care reform may have its greatest impact upon the behavioral healthcare field.

In other words, in order for mental health to be more accepted, primary care physicians — those docs who already see most people with mental health concerns initially anyway — really should be at the forefront of coordinating all of a patient’s care, including their mental health care. I’m not sure I entirely agree with this approach, but it makes a certain sense and is certainly a more elegant option than what currently exists today.

There were six working groups this year, and you can view both the video of the entire symposium and the powerpoint presentations of the working groups’ recommendations online. Since the recommendations are fairly lengthy, I’ll try my best to summarize the salient points from their slides below as succinctly as possible.

1. Reimbursement/Financing

• Define and promote a clearly articulated clinical integration model
• This makes it possible to have clearly defined outcomes tied to core payments, with performance incentives
• Financing that supports designs and outcomes (e.g. bundled payments)

2. Children and Adolescents

• Develop a National Children’s Agenda that drives a public health approach that addresses developmentally appropriate needs across the population (including prevention and health promotion).
• Promote the availability of holistic assessments that link the youth and family to services and supports that match developmental needs and promote resiliency and protective factors.

3. Workforce Development

• Expand the concept of who the workforce is and how we train that workforce to work together as equal partners in care in systems that fit the outcomes people desire while being served in their communities.
• The future healthcare workforce will be integrated, networked, collaborative, and community needs-driven, organized around the tenets of population health and the principles of recovery, including primary, secondary, and tertiary prevention, while sharing collective accountability.

4. Cultural and Ethnic Minorities

• Develop an integrated, community-owned health care delivery system that: aligns incentives for financing; supports community-defined evidence; fosters health IT, promotion, and prevention; addresses stigma; has culturally relevant, team-based care; and is accountable and outcomes-driven.
• Expand and improve the capacity of the primary and behavioral care workforce to meet the needs of racially, culturally, and ethnically diverse communities in an integrated setting

5. Research

• Build a registry for gathering promising practices to guide policy and reforms
• Conduct research on effectiveness of promising practices in the registry
• Use existing data sets to track the impact of health reform (e.g. how does reform impact spending on behavioral health?). Need to give more open and real-time access to data for researchers.
• Develop implementation strategies to ensure widespread dissemination of effective practices

6. Population Health and Prevention

• Advocate that existing task forces work on mental health issues and integration into primary care, as well as revise the evidence standards.
• Health reform money should be used on coordinated mental health promotion efforts.
• Identify groups, including public health advocates, to develop shared language, goals, and resources
• Obtain and fund community-level research on population-based interventions that have evidence, including comparative effectiveness work globally.

What happens next? It’s expected that because the policy summit is attended by the leaders from a wide range of organizations, businesses, and government representatives, they take these policy recommendations back to their respective groups to help guide their organization’s future work. It’s an imperfect system, but you can’t mandate change — you need to persuade it. It usually occurs gradually, in small steps over time.

Note your top picks in the comments and we’ll review those and the ones on our own list to come up with our big list for the year. If you had a favorite blog entry from the past year, we’d love to hear about that too in the comments!

The Year in Review will be published in December.

The first is from Leigh Pretnar Cousins, MS called Always Learning. Leigh is a private tutor and is studying in educational psychology. Although her blog will focus on the topic of educational psychology and learning, she believes these lessons are of value to all of us throughout life:

Every day my work teaches me some lesson that holds, not only for kids, but for all of us. I can hardly wait to share these things with you.

I’m excited to have this place to talk about learning and all its facets… Learning and school, learning and work, learning and emotions, learning and relationships, Learning and Life.

I agree. Learning doesn’t stop just because we don’t go to school any longer, and I look forward to reading her blog in the days and weeks to come.

Our second blog is called The Y Factor, which will talk about men, dating and the single life (from a woman’s perspective). Kate Nickerson (and others) will share her insights with us as she learns from her life experiences and psychotherapy:

I had no conscious realization how my life had been seriously screwed up by the way I related to men. So now I’m going to face the truth — deal with men in my life. Take the lessons and leave the negative memories in the past.

These lessons are what the “The Y Factor” will explore. From my father and grandfathers, to ex-boyfriends and bosses — all of the relationships with the men in my life will be dissected herein and my pithy insights revealed.

I’d also like to take this opportunity to remind our regular readers that we’re always looking for new bloggers and contributors here!

If you’re a mental health professional — especially a practicing clinician or researcher — and a writer (or someone who very much enjoys writing!), we’d love to talk to you. Drop us a line at:

blogs [at] psychcentral.com

We hope you enjoy these two new blogs!

Check out our new blogs now:

• Always Learning
• The Y Factor

Cicero said that “gratitude is not only the greatest of virtues, but the parent of all the others.” The English preacher John Henry Jowett wrote that “every virtue divorced from thankfulness is maimed and limps along the spiritual road.” And according to Aseop Fables, “gratitude is the sign of noble souls.” A dear professor of mine just acknowledged a thank-you note I sent him and told me that “gratitude is the sign of maturity and wisdom.”

I don’t feel like I’m very good at gratitude. This virtue comes hard to a depressive whose first thoughts are seldom positive. It has only been with much work and lots of practice that I have been able to cultivate gratitude and be genuinely thankful. Here are 12 techniques I use to help me get to the parent of all virtues.

1. See with the heart.

One of my very favorite quotes is from Antoine de Saint-Exupery’s “The Little Prince”: “It is only with the heart that one can see rightly, what is essential is invisible to the eye.” Every time I throw myself into a tizzy because things aren’t going as expected, or as I projected on my Excel spreadsheet for the year 2020, I have to remind myself that I’m looking with the wrong instruments: I need to go back and tell my heart to get some guts and speak up to my head because it’s starting to listen to my eyes again.

2. Change your language.

Learning how to see with the heart–shifting perspectives ever so slightly–is easier once you learn how to talk to yourself and to others. Dan Baker, Ph.D., writes in “What Happy People Know”: “Just as changing your life can change your language, changing your language can change your life.” I do a lot of self-bashing, and when I’m in the middle of a rant, I’m not able to be thankful. According to Baker, recent research has actually proved that: it’s impossible to be simultaneously in a state of appreciation and fear, which is why gratitude and appreciation are antidotes to fear. Moreover, the words I speak to myself and to others really do alter my perception of the world. But when I can recognize the toxic self-talk and change my choice of words, the seeds of gratitude can grow.

3. Get a gratitude partner.

Shifting perspectives–seeing that the cup you thought had one teensy drop is actually two-thirds full–and communicating with new language takes time, discipline, and practice. Just like working out. So it makes sense that a gratitude buddy might help you stay in line, just like your running partner does, or, well, is supposed to. Because, come on, who really wants to wake up at 5:30 in the morning on a dark, cold morning and jog around town, right? Only those who are training for the Olympics, exceptionally disciplined, or have work-out partners who will yell and get even if they are stood up.

4. Remember.

“Gratitude is the heart’s memory” says the French proverb. Therefore, one of the first steps to thankfulness is to remember… to remember those in our lives who have walked with us and shown kindness. I have been extremely fortunate to have so many positive mentors in my life. For every scary crossroad–when I was tempted to take a destructive path and walk further away from the person whom I believe I was meant to become–I met a guardian, a messenger, to lead me out of the perilous forest.

5. Keep a gratitude journal.

Gratitude can do more than make you smile. Research conducted by psychologist Robert Emmons at the University of California at Davis, author of “Thanks! How the New Science of Gratitude Can Make You Happier,” has found that it can also improve your health: raise energy levels, promote alertness and determination, improve sleep, and possibly relieve pain and fatigue. Emmons maintains that writing in a gratitude journal a few times a week can create lasting effects.

6. Write a thank you letter.

Another gratitude exercise suggested by Dr. Emmons, known as “the father of gratitude” in the psychology world, is to compose a “gratitude letter” to a person who has made a positive and lasting influence in your life. Emmons says the letter is especially powerful when you have not properly thanked the person in the past, and when you read the letter aloud to the person face to face.

7. Make a gratitude visit.

Emmons encourages folks to read their letters aloud in person. But I like to go free style. I just show up, usually to a high school or college classroom, and I tell the students what a difference in my life their teacher has made, that I hope that they know how lucky they are to be learning from such an exceptional person, and to be sure to take lots of notes because chances are that they won’t throw out their notebooks after the course is over.

8. Start a gratitude club.

This sounds like an idea for those with, well, lots of time on their hands. But I’m only suggesting it because it works. Last year, Group Beyond Blue held four “self-esteem forums,” where we got online at a specific time, and were each assigned one person to whom to write a warm-fuzzy letter. A few people visited the thread, just curious about what we were up to, and wept after reading some of the letters.

In his book, “Authentic Happiness,” Martin Seligman, Ph.D., the father of the positive psychology movement, describes the dramatic impact of “Gratitude Night,” where class members bring a guest who had been important in their lives but whom they hadn’t thanked properly. Each member of the class presents a testimonial about the person and thank them. Gratitude night has become the high point of his class, and many students remark on their evaluations of the class at the end of the semester that gratitude night was truly one of the best nights of their entire life. Writes Seligman: “We do not have a vehicle in our culture for telling the people who mean the most to us how thankful we are that they are on the planet.”

9. Acknowledge yourself.

Most published books include a page or two of acknowledgments, where the author cites all the persons who helped shepherd her book to production. It’s like the Oscar moment, when the actor is up on stage and is rattling off every name he can think of and hopes to God he didn’t forget anyone–especially his spouse. The truth is that most people, and especially those who suffer from low self-esteem, do forget a very important figure: themselves. Which is why I think a healthy activity is to write a page of acknowledgements to yourself. Mine would go something like this:

And I thank you, Self, for doing all that you do to try and keep me healthy: for storing the kids’ Halloween bags up where you can’t reach it, where you need a stool to get it down, which is entirely too much effort for a Kit Kat; for exercising four to five times a week; for going to therapy; for trying every day to erect boundaries between your work and home life; for taking six Omega-3 soft-gels capsules a day in addition to all the other vitamins and meds you swallow; for trying your best at good sleep hygiene; and for laughing at stupid stuff whenever possible, because I say that it’s better than crying.

10. Accept a gift.

Sometimes gratitude is hard because we don’t think we’re worthy of the gifts bestowed on us. Tal Ben-Shahar, Ph.D. explains this problem in his book “Happier: Learn the Secrets to Daily Joy and Lasting Fulfillment”: “When we do not feel that we are worthy of happiness, we cannot possibly feel worthy of the good things in our lives, the things that bring us happiness.”

One of the hardest acts of gratitude is to graciously accept a gift, to believe in the goodness of the person who gave it to us, and to believe in ourselves enough to receive it. When I was a senior in college, a homeless man wanted to take me out to lunch. I had been spending my Fridays at a shelter and we had become friends. I didn’t feel right about his spending the only dollars he had on a lunch for me. It should be the other way around.

“Let me take you,” I said. And he frowned and became sad.

“Please,” he pleaded, “Let me do this. It would make me happy.”

So I let him. And it did.

11. Pray.

“If the only prayer you say in your life is ‘thank you,’ that would suffice,” wrote Meister Eckhart. I remember that piece of advice as I say my prayers in the morning, the hour I spend running around the Naval Academy. I start with a rosary, then I launch into all my prayer requests, which probably sound to God like Katherine’s Christmas list does to me: “Mom, have that man, Santa, get me everything I have circled in this catalog, okay?”

And then, when I reach my favorite stretch of the run–where the academy field follows the Severn River, a gorgeous spot on the campus that takes my breath away–I don’t say anything. I just take in the beauty with a grateful heart. My only prayer for those three minutes is “thank you.”

12. Give back.

The other day I was trying to come up with a way of repaying a former professor of mine for all his encouragement and support to me throughout the years. Nothing I could ever do could match his kindness. No letter of appreciation. No visit to his classrooms. So I came up with this plan: perhaps I could help some young girl who fell into my path in the same way that he helped me. I told my professor-friend that I would try to help and inspire this lost person–I would try to guide her to a source of love and self-acceptance–just as he had done for me.

Giving back doesn’t mean reciprocating favors so that everything is fair and the tally is even. That’s the beauty of giving. If someone does an act of kindness for you, one way to say thanks is to do the same for another.

In the past few days, Meagan had found it increasingly hard to fall asleep, and noticed that her appetite was poor. From time to time, she found herself weeping or sighing, but not knowing what to do. She wondered if “maybe having a few drinks” might do her some good.

Meagan (a composite character) has a number of risk factors for feeling down or depressed. First, women have rates of serious depression about twice those of men, and are also at higher risk for a particular type of major depression called Seasonal Affective Disorder (SAD). In addition, the combined stresses of holiday chores, child care, and financial woes put Megan at risk for what is popularly known as “the holiday blues.” So does Meagan’s “anniversary reaction” over the death of her mother. But what do we really know about the “holiday blues,” beyond hundreds of anecdotes and Internet postings? How do the “blues” differ from SAD and other forms of major depression? And is the commonly-held notion that suicide rates soar during the Christmas and winter holiday season really valid? Some recent research sheds light on these questions, while also highlighting many “grey areas” in our knowledge.

Let’s deal with the “Christmas suicide” story first. From all the data we have gathered in the U.S. and parts of Europe, we can say confidently that this is a myth. In fact, we have evidence going back to the 19th century that suicide rates generally decline in the late fall and winter months, and spike upward in late spring and summer. The precise reasons for this pattern are not known, but the finding is consistent across many studies. In fact, data from Zurich, Switzerland, show that suicide rates begin to fall as early as late November, and remain lower until just after New Year’s Eve. That’s the good news, and ought to allay fears that Christmas, Chanukkah, Kwanzaa or other winter celebrations are times of high suicide risk. The not-so-good news, however, is that suicide rates appear to spike upward after New Year’s Eve — largely among men. Rates for women seem to return to baseline, without a major spike.

There are two main hypotheses to explain these patterns. The “broken promises” hypothesis holds that, during the holiday season, people have very high expectations. Like Meagan, many view the holidays as a time to put things right, experience the joy of family and friends, and perhaps to experience some kind of spiritual renewal. Unfortunately, many are disappointed when these hopes are dashed — and some who become very despondent may take their lives. In contrast, the “withdrawn support” hypothesis begins with the observation that the winter holidays are usually a time of increased contact with family and friends. Social contact and support are known to protect against the risk of suicide. But after New Year’s Day, social supports usually diminish rapidly. This is what I call the “picking up the wrapping paper phase,” and it may be the time some very vulnerable individuals decide to take their own lives. Why does the post-holiday increase in suicides affect men more than women, at least in Switzerland? It may be partly because women are better than men at maintaining post-holiday social support networks, but this remains speculative.

With all the annual hoopla over the “holiday blues,” it is surprising that so little solid research has been done on it. There seems to be no specific definition of the term, and — so far as I can tell — there are no well-designed epidemiological studies of the phenomenon in the U.S. That said, Dr. Jennifer Wider reports that nearly two-thirds of women surveyed by the National Women’s Health Research Center reported feeling depressed during the previous year’s winter holidays. I’m not aware of comparable data for men. However, Dr. Wider observes that often, during the holidays, the burdens of family caretaking fall mainly on the shoulders of women. Increased alcohol use during the holidays, combined with family stressors, may set many women up for the holiday blues. Of course, men are hardly immune to this condition, and are at higher risk for completed suicide.

Psychologist Dr. Herbert Rappaport believes that those he calls “fixers” — individuals intent on “making everything right” during the holidays — are especially prone to grief reactions after Christmas and Chanukkah. Fortunately, the “holiday blues” are usually short-lived, lasting a few days or perhaps a week or two in most cases. This differs from SAD, which tends to last weeks or months, and reappears winter after winter, regardless of social stressors. SAD, which affects perhaps 10 percent of the population, may be related to decreased daylight in the winter months, which in turn may reduce mood-boosting brain chemicals like serotonin. SAD is often characterized by excessive daytime sleep, substantial weight gain, inability to function, and persistent thoughts of suicide. Unlike the “blues,” SAD and other types of major depression require professional intervention.

Preventing the holiday blues involves four main strategies: keeping expectations realistic; delegating responsibilities; shoring up social supports; and avoiding excessive alcohol consumption. More detailed advice is found in several of the articles listed below. Finally, another good strategy, according to Dr. Hinda Dubin of the University of Maryland Medical Center, is to find ways of helping those less fortunate than oneself. Taking the focus off your own problems and aiding somebody truly in need may be the best gift you’ll ever get during the holiday season!

For more information on coping with the “holiday blues,” see the following websites:

• Beating the Holiday Blues
• Managing the holiday blues
• Beating the Holiday Blues
• Nine Ways to Beat the Bah Humbugs
• Wrung-Out by Ringing-In the Holidays: Dealing with Post-Holiday Blues

So what does the Army do? Does it recognize the significance of this number with a solemn, sincere statement? No, instead it turns on the full denial PR machine:

“We are almost certainly going to end the year higher than last year,” General Peter Chiarelli, the Army’s vice chief of staff, told a Pentagon briefing.

“This is horrible, and I do not want to downplay the significance of these numbers in any way.” [...]

Chiarelli cautioned against generalizing about the causes of the suicides, or assuming links to combat stress on forces stretched thin by the wars in Iraq and Afghanistan.

So in one breath, General Chiarelli says he doesn’t want to downplay the significance of these numbers. In the next, he says we can’t generalize these numbers to any actual military combat missions that soldiers may be actively involved in. Huh?

With all due respect, perhaps General Chiarelli needs to take a course in logic or read more of the prior reports released about this increasing problem within the U.S. military. To not connect the dots between the never-ending wars in Iraq and Afghanistan (did no one study military history and the Russian invasion of Afghanistan?) is to be in a state of irrational and delusional denial. Sorry, General, but such statements make you sorely out of touch with your people and reality.

When you’re threatening court martial to moms who can’t find child care for their 10-month old before deployment and have psychiatrists shooting up your training bases because you don’t acknowledge the inherent conflicts in service amongst your ranks (or your officers don’t have the stomach to discharge someone they clearly saw as problematic), then yes, you have some serious problems. And yes, they are related to the two wars you are currently fighting.

As the article notes, the military’s suicide rate among active-duty soldiers was about 20 per 100,000, nearly double the national U.S. rate of 11.1 suicides per 100,000 people.

There is something significantly wrong there if twice as many people in your service are taking their own lives. This hasn’t always been the case. And rather than trying to whitewash the issue, you should be pulling out all the stops — and all significantly increasing the funding — to figure out how to stop the blood letting.

Read the full article: Army suicides set to hit new high in 2009

One researcher, John Horgan PhD at Pennsylvania State University, found that people who are more open to terrorist recruitment and radicalization tend to:

• Feel angry, alienated or disenfranchised.
• Believe that their current political involvement does not give them the power to effect real change.
• Identify with perceived victims of the social injustice they are fighting.
• Feel the need to take action rather than just talking about the problem.
• Believe that engaging in violence against the state is not immoral.
• Have friends or family sympathetic to the cause.
• Believe that joining a movement offers social and psychological rewards such as adventure, camaraderie and a heightened sense of identity.

A lot of this is not particularly surprising, as we learn time and time again from the profiles constructed in the media of famous terrorists after-the-fact. But the insights gained from talking to ex-terrorists helps us better understand individual terrorists’ motivations:

For instance, based on what he’s gleaned about why people leave organizations, a particularly promising strategy may be highlighting how the promised glamorous lifestyle never comes to pass — an experience poignantly recounted by a former terrorist now in hiding. The man told Horgan he was lured into a movement as a teen when recruiters romanticized the cause. But he soon discovered his comrades held sectarian values, not the idealistic ones he had, and he was horrified when he killed his first victim at point-blank range.

“The reality of involvement is not what these kids are led to believe,” says Horgan. “Speaking with repentant former terrorists, many with blood on their hands, offers an extraordinary opportunity to use the terrorists’ own words and deeds against them.”

Arie Kruglanski PhD, co-director of the National Consortium for the Study of Terrorism and Responses to Terrorism (START), conducted a study that surveyed thousands of people in 15 countries. In the yet-unpublished research, he found that “Muslims who have a more collectivistic mentality are more likely to support terrorist attacks against Americans than those with more individualistic leanings. The research also found that the lower people’s reported personal success in life, the greater their tendency to endorse collectivistic ideas and to support attacks against Americans. The findings suggest that joining terrorist groups may confer a sense of security and meaning that people do not feel as individuals.”

Psychologist Clark McCauley PhD, a co-investigator at START and director of the Solomon Asch Center for Study of Ethnopolitical Conflict at Bryn Mawr College, believes that too much focus is on terrorist behaviors and their motivations, while ignoring the larger picture of how governments can unintentionally be reinforcing some of the terrorist’s actions:

[I]f terrorists commit an attack and a state uses extreme force to send a punishing message back, the terrorists may use that action to drum up greater anti-state sentiment among citizens, lending justification to their next actions. Yet research focuses almost solely on terrorist actions and neglects the important other side of the equation, he contends.

So how do you combat terrorism, if not by sheer force (which, as we’ve seen, is largely ineffective)? Kruglanski and other researchers have some ideas, by implementing anti-terrorism programs that are delivered to captured terrorist prisoners. The programs have three parts:

• An intellectual component involving moderate Muslim clerics who hold dialogues with imprisoned detainees about the Qu’ran’s true teachings on violence and jihad.
• An emotional component that defuses detainees’ anger and frustration by showing authentic concern for their families, through means such as funding their children’s education or offering professional training for their wives. This aspect also capitalizes on the fact that detainees are weary from their lifestyles and imprisonment.
• A social component that addresses the reality that detainees often re-enter societies that may rekindle their radical beliefs. A program in Indonesia, for instance, uses former militants who are now law-abiding citizens to convince former terrorists that violence against civilians compromises the image of Islam.

Similar programs like this can help entire radical Islamic groups renounce violence when well-implemented and embraced, as the original article notes with specific examples. The key is teach potential terrorists that much of their terrorist teachings were based upon lies, that you need to address their anger and frustration, and help them find a life within everyday society. This doesn’t seem like rocket science, and yet today, we still seem to ignore the potential of these interventions and strategies for helping to reduce terrorism in the world.

Although it’s lengthy, if you’re interested in this topic, the full article is well worth a read.

Read the full article: Understanding terrorism

Individuals reporting lower marital satisfaction experienced more non-specific physical illness symptoms over a 4-year period than individuals with higher marital satisfaction. Among healthy women, lower marital satisfaction was also associated with a more rapid progression of carotid atherosclerosis. Furthermore, women who were initially dissatisfied in their marital relationship were more likely to develop metabolic syndrome over an 11-year period.

Among women hospitalized for an acute coronary event, those who reported moderate to severe marital strain at baseline were 3 times more likely to experience a recurrent coronary event during a 5-year follow-up, compared to women reporting less marital stress. Poor marital quality was also associated with a lower 3-year survival rate among end-stage renal disease patients, and a lower 8-year survival rate among congestive heart failure patients.

Collectively, these results from prospective observational studies provide evidence of an association between marital stress and negative health outcomes.

The latest research from Graham et al. (2009) shows that couples who are more considerate and rational during a fight release lower amounts of stress-related proteins. This suggests that rational communication between partners can ease the impact of marital conflict on the immune system.

Individuals in a stressful situation — as in a troubled relationship — typically have elevated levels of chemicals known as cytokines. These proteins are produced by cells in the immune system and help the body mount an immune response during infection. However, abnormally high levels of these proteins are linked to illnesses such as cardiovascular disease, type-2 diabetes, arthritis and some cancers.

When people used words in a conflict-resolution discussion with their spouse that were indicative of a rational, calm and thoughtful discussion — words like think, because, reason, why — the researchers found lower amounts of cytokines, the stress-related proteins. The researchers suggest it is because these kinds of words suggest that people are either making sense of the conflict, or at least thinking about it in a deeper, more meaningful manner.

Virtually the same research team led by Gouin et al. (2009) looked at the same set of couples’ attachment style in a separate study. Attachment style refers to Bowlby’s (1982) theory about how babies reacted to their parents in times of stress or danger: “Securely attached children exhibit distress upon separation from their mothers, but are quickly comforted when reunited. In contrast, anxious children exhibit intense distress upon separation, and are not easily soothed following their mother’s return. Avoidant children do not display signs of distress upon separation, and refrain from seeking contact upon reunion with their mothers.” The researchers note how this corresponds to adulthood relationships:

[Other researchers] argued that in adulthood, the attachment bond established between long-term romantic partners is similar to that of the parent–child relationship, albeit both partners serve reciprocally as attachment figures for one another.

Adulthood attachment style is defined along two dimensions. Attachment anxiety reflects fear of the partner’s rejection, separation or abandonment, while attachment avoidance represents difficulties in relying upon and opening up to others, and avoidance of intimacy with and dependency on one’s romantic partner. [...]

Anxious individuals worry about being rejected in their close relationships and are overly dependent on others for support and self-esteem. Avoidant individuals become uncomfortable and pull away when their partners get too close and prefer being self-reliant rather than asking others for help.

The researchers found that individuals with higher levels of attachment avoidance — those who pull away when their partners get too close — had larger stress-related proteins to a marital disagreement, compared to less avoidant individuals. These same folks also displayed more negative behaviors and less positive behaviors during the discussion of a marital disagreement. They found no significant relationship between people with attachment anxiety and the stress-related proteins.

The take-aways from these two studies?

Learning conflict-resolution skills will likely benefit your relationship. Being able to calmly and rationally discuss difficult issues in a relationship — money, family, child-rearing — will result in less stress. In addition, being “securely attached” in your relationship, or at least not using an avoidant attachment style, will benefit you as well. People who pull away in relationships are likely to have more of those stress-related proteins, behave more badly, and have less positive behaviors during a disagreement.

Read the full news article: Thoughtful Words Reduce Stress of Marital Conflict

References:

Gouin, J-P., Glaser, R., Loving, T.J., Malarkey, W.B., Stowell, J., Houts, C., & Kiecolt-Glaser, J.K. (2009). Attachment avoidance predicts inflammatory responses to marital conflict. Brain, Behavior, and Immunity, 23(7), 898-904.

Graham, J.E., Glaser, R., Loving, T.J., Malarkey, W.B., Stowell, J.R., & Kiecolt-Glaser, J.K. (2009). Cognitive word use during marital conflict and increases in proinflammatory cytokines. Health Psychology, 28(5), 621-630.

About a month ago, Time Magazine published the results of a landmark survey gauging where America stands on the battle of the sexes. The results show that women are much more powerful than they were 40 years ago. In the 60s, one-third of all workers were woman. Now half are. Almost 40 percent of women are the primary breadwinners or are contributing substantial income for the household budget. And according to a Mediamark Research & Intelligence survey, women make 75 percent of the buying decisions in the home. You know the telemarketer who asked for the decision-maker of the house? Apparently it’s the wife.

Women’s power extends to the academic world, as well. Author Nancy Gibbs explains in “Time” that half of Ivy League presidents are women, and the female dropout rate has been cut in half since the 70s. Also, the ratio of 60-40 of men and women on college campuses has reversed. Moreover, half of all law and medical degrees go to women.

But they are stressed, anxious, and not as happy.

Why?

According to the poll results, both men and women say that the government and businesses haven’t adjusted to the revolution and need to do more to help families manage it all. For example, 54 percent of women and 49 percent of men say businesses need to be more flexible with work hours and schedules; they also agreed that companies need to give more paid time off, better or more day-care options, and longer school days or longer school years.

But are women really less happy than they were back in the day we wore pearls with our aprons and greeting Dad at the door when he arrived home from work, the turkey roasting in the oven?

Gibbs writes, “It may be that women have become more honest with the same pressures and conflicts that once accounted for greater male unhappiness. Or that modern life in a global economy is simply more stressful for everyone but especially for women, who are working longer hours while playing quarterback at home.”

I think she nailed it there. It’s comparable to therapy. Before you sit yourself on that couch, you think have a few problems, but you’re not sure what they are. Then the therapist starts prodding you, and yikes! You got yourselves a lot of bloody problems.

From my perspective, I do think I have a more fulfilling life in that I have to use my head for more things than figuring out why the Bendaroos we ordered from the infomercial sucks in comparison to what they promised us. But my job does bring a considerable amount of stress. So I’m happier in one sense, and much more anxious and stress in another. Like Gibbs says, I am probably experiencing the male stress–the pressure transforming ideas and brain power into cash to buy dinner–than many women just simply didn’t experience 30 or 40 years ago.

This is the part in a post that I usually say something that makes you feel better. Like, oh but it’s going to get easier next month.

I don’t have any answers. But I’m glad someone at least asked the question because now I know I’m not alone in feeling like I’m one lousy juggler.