Here’s What You Can Do When the World Feels Upside Down

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.

I wish you all the best,

Dr. Samantha Boardman

An Antidote for Overthinking

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.

“There is nothing either good or bad, but thinking makes it so.”
William Shakespeare

 

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:

“Thinking too much just brings it back to me, me, me—but thanking takes my eyes off myself and my mistakes and puts them on others, on things bigger than myself. I can’t stand here very long without being humbled at how small I am and amazed at how big and beautiful our world is.”

I wish you all the best,

Dr. Samantha Boardman

7 Habits That Can Cut the Risk of Depression in Half

“We are what we repeatedly do.”

—Aristotle

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

Frequent social connection reduced the risk of depression by 18% and was the most protective against recurrent depressive disorder. Put simply, happiness doesn’t only come from within, it also comes from “with.”

3. Drink less

Moderate alcohol consumption decreased the risk of depression by 11%. Less is clearly more. Greater than one drink a day for women and two drinks a day for men can actually increase the risk of depression.

4. Eat well

People who maintained a healthy diet were 6% less likely to report an episode of depression. Increasing evidence shows that the Mediterranean diet can boost mood and dial down symptoms of depression and anxiety. Refined carbs, processed foods, and sugary drinks are bad for the body and the brain.

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

A sedentary lifestyle was considered independently from exercise. Taking breaks and stepping away from screens regularly reduced the chances of depression by 13%. If you’re reading this sitting down, please stand up and stretch.

 

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.

I wish you all the best,

Dr. Samantha Boardman

The Difference Between Feeling Anxious and Having an Anxiety Disorder

What does anxiety feel like to you?

Here are a few descriptions I have heard over the years:

From the literal:

  • Queasy
  • Revved up
  • On edge
  • Worried

To the metaphorical:

  • Like a pit in my stomach
  • Like an internal storm
  • It’s a sinking feeling

And my favorite: “It’s like a toddler. It never stops talking, tells you your wrong about everything, and wakes you up at 3 a.m.”

The American Psychological Association defines anxiety as “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.” Feeling anxious can be a deeply uncomfortable experience. It’s also perfectly normal. Just because it’s awful doesn’t make it a disease that needs to be treated.

The key difference between having an anxiety disorder and normal anxiety is the extent of dysfunction and distress it causes. Generalized Anxiety Disorder, one of the most common diagnoses, is characterized by persistent, excessive, and unrealistic worry about everyday things. This worry could be multifocal such as finance, family, health, and the future. It is excessive, difficult to control, and is often accompanied by many non-specific psychological and physical symptoms. Excessive non-stop worry is the central feature of generalized anxiety disorder.

Diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) aka the “bible” of Psychiatry, include the following:

  • Excessive anxiety and worry for at least six months
  • Difficulty controlling the worrying
    • The anxiety is associated with three or more of the following symptoms for at least 6 months:
      • Restlessness, feeling keyed up or on edge
      • Being easily fatigued
      • Difficulty in concentrating or mind going blank, irritability
      • Muscle tension
      • Sleep disturbance
      • Irritability
  • The anxiety results in significant distress or impairment in social and occupational areas
  • The anxiety is not attributable to any physical cause.

Put simply, feeling anxious at a given point in time about something stressful going on in your life does not mean you have an anxiety disorder. High anxiety may be appropriate and even adaptive in certain contexts. For instance, going off to college, switching jobs, or dealing with a break up may fill you with dread but that doesn’t make it pathological. There is plenty of evidence showing that anxiety can be beneficial under some circumstances. It might motivate you to prepare for a test or remind you to check the battery on the fire alarm.

In some situations, such as in Ukraine, anxiety can be protective. As Dr. David Rosmarin recently wrote in The Wall Street Journal since the Russian invasion, residents who experience nervousness and worry, “are probably better off than their neighbors who are less anxious. They are more likely to survive a military attack, since a stress response yields benefits such as greater situational awareness, quicker response time, and even constriction of blood flow in the event of injury.”

Anxiety is not “all bad,” and an absence of anxiety is not “all good.” Unfortunately, the current conversation about anxiety in any form portrays it as something to be minimized, avoided, and treated. By pathologizing anxiety, we miss out on the opportunity to learn and potentially grow from it. Plus, we are making people anxious about being anxious. Because of all the negative implications swirling around anxiety, they are mistakenly led to believe that there is something wrong with them.

I have met many young people who have diagnosed themselves with anxiety because they took an online screening test that only asked two questions — one about feeling nervous and the second about being unable to control worry over the past two weeks. There is no inquiry about context. No nuance is explored. In under a minute they are diagnosed as a likely case of generalized anxiety disorder.

Here are the questions:

Answering “more than half the days,” to one question and “several days,” to the other is enough to screen in. Pretty much anyone going through a rough patch will qualify. The intention behind this simple test is to rapidly identify those in need of treatment. There may be other unintended consequences as well. Labeling oneself as having an anxiety disorder can shift a person’s self-concept. Believing you have a mental illness might impact your response to an awkward social situation or influence a decision to take on a challenge.

Of course, its entirely possible that I am overly anxious about over pathologizing anxiety. These concerns are a perfectly normal and healthy response to something that is stressing me out.

I wish you all the best,

Dr. Samantha Boardman

How We Talk About Mental Health Matters

The practice of seeking support when we’re distressed is typically associated with emotional well-being. It makes sense: Most of us believe that having somebody—a friend, a parents, a therapist—who listens to all our travails will make us feel better.

But that may not be the case. In fact, endless discussions about our problems can inadvertently amplify distress.

A patient of mine who had a difficult relationship with her mother-in-law would spend hours rehashing the latest incident or insult with her best friend and speculating about what her “monster-in-law” might do next. Venting was her go-to conversation. Afterward, however, she would often feel even angrier and more agitated.

The reason is that individuals who ruminate, or dwell on negative feelings and distress, have a hard time letting go of what’s bothering them, which leads to a cycle of negative thinking. The more a person ruminates, the worse they feel, which then contributes to more rumination.

Co-rumination—when we ruminate with someone else—isn’t any better, even if it feels good in the moment. But excessively discussing personal problems without ever coming up with a solution can make you feel worse, sending you into an emotional sinkhole. A 2022 study found that co-ruminating about Covid-19 with friends and on social media was associated with heightened depression and anxiety symptoms.

The same is true for parents who, naturally, want to hear of all the difficult things their child is enduring. But there is evidence that turning any problem into a continuing centerpiece of conversation can ultimately undermine the development of coping skills. If your teenager is upset about something, asking her to recount every little detail to you and perhaps later to your partner—“Tell your dad exactly what happened today at school”—could make her feel even worse. You might be sending the unintentional message that the issue is more serious than it is, or that you believe your child can’t handle the situation.

An alternative approach

So, what should people do instead when dealing with a distressed friend or relative?

I may be a “feelings doctor,” but I worry about encouraging internal fixation and problem talk. A basic principle of every nonpharmaceutical treatment for depression and anxiety involves putting some distance between oneself and one’s emotions and acknowledging that feelings aren’t facts.

Psychodynamic therapy, mindfulness meditation and exercise, to name a few treatments, all create space between us and what is running through our head. Deep breathing, pretending to be a fly on a wall, imagining your thoughts are leaves on a stream floating, are well-recognized tools that dilute the power of feelings, provide some perspective, and promote self-regulation.

Cognitive behavioral therapy, 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. Rather than rehashing problems, such therapy entails learning that thoughts aren’t always a reflection of reality and encourages reframing negative thoughts.

Focus on strengths

So if your child had an issue with Johnny today, don’t let the first question you ask after school tomorrow be, “Was Johnny mean to you again today?” If you don’t let it go, your child won’t either. When listening to loved ones, stay calm, express empathy, and encourage them to consider the situation from alternate perspectives. These are far more effective methods for working out problems, rather than to mine for pain and dwell on resentment.

Instead of only asking about what’s wrong, consider inquiring about what’s strong.
Focusing on a person’s strengths may be a more effective strategy for navigating challenges than fixating on the problems.

Similarly, if your best friend calls you to talk about something that is bothering her, avoid questions that encourage her to revisit every detail. “Start from the beginning. Tell me everything!” will only lead to a play-by-play of what took place and what she was feeling. Consider instead posing a question that might help your friend gain some distance from the situation. I often ask my patients, “If someone else were in this situation, what advice would you give them?” Rather than dwelling on the details of what happened, help the person to generate a plan of action and to capitalize on their strengths.

To paraphrase Nobel Prize-winning psychologist Daniel Kahneman, nothing in life is quite as important as you think it is while you’re thinking—or talking—about it. I don’t mean to imply that we shouldn’t talk to loved ones about what’s bothering us. All I am saying is that it shouldn’t be the only thing we talk about.

I wish you all the best,

Dr. Samantha Boardman

How to Stop Jumping to Conclusions

What makes you tick?

This is the question that drew me to psychiatry in the first place. What interested me most was not what people did but why they did it. What I have learned along the way is that there is so much that we get wrong about others. All too often, in an attempt to make sense of someone else’s behavior, we jump to conclusions about their “true self.” Using a few breadcrumbs of information, we are quick to make assumptions and attribute their behavior to a fixed aspect of their personality. The person who cut me off in traffic is surely a jerk. The woman who screams at her child lacks patience. The teenager who breaks the vase is clumsy. The dog owner who doesn’t pick up her dog’s poop is selfish. The coworker who leaves early is lazy.

Put simply, we see other people’s behavior as a reflection of who they really are. This is known as “correspondence bias”— we assume that their actions correspond to their personality. In doing so, we disregard all the other reasons that might explain their actions. In the process, we underestimate their intentions and the situation. We ignore external factors and contributing circumstances.

But, when it comes to ourselves, we do the complete opposite—we attribute our behavior to the situation and discount the role of personality. If I cut someone off in traffic, it’s because I am late for an important meeting. If I scream at my daughter, it is because I didn’t sleep well last night and she said something inappropriate. If I break a vase, it’s an accident. If I don’t pick up after my dog, it’s because I ran out of poop bags. If I leave work early, it’s because I have a doctor’s appointment. The only reason my behavior is anything less than stellar is because of external reasons.

We are quick to make excuses for ourselves but tend not to extend the same generosity to others.

Psychologist Kurt Lewin likened this tendency to think that others are as they act to Aristotle’s understanding of the physical world. Aristotle believed that objects behaved according to their inherent properties. Rocks fell to the ground to get closer to the earth and flames rose to the sky to reach heaven. Accordingly, Aristotelian physics held that the heaver an object, the faster it would fall. It wasn’t until Galileo came along centuries later that the role of external forces was considered. His insight that the behavior of objects must be understood in the context of the situation transformed physics. It is said that he demonstrated the role of air resistance by dropping objects from the top of the Leaning Tower of Pisa.

When it comes to judging the behavior of others, we are stuck in an Aristotelian mode—ready to make assumptions about their true nature based on a few observations and limited information. But in explaining our own behavior, we are Galileans—full of understanding and awareness of external factors.

Thanks to correspondence bias, we jump to conclusions and are left with the false impression that we really know someone, that we’ve got their number, for better or for worse. As Harvard psychologist Daniel Gilbert points out in a famous paper on the topic:

We may strive to see others as they really are, but all too often the charlatan wins our praise and the altruist our scorn. Juries misjudge defendants, voters misjudge candidates, lovers misjudge each other, and, as a consequence, the innocent are executed, the incompetent are elected, and the ignoble are embraced.

Correspondence bias is famously hard to overcome.

Even when we’re fully aware of the outside pressures that people face, we still understand their behavior as a reflection of enduring qualities. In a well known experiment, subjects were shown essays that opposed or supported Cuba’s president, Fidel Castro. Even when the subjects were told that the essayists had been instructed by a debate coach to defend a particular point of view, many of the subjects still inferred pro-Castro leanings in the essayists that defended him. As Gilbert observes, the subjects were basically saying:

“Well, yes, I know he was merely completing the assignment given him by his debate coach, but to some degree I think he personally agrees what he wrote.”

Correspondence bias is problematic because it distorts judgments and leads to misunderstandings. I worry that the rise of everyday use “therapyspeak”—prescriptive language describing certain psychological concepts—amplifies correspondence bias. Based on a tidbit of information or unpleasant interaction, we can justify writing someone off as “toxic” or “demanding.” Connections and potential connections suffer as a result.

Jumping to conclusions about what makes someone tick gets us nowhere. What we can do is simple: give everyone you meet the benefit of the doubt. Consider their intent. Resist wound collecting. Think about what else might be going on in their lives. Last but not least, ask yourself, “What would Galileo say?”

I wish you all the best,

Dr. Samantha Boardman