Before my kids could even talk, I was telling them to say thank you. I must have sounded like a broken record.

🗣️ Say thank you to Daddy for the bedtime story.

🗣️ Say thank you to Aunt Serena for the winged pajamas.

🗣️ Say thank you to Charlie for bringing your bottle.

It’s a small wonder that they didn’t rise up out of their cribs and try to shove one of their stuffed animals in my mouth to keep me quiet.

In addition to having good manners, I hoped they would internalize the importance of expressing gratitude. It took me a while to realize that there is a vast gap between mindlessly uttering the words “thank you” and actually being grateful.

Alas, mindless gratitude is not gratitude at all. When saying “thank you” becomes an automatic response to thankless interactions like a police officer handing you an undeserved parking ticket or a telemarketer interrupting dinner, you know it’s an empty phrase. Not so long ago, I caught myself thanking Amazon’s Alexa for giving me the weather. For the record, she did respond, “you’re welcome.”

How can we make gratitude a habit without it becoming habituated? How can we raise grateful children? How do we express genuine gratitude for a present? Psychologist Andrea Hussong from the University of North Carolina Chapel Hill explores gratitude beyond good manners. In an interview with the Harvard School of Education, she describes a strategy to help boost gratitude and that may be especially useful for anyone who struggles with writing thank you notes.

According to Hussong, the key is to look for the gift beyond the gift. Rather than focusing on the actual object, consider what the giver’s intention was. Reflect on the effort and thoughtfulness that went into it. Hussong’s work focuses primarily on children but has applications for us all.

Here is Hussong describing the process for finding the gift behind the gift:

There is a lot more to gratitude than being thankful for what you have been given. In a Harvard Business Review article, “Stop Making Gratitude All About You,” Professor Heidi Grant Halvorson captures what so many of us get wrong about gratitude:

Recent research suggests that people often make a critical mistake when expressing gratitude: They focus on how they feel — how happy they are, how they have benefitted from the help — rather than focusing on the benefactor.

Halvorson’s research found that those who expressed gratitude towards another person had stronger and more loving relationships than those who focused on the benefits to themselves. In other words, if your partner sends you flowers today, you can think to yourself about how receiving flowers makes you really happy or you can channel your inner gratitude towards your partner by actively saying or doing something that acknowledges how awesome your partner is.

Many people keep gratitude to themselves. They feel it but don’t express it. They assume the other person already knows how much they are appreciated or they worry about finding the right words to say what they want to say.

Putting pen to paper or sending a thank you email may seem unnecessary or feel awkward but it’s definitely worth it. According to a recent study, we systematically underestimate how uncomfortable expressions of gratitude might make someone feel. Misunderstanding the consequences of saying thanks keeps us from engaging in a simple action that would make us and someone else a little happier. The conclusion of a study is crystal clear: every time we don’t express gratitude, we are missing an opportunity to give others and ourselves a boost.

Gertrude Stein famously said, “Silent gratitude isn’t very much to anyone.” She was right. Say it. Write it. Express it somehow. Whatever you do, please don’t keep it to yourself.

Thanksgiving is just around the corner. Here are a few tips to help you and your family keep the peace and make the most of the holiday:

1. Be clear-eyed

Manage expectations. It’s nice to have high hopes for the holidays but be realistic. There is no such thing as the perfect holiday. Aim for good enough.

2. Be picky

Choose carefully what you say “yes” to. There is a difference between events you want to attend and events you feel like you have to attend. Don’t be afraid to say, “Thank you for thinking of me. Unfortunately, I cannot make it.” If you are feeling particularly stuffed socially, having an exit strategy works wonders.

3. Find common ground

A family dinner is not the time to change someone’s mind. If heated debates about politics, money, religion, or any other contentious topics are inevitable with friends and family this holiday season, beware of persuasion fatigue. Set aside differences. Focus on what you have in common. There are so many other things to talk about.

4. Sit at a round table

If you would like to keep the peace, take a page from King Arthur’s book and sit at a circular table. Research shows that people seated at a round table—as opposed to a rectangular or square one—get along better and are less likely to bicker.

5. Turkey tastes better when shared

We are social creatures and our wellbeing—both physical and mental—depends on our connections. Reach out to someone who may be on their own this Thanksgiving. Don’t assume everyone has plans. Extending an invitation and including them in your tradition will make the meal merrier. As studies show, food and wine taste better when shared.

6. Go deep

Stop worrying about making better small talk, it’s deep conversations that make us feel whole. Studies show that people prefer meaningful conversation to chitchat about the weather. Plus, deep talk will help you veer the conversation away from the minefield of politics. Some of my favorite conversation starters include:

• Given the choice of anyone in the world, whom would you want as a dinner guest?
• If a crystal ball could tell you the truth about yourself, your life, the future, or anything else, what would you want to know?
• What is the one thing you couldn’t live without?

7. Go for a walk

‘Tis not the season to be a couch potato. Just a short stroll (15 minutes does the trick) can boost your mood and reduce stress. If you live in colder climates, walking in a winter wonderland is especially mood-enhancing. Plus, being outdoors will also help improve sleep quality.

8. Lose the phone

Just the sight of a phone—yours or someone else’s—is enough to undermine the quality of a conversation. You will have a better holiday if you put your phone away.

I wish you and your loved ones a happy and healthy Thanksgiving.

And if all else fails, remember, “There’s always something to be thankful for on Thanksgiving. Even if it’s just not being a turkey.”

“Take it easy for a few days.” My doctor’s instructions were straightforward. I had just had a lumbar puncture and was supposed to chill out for 48 hours. “Getting enough sleep will help you recover. Rest when you feel tired,” explained the discharge summary. I understand the importance of sleep. Rest, however, is a more elusive concept. Does it refer to the mind, the body, or both? Put simply, what does it really mean to “take it easy?”

Research on rest is hard to come by because it is hard to pin down. Claudia Hammond, a psychology professor at the University of Sussex defines rest as “an activity that is restorative, intentional, relaxing.” In 2016, more than 18,000 people responded to a survey called The Rest Test which asked them how they unwind. The top answer was reading. Walking, taking a bath, and daydreaming were in the top ten.

Whether an activity is restful is in the eye of the beholder. For instance, reading might be a salve for one person but for a student preparing to sit for the Bar exam, it might be the exact opposite. Spinning class is my friend Marjorie’s favorite way to decompress. It is my version of hell.

Rethinking resilience

When we talk about mentally strong people, we typically focus on how productive and focused they are. As Shawn Achor and Michelle Gielan described in the Harvard Business Review:

We often take a militaristic, “tough” approach to resilience and grit. We imagine a Marine slogging through the mud, a boxer going one more round, or a football player picking himself up off the turf for one more play. We believe that the longer we tough it out, the tougher we are, and therefore the more successful we will be. However this entire conception is scientifically inaccurate. The very lack of a recovery period is dramatically holding back our collective ability to be resilient and successful.

Setting aside time to recover and rest might seem antithetical to modern life, but failing to do so can leave us emotionally and physically depleted. A recent article in The New Yorker entitled Why Are We So Bad At Getting Better? explores the perils of powering through instead of powering down:

After an infection, a surgery, or a panic attack, patients increasingly feel that they need “permission to recover,” and treat convalescence less as a chance to heal than as something to get over with. And, when we prize efficiency over recovery, we risk ending up with less of both.

I cannot help but think that bed rotting, the new trend sweeping TikTok which involves lounging in bed for extended periods of time—not to sleep but to do passive activities—is a reaction to the lack of downtime in our lives. Every once in a while, it’s possible that bed rotting might be restorative but I would caution against it as a go-to strategy to unwind. While lounging in bed all weekend may sound appealing at the end of a long work week, people often say they feel even more drained when they spend their time in mind-numbing passive activities. While lounging in bed may be just what the doctor ordered when recovering from illness or a surgical procedure, I do not think of it as an example of “an activity that is restorative, intentional, relaxing.”

What are you waiting for?

Many of us look to weekends, vacations and holidays as the best chance to recover from the daily grind but research shows that if we want to feel better, building regular downtime into our everyday lives is a more effective strategy. People tend to postpone breaks as a reward for when a task is complete but studies show that incorporating regular “microbreaks” (10 minutes is enough) from demanding activities restores vigor and reduces fatigue. The key is to completely detach from the work you are doing and to engage in a revitalizing activity. Note to self: that does not mean scrolling through social media.

Here are 6 ways to find rest every day:

1. DETACH. Distance yourself from negative and stressful thoughts

2. RELAX. Take time to chill out and get away from the task at hand

3. DECIDE. Be deliberate about how you spend your time

4. EXPAND. Stretch your mind or body

5. ADD VALUE. Do something that is personally meaningful

6. CONNECT. Engage deeply with others

All too often we misjudge what will replenish us or fortify us. There is a lot we can’t control in our lives but we can be deliberate about how we spend our downtime. I recommend choosing activities that oxygenate the mind and body.

Bottom Line: Every day may not be relaxing, but try to find micro-moments to relax every day.

One of the best parts of my job is getting to hear what’s on your mind. Below are answers to three questions I am asked almost every day from patients, family, friends, and this community.

What are the best ways to manage stress?

When the world feels upside down, focus on what you CAN control. What time are you going to bed? Are you engaging in activities that make you feel strong? Are you glued to the news? It’s healthy to talk about what’s going on but remember to talk about other topics as well. Above all, reach out, connect, and be there for each other. The choices you make on a daily basis are the most reliable ways to navigate stressful times.

How do you balance being informed and tuning into the news without letting it completely overwhelm you?

Let’s face it – the news these days is bleak and it’s hard not to become upset or outraged or both. Constantly refreshing your feed, scrolling for more information, or watching your favorite news channel on a loop may give the impression that you’re in the know but actually the opposite is true. Following a breaking event may make you feel more involved but will not make you more informed.

The trick here is to optimize how, when, and from where you’re going to get your news. Here are some strategies anyone can use to keep up without burning out:

Be picky. Designate a time—either once or twice a day—to get your news fix from an established source.

Follow the facts. Skip commentary and media that predict what might happen. Listening to so-called experts weigh in on the future is basically glorified gossip. Read or watch stories that intelligently present digested and reliable information about what happened. Ignore the rest, it’s just noise.

Replace doom scrolling with delight hunting. Be deliberate about generating positive emotions every single day and especially on bad news days. Research shows that the best way not to feel overwhelmed or paralyzed by the barrage of negativity is to counterbalance it with uplifts.

Bottom line: Think of your attention as a flashlight. Where do you want to shine it?

How do we speak to our children about world crises?

When it comes to difficult emotions surrounding world crises, how you talk to your children matters almost as much as what you are talking about. Here are some guidelines that might be helpful:

Take a deep breath. Before engaging your child in conversation about a difficult topic, do your best to be in a calm head space. Your emotions and body language will speak volumes to them. Kids mirror our reactions.

Listen more than you talk. Find out what they know and what their concerns are. Their worries might be quite different from yours, depending on their age, what their friends are talking about, and what they have seen on social media.  Be honest but avoid details, especially with younger kids.

It’s okay to say “I don’t know.” 

I have always found that the most honest conversations take place in the car or walking side by side. Kids are more likely to open up when they are next to you (or behind you in the car), not across from you.

Explore nuance when possible. Resist binary thinking–we miss a lot when we divide  the world between good and bad.

Pay attention to small positive moments in the day. We so easily give our attention away to mindless activities, negative news, and draining social media. Reclaim it. Clock the good moments. Share them. Savor them.

As Mr. Rogers said, Look for the helpers. What are the positive actions your child or your family can take? The act of contributing to something can bring great comfort.

What else is on your mind?

What other questions do you have about countering stress and cultivating wellbeing? Please submit your questions—either in the comments below or by sending me a message. All answers, as always, will be backed by science and research.

Feelings aren’t facts.

A basic principle of every non-pharmaceutical treatment for depression and anxiety involves putting some distance between oneself and one’s emotions. Psychodynamic therapy, mindfulness, meditation and exercise, to name a few, create space between us and what is running through our head. Cognitive Behavioral Therapy (CBT), one of the most widely studied interventions, teaches patients to identify and challenge faulty habitual thinking patterns known as cognitive distortions such as all-or-nothing thinking and emotional reasoning. CBT entails learning that thoughts are not always a reflection of reality. Just because you feel a certain way does not necessarily make it true. Put simply: Feelings are real but they might not be true. This is not gaslighting. This is psychology 101.

Our beliefs, and the feelings that they give rise to, impact how we interpret a situation as well as our subsequent behavior. Imagine passing someone in the hallway who doesn’t say hello. You might assume that they dislike you and this hurts your feelings. As a result, you decide the person is unfriendly and avoid future interactions with them. You ask yourself, “Why bother making an effort with someone like that?” You might even tell yourself that the person is toxic and undeserving of your good will.

What else could be going on here?

Maybe the hallway snubber has a deadline to meet. Maybe they were up late last night with a sick child. Maybe they just didn’t sleep well. CBT teaches patients to consider other possibilities—indeed it may be that the person dislikes you but there are other explanations as well.

Acceptance and Commitment Therapy (ACT), a close cousin of Cognitive Behavioral Therapy, offers some useful data driven strategies to detangle yourself from your thoughts and feelings. Most of the time, we live in a state of cognitive fusion—fully believing our thoughts and feelings without giving a second thought. Put simply, our reality is fused with our emotions. These “defusion exercises,” as they are known, create some space and perspective.

Here are 6 examples:

THE RUNNING SUSHI

Picture your thoughts as the many small plates on a conveyor belt in a sushi restaurant. All the dishes pass by one after another, the same way your thoughts appear and go away one after another. You can choose to reach for the plates of sushi (thoughts) or let them pass by. If they reappear later, you still don’t have to grab them.

 

THE FISH HOOK

Thoughts are like fish hooks, and you are a fish swimming around in the water. You can’t control how many fish hooks you come by, but you can decide whether you swim past them or take the bait. It is impossible to avoid some thoughts as you go through life, and sometimes, you will take the bait. But you can still choose to unhook yourself and swim past the hooks.

 

CLOUDS IN THE SKY

Thoughts are like clouds in the sky. They come and go, and there is nothing you can do to influence them. Trying to push them away or worry about them is not necessary or helpful. The best thing is to let clouds occupy their own space and allow them to float by. Try doing the same thing to your negative thoughts and feelings.

 

PASSENGERS ON THE BUS

Imagine yourself driving a bus. Treat difficult thoughts as rowdy/annoying passengers. See if you can keep driving, rather than stopping when they want or trying to kick them off. Can you stay focused on driving your bus safely to your destination?

 

THOUGHT TRAIN

Imagine your anxious thoughts are like trains arriving at a railway station. Rather than climbing on board, stay on the platform, and watch the trains go by.

 

WATCH YOURSELF

To defuse a negative thought such as “I am a failure,” say instead, “I’m having the thought that I am a failure.” To defuse it even more, add, “I notice I am having the thought that I am a failure.” I think of this exercise as the equivalent of putting on goggles when swimming in the sea. The result is less blur and more clarity.

(examples via Metacognitive Therapy Central)

We all have a tendency to over-identify with our thoughts and our feelings. The purpose of these exercises is to disrupt the overthinking spiral.

One last strategy involves trading an “i” for an “a.” Writer Elizabeth Musser explains:

Your answers to these seven questions have serious implications for your mental health:

1. Do you get between 7 and 9 hours of sleep a night?
2. How much junk food do you consume?
3. Do you make time for friends and family?
4. Do you exercise regularly?
5. How many hours a day do you sit at your desk?
6. Do you smoke cigarettes?
7. How much alcohol do you consume?

A new study published in Nature Mental Health found that a healthy lifestyle can prevent depression, even in those who had a genetic predisposition.

While pharmaceutical advertisements have led many to believe that major depressive disorder is caused by a lack of neurotransmitters, it has become increasingly clear that depression is much more than a chemical imbalance. Remember the classic Zoloft commercial from the early 2000s showing that sad blob with a cloud following it around?

The voiceover explains: “While the cause is unknown, depression may be related to an imbalance of natural chemicals between nerve cells in the brain. Prescription Zoloft works to correct this imbalance.”

Zoloft transforms the sad blob into a smiling blob and the cloud literally dissipates. More recent evidence paints a more complicated picture debunking this simplistic model. Antidepressant medications work for some people but not because they correct a chemical imbalance. What remains unclear is exactly how they work.

What is clear is how daily habits can boost mental health. Researchers examined data from almost 290,000 people—of whom 13,000 had depression—over a nine-year period, and identified seven healthy lifestyle behaviors linked with a lower risk of depression:

1. Prioritize sleep

Sleeping seven to nine hours per night reduced the risk of depression including single depressive episodes and treatment-resistant depression by 22%. Of all the depression reducing factors, getting a good night’s sleep on a regular basis made the biggest difference.

2. Cultivate connections

3. Drink less

4. Eat well

5. Move regularly

Frequent exercise can improve daily mood and also cuts the risk of of depression by 14%. A related study published in the British Journal of Sports Medicine found that physical activity was 1.5 times more effective than medication in reducing depression. Not surprisingly, the sports that give people the biggest boost typically involve others—tennis, soccer, and other team related activities.

6. Don’t smoke

Never smoking decreased the risk of depression by 20%. Enough said.

7. Get up, stand up

These lifestyle factors are more than icing on the cake. I would argue that they are the cake. People who maintained most of these seven healthy habits—five or more—had a 57% lower risk of depression. We all know that a healthy lifestyle is important for our physical health. It’s just as important for our mental health.

Bottom Line: While many with depression benefit from medication and therapy, lifestyle medicine can make a meaningful difference in reducing symptoms and preventing it altogether.