Along with bell bottoms and feathered hair, mood rings were all the rage in the 1970s. A quick glance at the color of the ring would let you know if you were feeling good, bad or in between. Black signified nervousness, blue meant relaxed, and violet meant passionate. The rings were said to change color in response to the wearer’s body temperature which was supposedly associated with their emotional state. It didn’t take long for mood rings to be escorted to the halls of scientific eye rolls but the interest in mood awareness persists. Just last year Apple launched a State of Mind feature in the Health App to help users monitor their emotional state. The idea is to label your mood and then track it. As an aside, according to my daughter, mood rings have made a comeback and she tells me the color amber means her mom is annoying her but that is a discussion for another day.

In the same way that adults are guided to focus on their emotional state, children are too. Toys such as the Emotions Coin Drop are designed to help children better understand how they are feeling at a given moment. It features six colorful coins that each represent a feeling: happy, sad, angry, surprised, silly, and anxious. The idea is to help children identify and talk about  their inner state and to grow emotional self-awareness at a young age. In Pixar’s Inside Out movies, feelings are also a central theme and portrayed with main character energy. From behind a console inside a young girl’s mind, characters such as Joy, Anxiety, Ennui, Embarrassment and Fear control and sometimes upend her thinking and actions. Her internal landscape shapes her existence in the world. The message is clear: in order to be psychologically fit, it’s important to take time and energy to process and understand what is going on in your head. An awareness of how you are feeling, thinking about how you are feeling, and talking about how you are feeling, we are led to believe, are the building blocks of mental health.

“If you had diabetes, would you take insulin?” This was the question I was trained to ask any patient who was on the fence about taking prescription medication for a mental health issue. Equating a mental illness with a physical one was intended to persuade the person that there was a straightforward biological explanation for their symptoms and a simple remedy.

Looking back, I realize that the-brain-is-broken-and-medication-can-fix-it argument may not have been the most effective message. For starters, it completely ignores psychological and social factors such as homelessness, isolation, family dynamics, and poverty that can trigger mental illness. It also overlooks the role of lifestyle factors such as diet, sleep, and physical activity that buffer and boost mental health.

In his book Healing, former director of the National Institute of Mental Health, Tom Insel discusses what he believes to be the most important contributors to recovery: people, place, and purpose. In other words, having people who support you, having a sanctuary to heal, and discovering a purpose or mission. A psychiatrist friend summed it up this way: mental health is having someone to love, somewhere to live, and something to do. A woman who is depressed because she is in an abusive relationship doesn’t need Prozac, she needs a safe haven.

Happiness is not all in your head

When we talk about a mental disorder using the biological model and equate it with physical illness, we ignore context. We also overlook a key contributor to mental health: the role of personal agency. Having a sense of agency means that you feel like you are in the driver’s seat, that you have a say over your actions, that life is not just happening to you. Being told you are governed by neurochemical abnormalities is the opposite of empowering. Research shows it can also promote negative social attitudes. However well intended, the biological model may inadvertently promote a defeatist attitude and feelings of powerlessness:

“Biological explanations appear to lead to certain forms of so-called psychological essentialism in which mental disorders are seen as having unique, immutable essences—located in the brain or DNA—that produce the symptoms and behavior of patients. This view, in turn, can yield the belief that people with mental disorders are categorically dissimilar from so-called normal people, and the perception of such strict social boundaries between groups of people can lead to more negative intergroup attitudes. It can also exacerbate the perception that mental disorders are relatively permanent and difficult to overcome or treat effectively, which is known as prognostic pessimism.”

Messaging matters 

A few years ago, I remember a patient’s sense of relief when I told him he was in the midst of a major depressive episode. The word “episode” helped him see his symptoms as time limited, rather than permanent and pervasive. The problem with the biological model is that it promotes a fixed mindset about mental illness–that it’s stable and innate. Promoting a growth mindset–the belief that it is changeable and that the person has agency–is a healthier message.

A recent study published in the Journal of Clinical Psychology found that when college students read messages on social media that promote a growth mindset about mental health challenges, they were more optimistic about getting better. Even subtle differences in wording was enough to sway people’s beliefs about depression and anxiety and their treatment.

Participants were divided into three groups. Some viewed a series of tweets on X that conveyed a fixed mindset. For instance, one tweet said, “I can’t wait for my seasonal depression to be over so that I can get back to my regular depression.”  A second group read tweets that emphasized a growth mindset. These messages emphasized the fluid nature of mental health and the ability to take control over it. For example, one of these tweets read, “I got this” to a meme that read “telling those anxious thoughts who’s really in control.” A third group read tweets that did not touch on mental health at all.

Participants who read the fixed mindset tweets had more pessimistic views about mental illness and saw it as more permanent and that there was little a person could do to manage it. Participants who read the growth mindset tweets were more likely to see depression and anxiety as temporary conditions that people can take steps to alleviate.

Bottom line

There are many reasons a person might experience mental distress, including biological, psychological, and social ones. If we only address the biological factors, we risk undermining optimism and key contributors to mental health: people, place, and purpose.

Why do so many smart people miss obvious warning signals that are right in front of their nose? Denial is a powerful motivator. Think of the parent who refuses to acknowledge that their child needs professional help or the spouse who ignores mounting evidence of a cheating partner or the individual with intermittent chest pain who postpones a visit to a doctor. Willful blindness goes hand in hand with wishful thinking. The problem with living in a bubble is that bubbles burst. As Ayn Rand observed, “You can ignore reality, but you can’t ignore the consequences of ignoring reality.”  

One might assume that denial is a problem faced by individuals, not groups. When people get together, the thinking goes, they get smarter. As the old saying goes, “none of us is as smart as all of us.” But plenty of evidence shows that this is not the case.  There is no safety in numbers when it comes to collective delusions. When great minds think alike, greatness evaporates.

Groupthink turns out to be a denial amplifier. First defined by Yale psychologist Irving Janis, groupthink explains how a group of intelligent people can fall prey to a shared form of willful blindness and overconfidence. From the Vietnam War to the Challenger disaster to the 2008 financial crisis, groupthink has led to poor and sometimes catastrophic decisions. Defined as “a pattern of thought characterized by self-deception, forced manufacture of consent, and conformity to group values and ethics,” groupthink promotes and reinforces reality avoidance.

According to Janis, it’s the reason we remain “color-blind in a sea of red flags.”

Janis identified 8 symptoms of groupthink

1. Self-Censorship

2. Stereotyping

3. Unanimity

4. An illusion of invulnerability

5. Rationalization

6. Self-appointed “mindguards”

7. Direct pressure on dissenters to conform

8. Belief in inherent morality

Groupthink may explain why so many were shocked by the president’s debate performance two weeks ago. Red flags were there for quite some time but warning signals were systematically cast aside or met with denial, evidence was avoided or selectively interpreted, and dissenters were shunned. It seems that the Biden family is also engaged in its own well-intentioned groupthink, insisting that everything is just fine when it clearly isn’t.  An inner circle that is supportive is as valuable as having an inner circle that is honest and clear-eyed.

To avoid reality avoidance, experts say every inner circle should have a designated dissenter-in-chief. Someone needs to be the skunk at the picnic to poke holes in the narrative, to offer constructive criticism, to voice unpopular ideas, and to float alternative options. As Adam Grant recently wrote in an op-ed in The New York Times, “service is not only about stepping up to lead. It’s also about having the courage to step aside.”  It’s invaluable to have an inner circle who believes in your light.  It’s also invaluable to have an inner circle who helps you see the light.

“Whether you think you can or think you can’t, you’re right.” Henry Ford

Imagine a stressful everyday situation—being late to a meeting, giving an important presentation, or taking an exam.  Your perception of your ability to cope shapes how you will actually cope. If you believe you are up to the task, you are more likely to rise to the occasion.

The benefits of an “I Can” attitude

Perceiving a stressful situation as a challenge to rise to rather than a threat that will subsume you decreases anxiety, boosts attention, and increases performance. An “I Can” attitude, as psychologists call it, makes it easier to navigate difficulty. It also makes people more likely to embrace opportunities and pursue new goals. If you think it’s possible to achieve something, you’re more likely to go for it and more likely to persist, even when you encounter road bumps along the way. When you don’t believe in yourself, you are more likely to choke, flail, or avoid the stressor altogether. Self-doubt becomes self-fulfilling.

The three sentences “I think I can. I think I can. I think I can,” from the beloved children’s book, The Little Engine That Could, capture the essence of what is known as self-efficacy theory. Self-efficacy is a belief in your capacity to take action, to complete tasks, and to reach goals. It’s more than thinking you can, it also entails acting on those beliefs and taking concrete steps to transform those hopes into reality.

Given the benefits of an “I Can” attitude, it’s worth exploring how this kind of mindset can be cultivated. A pilot study recently found that students who spent just 35 to 40 minutes in an online course did just that. The “I Can” intervention emphasized 5 key features:

1. That the brain has a capacity to change and grow—i.e. how the brain’s structure and malleability make an optimal foundation for learning and development.
2. The importance of effort and long-term commitment in increasing skills, knowledge, and becoming an expert.
3. Having a “not yet” mentality, and recognizing that additional training is essential to further refine skills and master future challenges.
4. The importance of passion—defined as a strong interest in an area, theme, or skill. They highlighted how passion is an important motivational force providing necessary focus to achieve long-term goals. With this in mind, students were encouraged to spend time on things they enjoy to develop their passion.
5. The intervention concluded by prompting participants to reflect on their learning experience by creating a scenario where they offered advice to fellow students struggling with a difficult subject.

Participants in the study reported greater persistence and belief in their ability to achieve their goals. “When people develop stronger belief in themselves or ‘self-efficacy,’ it is almost as if a switch is flipped,” explained lead researcher Hermundur Sigmundsson.

The power of positive expectations

Believing in your ability to succeed matters. So does having others believe in you. A classic study highlights how we tend to live up to what’s expected of us and how a “You Can” attitude can be transformative. As part of the experiment, at the beginning of the school year, students took a test that was said to identify “growth spurters”–students who were most likely to thrive academically. Teachers were given the names of these little geniuses and guess what … as predicted, they flourished. But here’s the catch—the growth spurters were not singled out because of superior performance on a test, they were actually chosen at random.

So why did these students excel? No, fairy dust was not sprinkled into their lunch boxes. The key difference was that having high expectations of these students shifted how the teachers behaved towards them. Teachers were warmer and more patient with the growth spurters. They also took more time to teach them the material, listen to their questions, and gave them better feedback. As the researchers observed, the only difference between them and their peers was in the mind of the teachers and this made all the difference. A “You Can” attitude from the teachers promoted an “I Can” attitude in the students. 

Along these lines, students in a recent study were asked to submit an essay on their personal hero. The papers were returned to them with feedback from their teacher and one of two possible notes clipped to the top.

In the standard condition, the note said: “I’m giving you these comments so that you’ll have feedback on your paper.”

In the experiment condition, the note said: “I’m giving you these comments because I have very high expectations and I know that you can reach them.”

Students who received the latter version chose to revise their papers far more often than those who received the standard one. They also went on to receive better grades. The impact was especially powerful among minority students—64% of Black students revised their essays, compared to only 27% of Black students in the standard condition. Knowing that their teachers believed in them motivated them to work harder. Positive expectations of others unlocks potential. On the flipside, negative expectations undermine potential. If a teacher expects Johnny to be a “problem child,” it is likely that his behavior will match expectations. Similarly, if a coach or manager is on the lookout for missteps, they will surely find them.

When expectations become reality

This psychological phenomenon of how our beliefs about a person become reality is known as the Pygmalion Effect. The Pygmalion Effect is not just limited to schools. Expectations about individuals become self-fulfilling in offices, on sports fields, in families and in romance. Employees do better when a manager has high expectations. People get better at a sport when the coach believes in their potential. Children thrive when parents recognize their strengths. Relationships do better when partners look for growth and possibility in each other.

The term Pygmalion Effect is a reference to Ovid’s Metamorphoses. In the myth, Pygmalion is a sculptor who falls in love with a statue he has created that comes to life. George Bernard Shaw appropriated this theme for the play Pygmalion about a professor, Henry Higgins, who transforms a Cockney flower girl, Eliza Doolittle, into a lady. As Eliza observes,

The difference between a lady and a flower girl is not how she behaves but how she’s treated. I shall always be a flower girl to Professor Higgins because he always treats me as a flower girl and always will; but I know I can be a lady to you because you always treat me as a lady and always will.

The play highlights the power of positive expectations. How we treat others can either diminish or elevate them.

When I was an intern in Neurology the head physician at the time, Dr. M, thought the world of me. “Dr. Boardman, what do you think?” he asked whenever there was a question about a diagnosis. “Good work, Dr. Boardman,” he said whenever I reported lab results or presented a new patient. I thrived under his leadership and did my utmost to live up to his high expectations. It motivated me to work harder and to do my best.

Everything changed when Dr. F replaced Dr. M as the attending physician. You see, Dr. F did not think so highly of me. It would be safe to say he thought very little of me and his low expectations became my reality. I started making dumb mistakes. My mind went blank whenever he asked me a question. My confidence evaporated along with my motivation. I started showing up late to rounds and unprepared. The star intern I had become with Dr. M was unrecognizable. Looking back, I recognize this was the Pygmalion Effect in action. The attending doctor’s beliefs about me became self-fulfilling.

If we want people to thrive, it’s essential to communicate our belief in their capacity to do so. Given the benefits of a “You Can” attitude, I worry about the current messaging about mental health that assumes fragility instead of strength. Rather than a “You Can” message, these well intended strategies are sending a “You Can’t” message. Rather than confidence, they communicate doubt in a person’s ability to navigate a challenge or handle discomfort. For instance, people are reflexively referred to therapy for stress of any kind, schools are eliminating tests to reduce anxiety, and trigger warnings are used to help people emotionally prepare for or avoid encountering distressing material. While the goal is to protect mental health, it’s possible that these interventions are undermining it. At the core of these interventions is an underlying assumption that people are ill-equipped to deal with adversity. An extensive meta-analysis including over 24 studies and seven thousand people published in Clinical Psychological Science found that trigger warnings do not prevent distress. If anything, the research suggests that trigger warnings actually heighten anticipatory anxiety. A related study found that trigger warnings counterproductively reinforce survivors’ view of trauma as central to their identity—a belief that has been associated with worse symptoms. Viewing strength as central to identity might be a more therapeutic approach.

Bottom Line

“Treat people as if they were what they ought to be, and you help them become what they are capable of being,” observed Goethe. The more we doubt people’s resilience, the more we risk undermining it. If we want to cultivate mental health, tools that promote an “I Can” and a “You Can” attitude are a better place to start.

We all have so much going on in our lives, so let me distill the research on wellbeing for you. Think of these quick bits as a personal apothecary that you can read, refer back to, and even send to a friend or loved one who might need a dose of practical, actionable strategies that are life-enhancing and resilience-building.

Here are this month’s positive prescriptions:

If you don’t want to be underwhelmed by pleasure, don’t overwhelm yourself with distractions.

According to new research published in the Journal of Personality and Social Psychology, distraction dilutes enjoyment, leading to overindulgence later on. Participants in the study entitled Underwhelming pleasures: Toward a self-regulatory account of hedonic compensation and overconsumption were asked how much they expected to enjoy their lunch before eating it. They were then asked to eat their lunch under one of three conditions: no distraction, moderate distraction (watching a video) and high distraction (playing Tetris). Afterwards, they reported on their actual enjoyment, satisfaction, and desire to eat more. They also reported on their snacking later in the day. Participants who ate while distracted enjoyed their lunch less and felt less satisfied, which was associated with greater snacking later on. The researchers termed this behavior “hedonic compensation” which they theorize applies to other activities beyond eating. For example, people who are distracted while watching a movie or playing a game may be more likely to engage in additional consumption (e.g., checking social media) to compensate for a diminished enjoyment of the original activity.

As the old saying goes, there are shortcuts to happiness and dancing is one of them.

Moods dictate how we move. When we’re happy, we tend to walk with a spring in our step and when we’re unhappy, our movements are more restricted. But does the reverse work too? Does how we move impact our mood? A study published in The British Journal of Psychology found that practicing a happy dance boosted participants’ mood and motivation. If you’ve hit a wall at work, it just might be time to get up and dance. Need inspiration? Follow Justin Neto on Instagram. Of course everyone in his class is smiling.

If you want to improve your mood, go outside and listen to birds. Yes, you read that correctly.

We often hear about skyrocketing stress levels in college students. A new study finds that birdwatching is a particularly effective tool to help them keep calm and carry on. Students who got into birding reported improved wellbeing and lower distress than those who did not. Five 30-minute bird-watching sessions was all it took. Related research has found that hearing birdsong can have a sustained positive impact on one’s mood. On those days when you just don’t feel like exercising, the simple act of going outside can give you a lift. Just be sure to leave your headphones at home. The podcast can wait.

Respecting our children’s autonomy improves the chances of them actually listening to us.

If you have a teenager and get a lot of eyerolls, this new study from UC Riverside might be of interest. When parents offer unsolicited advice (I know, I know … sometimes we just can’t help ourselves!) and it’s delivered in a way that promotes independence and respects their autonomy, our kids are more likely to take it to heart. So instead of saying “I don’t think you should play video games because you should study,” try “What’s your plan for this afternoon? You mentioned yesterday that you wanted to get a head start studying for your math test.” See the difference? If we want our children to take our advice, avoid finger wagging or “shoulding.”

A free throw in basketball is an intensely stressful situation. All eyes are on the player. Will they or won’t they sink the shot? Merely watching is anxiety-provoking for me. It’s hard to imagine what’s going through the head of the player in such a pressure-cooker moment.

In an article in Wired entitled Free Throws Should Be Easy. Why Do Basketball Players Miss? Robbie Gonzalez explores the mechanics and magic of making the shot. On paper, the free throw could not be more straightforward. It’s a direct, unguarded shot at a hoop 18 inches across, 10 feet off the ground, and 15 feet away. Like a carefully controlled experiment, the conditions are exactly the same every single time.

For 20 years, Larry Silverberg, a professor at North Carolina State University, has studied the physics of the free throw using computers to simulate trajectories of millions of shots to dissect the mechanics of the perfect throw. According to his findings, a successful free throw boils down to four parameters: the speed at which you release the ball, how straight you shoot it, the angle at which it leaves your hand, and the amount of backspin that you place on it.

Of course, practice is key but not any old practice. As anyone who has ever choked on a test knows, there is often a gap between preparation and actual performance. To avoid paralysis by analysis in a free throw situation, practicing under conditions that simulate high pressure scenarios can help. Cranking up the music, using an audio of a crowd booing, having the rest of the team run around the court 10 times if the free thrower misses, and competing against the clock can help build mental stamina.

Technique and practice are important. So are your teammates. A brand new study published in Psychology of Sport and Exercise suggests a less obvious tactic to improve the performance of a free thrower: a friendly tap on the back. Before you raise an eyebrow, plenty of research shows that non-verbal gestures of support are powerful stress-reducers so it makes sense that a small gesture conveying to the free thrower that “you got this” can boost confidence. Researchers from the University of Landau and Purdue University analyzed videos of basketball games and found that the chances of scoring rose when teammates showed their support through touch, such as a hand on the shoulder. Put simply, in one of the most stressful athletics tasks imaginable, physical touch enhanced performance.

There is a lesson here for those of us who don’t often find ourselves in the middle of a heated basketball game. Gestures of support matter in everyday life and they need not always be spoken. Showing that you care does not always require an in depth discussion. A pat on the back, a warm hug, and holding hands are powerful communicators of affection. People who experience higher “felt love” – brief experiences of love and connection in everyday life – also have significantly higher levels of psychological well-being, which includes feelings of purpose and optimism compared to those who had lower felt love scores.

Chances are they might also be better at sinking a free throw.