The Gratitude Attitude

If your parents repeatedly exhorted you to count your blessings, it may well prove to be one of the best pieces of medical advice they shared. In this season of giving and thankfulness, we share a brief synopsis of how gratitude – defined as appreciation of what is valuable and meaningful to oneself – is associated with a host of beneficial health effects.

Mental Health

A grateful outlook may contribute to lower rates of depression, stress and anxiety, greater emotional functioning, stronger social relationships, higher life satisfaction, and help reduce the impact of stress on negative health outcomes.

Physical Health

Studies suggest that an attitude of gratitude may help lower blood pressure and glucose, improve immune function, promote more efficient sleep, boost pain tolerance, and lead to better cardiovascular health. Specifically, research has pointed to how practicing gratitude may help decrease hemoglobin A1c levels and contribute to reducing biomarkers of inflammation. A recent observational Harvard study of more than 49,000 registered nurses found that those scoring in the highest level of gratitude had a 15% lower risk of death from cardiovascular disease. Other reports have found that grateful individuals tend to be more health-conscious, avoiding smoking and drinking alcohol. For instance, a recent experimental study showed that evoking feelings of gratitude in people who smoke reduced their urge to do so and increased the likelihood of their enrollment in smoking cessation programs.

The Gratitude and Health Connection

Taken together, research suggests that interventions targeted at increasing gratitude may be an effective resource for health promotion and maintenance. Or as Dr. Robert Emmons, a long-time leader in the field of gratitude research and professor emeritus of psychology at UC-Davis, more eloquently explains:

“Gratitude heals, energizes and changes lives. Studies have shown that gratitude is often deepened and strengthened in trying times, as they lead us to not take things for granted. Gratitude is not simply a switch that we turn on when life is going well, but also shines a light in the darkness.”

Interested in trying this out? Visit UC Berkley’s Thnx4.org site, which offers free 10- or 21-day group or solo journaling challenges.

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Midlife Crisis or Midlife Reassessment?

Like so many popular 20^th century concepts, the image of a man in an existential crisis at age 50 who trades in his long-time wife and car for newer models is on the wane – and may never have been correct. Psychoanalyst Elliott Jaques coined the term in 1965 to describe his midlife client’s sudden change in lifestyle and productivity, but the breakthrough “Midlife Development in the U.S. (MIDUS)” studies conducted over three decades beginning in 1995, proved otherwise. Only an estimated 10% of adults actually experienced a midlife crisis while the majority considered it a period of great satisfaction, redefining it as a time of deepened connections and continuity, peak earning power, career advancement, and greater emotional intelligence. In fact, asserts study author Margie Lachman, PhD, adults reach the apex of their competence and expertise in middle age, with time to chart a healthy course for the future.

Midlife Challenges and Stressors

Still, midlife does pose its share of challenges in terms of concurrently balancing as many as eight roles, including spouse, parent, grandparent, adult child, sibling, friend, co-worker, and caregiver. Partially a result of an ongoing cultural shift encouraging openness around mental health, today’s midlife adults are more frequently diagnosed and seek help with issues such as depression and anxiety – from 31% in 2019 to 45% in 2023 among ages 35 to 44; and from 26% to 36% among ages 45 to 64, as reported in the American Psychological Association’s annual “Stress in America” survey.

Work is the primary stressor for many midlife patients of concierge psychologist Dr. Rebecca Osei. “Their self-worth is intertwined with career achievement,” she says. “If they haven’t yet reached the goals they set for themselves, there can be issues with depression and how to move forward from this point.”

High achievers face their own set of problems, according to psychiatrist Brook Choulet, MD, who works with CEOs and elite athletes contending with mental health concerns despite the outward appearance of great success. “I often start by asking how they would feel if I sent them on a two-week vacation right now,” she says. “Their answer can help reveal whether they’re headed toward burnout (removing the stress factor of work improves their mood) or struggling with clinical depression or an anxiety disorder.”

Strategies for High Achievers to Overcome Stress and Anxiety

Top performers are driven to constantly keep chasing the next goal, rather than taking the time to appreciate their achievements, says Choulet. “Many also have perfectionist tendencies, leading to stress and fear of failure if everything is not done flawlessly.” She helps them overcome their challenges with strategies that include:

• Establishing good boundaries between personal and professional life.
• Adopting a growth mindset focused on progress rather than perfection.
• Developing stress management and self-care techniques. “Prioritize your own mental health in order to lead effectively.”
• Taking a pulse on what brings you joy. “This is particularly important as you near retirement and can’t imagine life without work. Lean into your network of friends and family and learn how to step away and enjoy what you really love,” says Choulet.

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A Welcome Change: Mental Health Issues Lose Their Stigma at Every Age

From unmentionable to oft discussed, American attitudes toward mental health have made a seismic shift over the years. It’s heartening to see recent polls showing 87% of U.S. adults agree having a mental health disorder is nothing to be ashamed of, and 86% saying people with mental health disorders can get better. Seeking help from a therapist has become normalized, due in part to an epidemic of mood disorders among Gen Z.

“It is this generation that may, in fact, finally break the stigma around mental health,” says Ken Ginsburg, MD, Children’s Hospital of Philadelphia, “freeing millions of Americans who have suffered terribly and silently to seek help.”

Mental healthcare has gradually worked into the mainstream, says concierge psychologist Dr. Rebecca Johnson Osei. “Just a generation ago, people were happy or angry and we didn’t label many feelings beyond that. Now there’s a lot of positive talk about therapy on tv and in films, which begets more conversations. The language in children’s literature has also changed to teach about feelings, so youngsters will be great stewards of this approach when they’re adults.”

Osei says some are beginning to view therapy as an opportunity to become better versions of themselves. “It’s gratifying to work with young couples who want to be in a good place emotionally before they get married, and people looking to address issues from their own childhood before they have children.”

Does that pave the way for annual mental health checkups? “The sooner you identify a problem, the easier it is to manage,” says Osei. “We can’t prevent everything, but we can listen to our minds the same way we listen to our bodies and seek help at the first sign of troubling symptoms.”

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Mental Health in Children

Age of Innocence – Or Anxiety for Today’s Kids?

From loud claps of thunder to dogs that can bite, a child’s world is filled with new, sometimes scary experiences. However, if fears can’t be managed with reassurance or distraction and persistently interfere with daily activities, your child may have an anxiety disorder. These most common childhood mental health disorders are now regularly screened for in children ages 8-18, and include:

• Generalized anxiety disorder: excessive worry about everything that’s happening in their world; focus on failures rather than successes.
• Social anxiety disorder: intense fear of doing or saying the wrong thing; shy, withdrawn, self-conscious; avoids social and performance situations.
• Panic disorder: suffers from unexpected panic attacks, described as “going crazy” with severe feelings such as “I feel like I’m going to die.”
• Separation anxiety disorder: worries about something bad happening when not with caregivers, difficulty sleeping on own, excessive homesickness; may avoid playdates, sleepovers.
• Specific phobias: intense, irrational fear of a specific object or a situation such as animals, storms, heights, water, blood, the dark, and medical procedures.
• Selective mutism: inability to talk when faced with new people or places, but have no trouble speaking in situations where they feel comfortable.

Symptoms of Anxiety in Children

Anxiety in children manifests in numerous ways: crying, tantrums, clinging, headaches, stomach aches, shortness of breath, sleep problems, under- or overeating, and poor school performance.

Treatment of Anxiety in Children

Exposure and response prevention (ERP) therapy – exposing children to the things that trigger their anxiety in structured, incremental steps and teaching them how to master their fear – has proven very effective. When appropriate, ERP therapy can be combined with anti-anxiety medications (SSRIs).

Fear Factor: Helping Children Understand and Manage Their Fears

The frequently experienced fears shown below can often be managed with education, exploration through play, and “bibliotherapy,” the use of reading aloud to children to address their worries. In a pilot study of a four-week bibliotherapy intervention for young children with persistent and interfering nighttime fears, clinically significant change in anxiety severity was reported. Additionally, increases in the number of nights children slept in their own bed, and decreases in child-reported nighttime fears were observed.

Try it: Magination Press, the children’s book imprint of the American Psychological Association, offers a large selection of literature designed to help families navigate life’s challenges. For example, in Booma Booma Boom, a boy guides his stuffed animals through a thunderstorm using sensory-based mindfulness to ease fear, find quiet, and understand that storms also bring good things, such as calming rain and water for plants.

Adapted from: UptoDate Overview of Fears and Phobias in Children and Adolescents
Sources: Child Mind Institute, CDC, Anxiety and Depression Association of America (ADAA), UptoDate

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Mental Health in Adolescent & Young Adults

Drugs, Drinking & Depression: The Kids May Not Be Alright

Every generation has seen their share of thrill-seeking teens acting out and making dubious choices regarding drugs and alcohol. “There’s a normative aspect to risk taking at this age,” assures clinical psychologist Gilly Kahn. “It’s hardwired into our systems to allow us to learn our place in the world.”

In the 2020s it’s increasingly likely that these kinds of activities are also being used by Zoomers (born between 1997 – 2012), particularly the older ones, to temporarily ease their depression and anxiety. New research from Harvard shows that, based on well-established measures used to screen for generalized anxiety disorder or major depressive disorder, 42% of people ages 18 to 25 reported being either anxious or depressed – almost twice as many as the teens surveyed. Additionally, more than half said their lives lack meaning or purpose.

If there’s a silver lining to be seen here, it may be the respondents’ willingness to share their condition, unashamed and unafraid to reveal mental health issues. “Young adults these days may be more emotionally aware and articulate than any generation in American history,” wrote the researchers.

Like older people, symptoms of depression in young adults and teens can include:

• Diminished pleasure in things they used to enjoy
• Fatigue and sleep issues
• Anxiety
• Constant sadness
• Feeling worthless, guilty or restless
• Physical ailments such as headaches and stomach aches
• Significant weight loss or gain
• Difficulty concentrating
• Isolation
• Thoughts of death or suicide

Dissimilar to older adults, they may also do poorly at school, be more apt to ‘act out’, and feel irritable, negative and argumentative.

Effective ways to treat depression include cognitive behavioral therapy to help change negative patterns of thinking and behaving, and interpersonal psychotherapy to develop healthier relationships at home and school. An anti-depressant drug (selective serotonin re-uptake inhibitor or SSRI) may also be prescribed when appropriate.

Most importantly, Kahn advises parents and grandparents to keep the lines of communication open by taking every opportunity to talk about emotions and ‘actively listen’. “Sometimes parents are completely surprised by a call from the school guidance counselor who alerts them to the fact that their teen was Googling information about depression or suicide. But teens are really good at trying to cover up how they feel and may not want to burden family members with their sadness or anxiety,” she says.

Consistently expressing unconditional love and acceptance, even if it seems unappreciated, is key. “Teens may give you attitude or not show gratitude in the moment, but don’t stop because it has a huge positive impact on their mental wellbeing,” says Kahn.

Essential Coping Skills for Teens and Young Adults Dealing with Anxiety and Depression

1. Understand. Put your emotions in perspective, gather your thoughts, and problem solve.
2. Distract. Take time away from a problem and stop spiraling; you’ll have a clearer mind when you return to it.
3. Move. Release endorphins to increase a feeling of well-being while decreasing cortisol (stress hormones).
4. Ground. Reconnect with your senses, be present in the moment.
5. Connect. Tap into your support system, engage in caring for others in the community.

`Adapted from: Harvard GSE Making Caring Common Project

Learn more from resources dedicated to supporting mental health:

Anxiety & Depression Association of America offers extensive information about anxiety, depression, PTSD, suicide and how to join free peer-to-peer support communities.

Cogenerate is an organization that fosters intergenerational collaboration through diverse programs, events, and media initiatives.

DoSomething is one of the largest nonprofits dedicated to providing opportunities for young people to take action on various pressing social issues.

Jed Foundation is a nationally recognized nonprofit that works to protect emotional health and prevent suicide among teens and young adults. Provides comprehensive resources to help young people prioritize their mental health while managing important life transitions.

Wondermind is a popular online resource for expert advice, candid conversations, and tailored content to help young people put their mental fitness first every day. It also has a “filter by
feels” feature, allowing you to find content specific to how you feel.

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Teens & Social Media

In Real Life (IRL), Can We Protect Teens from the Emotional Impact of Social Media?

YouTube, TikTok, Snapchat, Instagram, Facebook, WhatsApp, X, Reddit, BeReal. A majority of American teens visit these social media platforms at least once daily, and 30% say they are on them almost constantly. Their ubiquity is unquestionable, and teens’ connection with them seemingly unshakeable, but the impact on emotional health is still being explored.

Recent reports found frequent social media use may be associated with changes in the developing brain, potentially affecting emotional regulation and impulse control. “In early adolescence, when identities are forming, brain development is especially susceptible to social pressures, peer opinions, and peer comparison,” according to the U.S. Surgeon General. Of particular concern is evidence linking social media use to body image dissatisfaction, eating disorders, poor sleep and depressive symptoms.

Also noted however, are the benefits of social media, which include positive interactions among teenagers who find an online community of peers with a common interest or identity. Polling has shown a majority of teens and parents gave social media high marks for connecting them with support in tough times, giving them a place to show creativity, and feeling more connected with friends’ lives.

To keep youngsters safe, experts advise a combination of limits, discussion and coaching around social media use. “When children are young, hold the reins tightly by establishing specific expectations and rules,” advises psychologist Gilly Kahn. “Build trust and loosen the reins as they get older to allow less supervision…but let them know you’ll tighten it up again if they break your trust in any way.”

While a proliferation of parental control apps are available, like Bark which sends notifications when alert words are used (e.g. drugs, suicide), Kahn notes: “These are considered really invasive by teens, and if they want to get on social media, they’re going to find a way to do it.”

Instead, start with a family media plan to set rules about online time, content boundaries, and not disclosing personal information. Continue to have age-appropriate conversations with youngsters about who they’re connecting with and how they’re spending their time online. Try and keep family mealtimes and in-person gatherings device-free to help youngsters build social bonds. Consider restricting the use of phones, tablets, and computers for at least an hour before bedtime and through the night to help ensure restful sleep. Finally, model positive behavior on your own social media accounts.

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