“Ow… Ow… That hurts soooo much… Ow…” My patient was literally howling in pain. It was the middle of the night and I was the intern assigned to draw her blood for a procedure in the morning. The thing was, I hadn’t even poked her yet. Admittedly, I was a terrible phlebotomist but she didn’t know that. For her, the prediction of pain had created the experience of pain.

Increasing evidence shows how expectations shape reality:

If you expect a lecture to be boring, you’ll probably end up being bored.

Anticipating election stress in the future is enough to put you in a bad mood today.

If you have a negative attitude about aging, you’re more likely to experience cognitive and physical decline.

Believing stress is bad for you makes it more likely to damage your health.

Our brains are prediction machines, constantly simulating future scenarios. What we expect to see determines what we pay attention to. The brain fills in gaps and deletes details that don’t adhere to our expectations. This is especially true in ambiguous situations where we filter information according to our underlying beliefs.

The expectation effect in action.

Where is the toothbrush in this messy bathroom?

University of California, Santa Barbara

Most people spot the small one but miss the larger one behind it. What you expect to see literally determines what you see.

What you hear is determined by what you expect to hear.

There are countless examples demonstrating how assumptions shift the way we process information. Expectations change behavior and even physiology. A recent study found that assumptions about how full one would be after a meal impacted hunger and subsequent food consumption. On two different occasions, participants were served an omelette for breakfast. The first time, they were told it was a two egg omelette. The second time they were told it was a four egg omelette. The reality is that on both occasions it was a three egg omelette. When people thought they had eaten the smaller breakfast—the two egg omelette—they were more likely to report feeling hungry again after two hours compared to when they had eaten the bigger breakfast. They were also more likely to eat more for lunch and snack more throughout the day.

Expectations can lead us astray.

This is especially true when it comes to stress and mental health. Most research has focused on the implications of stressors that have already occurred, but what about the toll of anticipatory stress. Can anticipatory coping help us manage anticipatory stress?

Researchers Greg Feldman and Adele Hayes described four types of behaviors people turn to to deal with predicted upcoming stressors:

1. Problem Analysis: Actively contemplating the causes and meaning of the future stressor.
2. Plan Rehearsal: Envisioning the steps required to solve the anticipated stressor.
3. Stagnant Deliberation: Dwelling on the upcoming stressor but not finding any solutions.
4. Outcome Fantasy: Daydreaming and fantasizing about desired outcomes.

Not surprisingly, Stagnant Deliberation and Outcome Fantasy were considered to be the least helpful responses to anticipated stressors. Problem Analysis and Plan Rehearsal helped people feel confident in their ability to cope.

Psychiatry has traditionally focused on the past, but what if our mental health depends more on how we think about the future?

In Tomorrowmind, psychologist Martin Seligman asks this question and explores how prospection—the ability to consider the future—impacts health. He argues that distorted and overly pessimistic thinking about the future drives depression and likely contributes to helplessness and other mental disorders.

As I thought about healthy prospection and how expectations shape reality, I couldn’t help but think about how the current conversation about mental health may be inadvertently making things worse. Is it possible that mental awareness efforts may be backfiring? As Oxford psychologist Dr. Lucy Foulkes recently wrote about in an op-ed in StatNews:

Campaigns and social media posts just churn out the message that there’s this problematic thing called anxiety, and so people start interpreting all the lower-level stuff as symptomatic of a disorder. That’s unhelpful in itself — some people find it scary and stigmatizing to believe they might have a mental disorder. But I think it might be worse than that: interpreting common difficult emotions (like anxiety) might actually bring on these symptoms, in a self-fulfilling manner.

If a person believes their anxiety is the sign of a disorder, this can lead to changes in their self-concept — they will say to themselves and others “I am an anxious person” or “I have anxiety.” They might also start to change their behavior. In particular, they might start avoiding the things that make them anxious, and the people around them support this. But in the long run, avoidance prolongs and exacerbates anxiety symptoms. In other words, the changes in self-concept and behavior could actually generate anxiety in a way that becomes self-fulfilling.

While awareness efforts have enabled some individuals to recognize and report previously under-reported mental health problems, her research suggests it has also led to over-interpreting and over-pathologizing common psychological experiences. Expecting difficulties to damage mental health may ultimately be exacerbating symptoms and distress.

“There were many terrible things in my life and most of them never happened.” — Michel de Montaigne

“Only boring people get bored” … I have said this to my kids on countless occasions. Boredom has always been something I eschewed—in my mind, it is on par with laziness and suggests a lack of curiosity and purpose.

Many are uncomfortable with the thought of being bored.

A study published in Science found that people preferred receiving electric shocks to being left alone with nothing to do. How hard is it to sit alone in an empty room for 15 minutes with absolutely nothing to do? Apparently, very. Before the alone time began, the researchers administered a brief electric shock to demonstrate what it would feel like. Most participants described it as unpleasant. Some even said that they would pay money to not be shocked again. That changed once the experiment was underway. In the 15 minutes of solitude, 67% of the men and 25% of the women zapped themselves. Even the researchers were shocked by the shocks. “I’m still just puzzled by that,” commented one.

An aversion to boredom is easier to indulge these days thanks to the distraction machines in our pockets. Whenever there is a moment of downtime, cat videos and celebrity fashion faux pas and breakups beckon. In the digital age, preoccupation is a permanent state of being. Over-stimulation is our default mode. Our minds are always busy. Our attention always has somewhere to land. TikTok, Instagram, and Twitter are bottomless reservoirs of entertainment and diversion.

But what if boredom is something to be embraced and celebrated, a state of being to lean into?

What if sitting there and doing absolutely nothing is good for the brain? Researchers from Trinity College found that being bored can actually be good for us because it opens the door to creativity and meaningful activity.

German philosopher Martin Heidegger identified two levels of boredom: superficial and profound.

Superficial boredom — the most common state of boredom — refers to a situational restlessness in which people desire distractions. Waiting for a train and standing in line are typical experiences of superficial boredom.

Profound boredom — a less recognized state of boredom — refers to an existential discomfort where people struggle with their sense of self, but ultimately can result in the discovery of passion or meaning. Profound boredom stems from an abundance of uninterrupted time spent in relative solitude, which can lead to a state of apathy and existential questions like Why am I here? What is it all for? These uncomfortable ponderings pave the way for more creative thinking and activity.

Devices that promise an abundance of information and entertainment offer a temporary escape from superficial boredom but get in the way of finding more meaningful experiences. Plus, pacifying superficial boredom this way tends to backfire. Excessive social media consumption leaves people feeling empty and with regret. “The problem we observed was that social media can alleviate superficial boredom but that distraction sucks up time and energy, and may prevent people progressing to a state of profound boredom, where they might discover new passions,” said Dr. Timothy Hill, co-author of the study.

Dr. Hill continued. “Profound boredom may sound like an overwhelmingly negative concept but, in fact, it can be intensely positive if people are given the chance for undistracted thinking and development.”  Letting our thoughts meander unlocks creativity and refreshes the browser that is our brain. Boredom is a window we are always trying to close. As this study suggests, throwing it open may be a better strategy.

As Neil Gaiman said, “The best way to come up with new ideas is to get really bored.”

So rekindle your relationship with boredom. Put down your phone. Turn off that podcast. Look out the window. Find more time to do nothing.

Maybe it’s time to replace “Only boring people get bored” with “Only interesting people get bored.”

When someone is going through a rough patch, the typical recommendation is that they speak to a professional about what is bothering them. Articulating one’s feelings and challenging negative thought patterns, the thinking goes, is the best way to help an individual manage stress. A study published in The Journal of Positive Psychology turns this assumption on its head. Rather than focusing on an individual’s issues, the findings suggest that the best medicine for feeling down is doing something for someone else.

The study involved 122 people who had moderate to severe symptoms of depression, anxiety, and stress. Participants were split into three groups. Two of the groups were assigned classic cognitive behavioral therapy (CBT) interventions: either planning social activities (Group 1) or cognitive reappraisal (Group 2). The third group was instructed to perform three acts of kindness a day for two days out of the week. Acts of kindness were defined as “big or small acts that benefit others or make others happy.” Participant autonomy was emphasized. When, where, and for whom they completed the activities was completely up to them. Examples of acts of kindness participated later reported included giving someone a ride or baking cookies for a friend.

The good news is that everyone in the study got better.

At the 10 week mark, all three groups showed an increase in life satisfaction and a reduction of depression and anxiety symptoms but those who engaged in acts of kindness experienced the biggest boost. Moreover, this strategy showed a clear advantage over the other two CBT-based interventions in feelings of connectedness with others, “Social connection is one of the ingredients of life most strongly associated with well-being. Performing acts of kindness seems to be one of the best ways to promote those connections,” explained David Cregg, co-author of the study. It is worth noting that simply planning social activities (Group 1) was not enough to make people feel connected. There is something uniquely beneficial about performing acts of kindness that makes people feel that they are part of something larger than themselves.

The research also revealed why performing acts of kindness was so effective: it helped people take their minds off their own depression and anxiety symptoms.

It turns out that doing good deeds reduces self-absorption which often manifests during stressful periods. We often assume that people who are feeling sad or anxious have enough on their plate. The last thing we want to do is burden them with helping someone else. The results of this study suggest that our intuition is misguided. Doing nice things for people and focusing on the needs of others may actually help people with depression and anxiety feel better about themselves.

We are often told that happiness comes from within but decades of research points us in a different direction. Accumulating evidence shows that happiness comes from “with” as much as it comes from within. A brand new study published in Communication Research highlights a specific way that connecting with others boosts everyday well-being: through quality conversations. The researchers found that just one good conversation with a friend during the day made people happier and less stressed by day’s end.

Living in a time when people talk past each other more than to each other and engage with their phone more than the person next to them, these findings are worth paying attention to.

1. Catching up

Filling a friend in on what has happened since you last spoke or recapping the day is a significant contributor to relational satisfaction and has been shown to reduce loneliness. “How have you been this week?” is a good place to start.

2. Meaningful talk

Engaging in substantive or valuable conversation boosts well-being due to its ability to increase feelings of relatedness and satisfying the basic human need to belong.

3. Joking around

Sharing a laugh with a loved one reinforces connection and enhances relationship satisfaction. Plus, humor enhances a good mood, facilitates reframing of negative emotions, and promotes bonding through play and responsiveness.

4. Showing care

Verbal and non-verbal supportive communication is linked to less loneliness and stress and decreases in blood pressure and depression. Showing care manifests in a variety of ways including unspoken gestures, acts of kindness, and simply being present.

5. Listening

Providing emotional support through listening boosts feelings of self-efficacy, coping, and overall well-being. Listening isn’t an exercise in silence—it entails asking questions, looking up from your device, giving feedback.

6. Valuing others and their opinions

Expressing appreciation is something many of us are reluctant to do. We assume the other person already knows how we feel that it might be awkward to say it aloud. Reality check: they don’t know and it won’t be ask awkward as you think. Plus, studies show that verbally sharing gratitude is associated with happiness, life satisfaction, and vitality.

7. Offering sincere compliments

Like expressing gratitude, giving a compliment to a close friend can seem a little cringy, especially if it’s not something we are in the habit of doing. Start with something simple. Fill in the blank. “I really admire X about you.”

Regardless of the type of conversation a participant was assigned to have with a friend, they all made a difference. The very act of intentionally reaching out to a friend in one of these ways enhanced connection and reduced stress. Just one conversation was enough to provide a boost but more was better. “The more that you listened to your friends, the more that you showed care, the more that you took time to value others’ opinions, the better you felt at the end of the day,” explained co-author and University of Kansas professor Jeffrey Hall. Not surprisingly, the study found high-quality face-to-face communication was more closely associated with well-being than electronic or social media contact.

Given how stressed out people are, taking the time to have a real conversation is a simple remedy worth trying.

Bottom Line: You have a buffet of options to choose from. Start talking.

Last week I wrote about apologies and heard back from many of you about apologies you longed for but never received. Is it possible to forgive someone without one? Should we even try? A new study answers unequivocally “yes” to both questions and highlights how impactful letting grievances go can be for our mental health. For all the grudge holders out there (yes, me included—I still remember a time when a professor mocked a presentation I gave in medical school), this research is worth paying attention to.

The study found a statistically meaningful reduction in depression and anxiety in those who engaged in a forgiveness exercise. Dialing down resentment, anger, and suppression of negative thoughts likely contributes to this finding. There are no upsides to dwelling on past harms or allowing wrongs to fester. In the words of the great Don Henley in The Heart of the Matter, if “you keep carryin’ that anger, it’ll eat you up inside.” Think of forgiveness as an antidote for wound collecting, an interruptor of rumination, and a salve for brooding.

Merriam-Webster’s Dictionary defines the word “forgive” as “giving up resentment of, or claim of requital for.” The authors of the study describe it as replacing ill-will with good-will. They also provide a blueprint for how to do it. Participants in the active arm of the study completed a two-hour self-directed workbook over the course of two weeks.

The first step toward forgiveness is simply deciding to forgive. The next phase involves emotional forgiveness and entails five key steps based on the REACH method developed by psychologist Everett Worthington:

Recall the Hurt

We aren’t going to get anywhere if we keep telling the same story repeatedly. We need another, more objective (yet still true) story. So recall the event again, but this time as an observer—not as yourself.

Empathize with the One Who Hurt You

We have all experienced hurting others even with the best intentions, so we can understand that the person who hurt us might have not been aware of the consequences of their actions. Having a hypothetical conversation with the person who wronged you is one exercise the workbook recommends.

Give an Altruistic Gift of Forgiveness

Think about how you felt when you were forgiven and about how good it feels to simply do an altruistic act that a person does not deserve. Wouldn’t you like to forgive (emotionally) the person who hurt you?

Commit to Forgiveness

Experiencing emotional forgiveness is defined as the degree to which you actually feel that your emotions toward the person who offended or harmed you have become less negative and perhaps even more positive. Write about how much you emotionally forgave and how that feels.

Hold on to Forgiveness

Repeat REACH as necessary.

In addition to meaningful reductions in depression and anxiety, forgiveness is linked with lower mortality rates, lower cholesterol, lower blood pressure, lower cortisol (the stress chemical in our brains) and a lower likelihood of developing cardiovascular disease. Forgiveness may even support a healthier immune system. In addition to physical benefits, forgiveness is also associated with psychological benefits as well. Overall well-being is linked with forgiveness, as are higher quality marriages and committed romantic relationships. Forgiveness is even related to better sleep. There is evidence that children who learn how to forgive do better academically.

Here is what forgiveness is not:

• Excusing
• Forgetting
• Reconciling
• Forbearing
• Invalidating your own feelings
• Foregoing justice

Forgiveness doesn’t come on demand and can’t be forced. It’s not asking for an apology, creating excuses for the wrongdoer or being a pushover. There is no tolerance for the misdeed in forgiveness and it cannot come from a place of moral superiority. Contrary to the popular phrase, forgiveness does not require forgetting. Another important factor is time, forgiveness cannot be rushed.

In Spiritual Evolution, George Valliant, MD., professor of psychology at Harvard and pioneer of adult development, describes forgiveness as an end to a cycle of negativity that allows us to grow and heal. It can be a transformative experience: “Suddenly, the fight-or-flight response of vengeance is replaced by the calming green pastures and still waters of peace.”

Given all the animosity and unhappiness in the world, teaching and practicing forgiveness seems like a worthy public health intervention. Even if your emotional experience of forgiveness isn’t complete, the simple act of trying can make a difference.

As David Whyte says, “The great mercy is that the sincere act of trying to forgive, even if not entirely successful, is a form of blessing and forgiveness itself.”

“If it means so much to you, then … sorry.” Logan Roy’s apology to his children in episode 2 of the fourth season of Succession is a masterclass in How Not To Apologize. In Logan’s defense, apologies are hard. They often get stuck in our throat or come out the wrong way. Even well intended apologies don’t always land well. As Randy Pausch, author of The Last Lecture said: A good apology is like an antibiotic. A bad apology is like rubbing salt in the wound.