Tagged Anxiety and Stress

How to Reimagine Your Relationship to Alcohol

Reimagine Your Relationship to Alcohol

For many, January is a month to rethink how much they imbibe, whether they’re worried about heavy drinking or just looking for a reset.

Credit…Jordan Awan

  • Jan. 15, 2021, 2:47 p.m. ET

Seven years ago, Laura McKowen started a drinking journal. She knew alcohol was an issue for her — she knew it when her 4-year-old daughter helped her clean up the morning after a blackout, and she knew it the 10th time she drove to work hung over — but she needed to see it.

“Something very interesting happens when we put things on paper,” Ms. McKowen said, “because we have a lot of cognitive dissonance around drinking.” She couldn’t deflect around what she saw on the page, though: two bottles of wine a night. She got sober, and went on to help others do the same through coaching and teaching workshops.

Last January, Ms. McKowen published “We Are the Luckiest: The Surprising Magic of a Sober Life” and in March, she began hosting free sobriety support meetings on Zoom. By May, she had 12 employees and a company called The Luckiest Club, which offers classes and access to its community.

It’s no surprise Ms. McKowen found an eager client base. According to the 2019 National Survey on Drug Use and Health, more than 14 million American adults suffer from alcohol use disorder (A.U.D.), which is a term medical professionals prefer to alcoholism.

You don’t need an A.U.D. diagnosis to find your drinking problematic, though. Alcohol can impair sleep, cause weight gain, exacerbate anxiety, or subtly change your personality. A study conducted by the RAND Corporation in September suggests Americans are drinking 14 percent more often in response to pandemic-related stress, especially women, whose heavy drinking days increased by 41 percent in 2020.

When we go to work every day during non-pandemic times and don’t have an inordinate amount of stress, it’s fairly easy” to limit drinking to Friday nights, said James G. Murphy, a psychology professor and researcher at the University of Memphis who published a paper in November about alcohol and drug use during the pandemic. “When all of that structure is ripped away — when you’re worried about finances and your kids’ home-schooling and you don’t have to be anywhere in the morning, so no one will see if you’re hung over — alcohol can be way more difficult to manage.”

This is one reason you might be seeing more Dry January hashtags in your social media feeds this year. One month off from drinking can be an opportunity for the sober-curious to examine their alcohol use.

If any of this sounds familiar, here are some suggestions to help you navigate your relationship with alcohol or bring it to an end.

Get curious.

Take note of how much you’re drinking, as well as the pros and cons of that consumption. Are you opening that bottle of Riesling because it pairs well with your Chinese takeout, or are you hoping the third glass will drown out those voices in your head that are telling you you’re mediocre? Study your own habits — and be honest about them.

To give you some perspective, the federal government’s 2020-2025 U.S. Dietary Guidelines for Americans recommend no more than one drink per day for women or two for men (though some suggest fewer), and Dr. Murphy suggests the free alcohol screener at the website CheckUp & Choices. Take the questionnaire, which is used by health care providers, and use the score to assess your drinking. Similarly, Drinks Meter is an app with a daily calculator that helps put your own behavior into perspective using an anonymous database of over 6,000 people’s drinking habits worldwide.

“You don’t have to have things figured out, aside from wanting to make a change,” said Holly Whitaker, the author of “Quit Like a Woman: The Radical Choice to Not Drink in a Culture Obsessed with Alcohol” and creator of an online A.U.D. recovery program called Tempest. “You’re doing it right now, by being brave enough to read this article.”

Clear out the alcohol.

If you’ve decided alcohol is having a negative impact on your life, try distancing yourself from it for a while. Remove bottles from your physical spaces and booze-related content from your virtual ones. Cleanse your phone and computer of anything that might tempt you to drink.

It’s not about having a siloed existence or avoiding anything that creates an urge to drink, said Ms. McKowen, it’s about dismantling the myth that drinking is what makes life fun. “You want your online world to reflect the energy of where you’re going,” she said.

Then try not to drink for a month. Pick a date and stick with it. Experts say this is the best way to evaluate your alcohol use, and it’s a jump start on reducing your consumption, if that’s what you decide to do.

“Detoxification literally means removing the toxin,” said George F. Koob, director of the National Institute on Alcohol Abuse and Alcoholism. This can be done on your own unless you have moderate to severe A.U.D., in which case you should seek medical help. Untreated severe alcohol withdrawal can be fatal.

But fill the space with something else.

Alcohol does have positive effects: It squashes tension and lowers inhibitions. Remove it and you will miss it, at least initially.

So, identify other activities you love and increase them. Whether it’s exercise or spending time with friends, “we need another outlet to fill the void that alcohol leaves,” Dr. Murphy said.

Find your people.

You’re more likely to successfully abstain from alcohol if you have support. “Tell as many of your friends and family members who feel safe as you can about this,” Dr. Murphy said.

It also helps to connect with others who share your goal. In-person support meetings have become difficult to access in the pandemic, but help has proliferated online. Free sobriety support communities with virtual meetings include Alcoholics Anonymous, SMART Recovery, SheRecovers, In the Rooms, Eight Step Recovery, Refuge Recovery, Recovery Dharma, and LifeRing, among others. Neither good lighting nor charisma is required or expected; join from your phone while walking in a park or sitting in your car.

“I go to two meetings a day now,” said Braunwyn Windham-Burke, a reality TV star whose sobriety journey is currently playing out on season 15 of “The Real Housewives of Orange County.” “It’s so easy, because it’s in my bedroom.”

One Tempest member, Valentine Darling, 32, of Olympia, Wash., finds virtual meetings to be more L.G.B.T.Q.-friendly as well. “I feel safe sitting next to my house plants, so I’m more fully present and I’m also more authentically me: I wear dresses and express my gender queerness without worrying that anyone will follow me home.”

Many organizations have meetings specifically for people of color, certain age groups or even professions. Ben’s Friends is a sobriety support group geared toward restaurant workers. “We speak a common language in restaurants,” said co-founder Steve Palmer. “You find out that, ‘OK, he’s a line cook. She’s a bartender. These are my people.’”

Understand what recovery means for you.

If your month of sobriety was relatively easy to accomplish, then simply consider it a reset. But if you’re having trouble sticking to your plan, you might need more than group meetings. You may have A.U.D., which is a disease, not a moral failing, and it requires treatment like any illness. The most effective form of recovery usually involves long-term behavioral therapies and community support as well as medication, if needed.

The N.I.A.A.A. navigator can help you find the right treatment for you. The Substance Abuse and Mental Health Services Administration at the Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) also has an online treatment locator.

Be flexible.

If you decide you want to maintain your sobriety long-term, understand that treatment plans may vary over time. “The same practices that helped you quit drinking might not keep you sober later on,” Ms. Whitaker said. Maybe you’ve unlocked a trauma along the way, maybe you’re going through a divorce or maybe you’re living in the midst of a pandemic.

You haven’t done anything wrong; you just need a fresh set of tools.

Dr. Murphy recommends continuing to keep a log of alcohol use. Apps like Drink Control and Drinks Meter can help, but even using a pen and paper, make note of any benefits you see, to keep your momentum going. When you backslide, make note of that — and how you feel about it.

It probably took a long time to develop your current relationship with alcohol. Changing that relationship, then, will require sustained effort — and it might take several attempts. If the first one doesn’t last, Dr. Koob said, don’t judge yourself harshly. Just try again.

How to Reset (or at Least Lower) Your Stress in 5 Minutes

How to Reset (or at Least Lower) Your Stress in 5 Minutes

Jenny Taitz

Jenny TaitzDe-stressing in Los Angeles 💆‍♀️

This year has already proved to be the emotional equivalent of an ultramarathon. To help you hit the reset button, it’s key to know some quick, efficient stress-reducing strategies.

Here are a few ideas from an assistant clinical professor in psychiatry

To Start a New Habit, Make It Easy

Well Challenge Day 7

To Start a New Habit, Make It Easy

Removing obstacles makes it more likely you’ll achieve a new health goal. The 7-Day Well Challenge will show you how.

Credit…Andrew B Myers
Tara Parker-Pope

  • Jan. 9, 2021, 5:00 a.m. ET

Whether your goal for the new year is to lose weight, start exercising or focus on self-care, ask yourself: How can I make this easier?

In the scientific study of habit formation, the thing that makes it harder for you to achieve your goal is called friction. Reducing friction means removing an obstacle or coming up with a strategy that makes a task easier to do. And if you figure out how to make a goal easier, you’re more likely to succeed.

Friction typically comes in three forms — distance, time and effort. For instance, living far from the gym or a favorite walking trail makes it less likely that you’ll go. (One study found that people who lived 5.1 miles from the gym went only once a month, but those who lived within 3.7 miles went five times a month or more.) Time constraints can also get in the way of new healthy habits. If you don’t have much free time, it’s harder to start meditating or working out. And if something requires a lot of effort — like healthful cooking in a disorganized kitchen — you’re less likely to do it.

Sometimes adding friction to your life helps you achieve a goal. In one study, slowing down elevator doors by 26 seconds prompted more people to take the stairs. Removing vending machines from schools makes it harder for teens to snack on junk food or drink sugary soda.

“The friction you set up or remove in the environment is going to have an effect long after you’ve gotten discouraged and are less excited about the new behavior,” said Wendy Wood, a research psychologist at the University of Southern California and author of “Good Habits, Bad Habits.” “That’s why friction is so powerful. It persists.”

Pandemic life has altered many of our routines — so friction that used to be there may have disappeared, and new challenges may have added new friction. For instance, some people no longer commute to work, giving them more time to do other things. While online schooling has made life tough on many parents, families also may have fewer extracurricular obligations, making it easier to have dinner at home. To identify the friction that may be stopping you from achieving your goals, take a moment to think about the time, distance and effort the goal requires.

“Ask yourself, ‘What would make it easier for me to do this?’” said Dr. Wood. “You want to reduce the effort. The thing about friction is we often don’t focus on it when we’re changing our behavior. We focus on ourselves and keeping ourselves motivated and exerting willpower. But you have to recognize that you’re also going to be influenced by the things going on around you.”

For today’s final Well Challenge, try to make a new habit a little easier with these friction-busting ideas.

Day 7

Make Your Life Easier

Everybody has different goals for better health. Here are several different ways you can create a new health habit with less effort. Choose one or several to try or come up with your own easy health resolution.

Sleep in your workout clothes. If you’re trying to start a morning exercise routine, make it easy to get dressed for a morning run or workout. Sleep in some or all of your workout clothes. Put your shoes and socks by the bed. It’s one less obstacle to slow you down in the morning.

Put hand weights by your desk. Keep light hand weights nearby and do some reps while you’re on a conference call.

Hang hooks by your door. Whether you’re always losing your keys or forgetting your mask, creating a station of hooks or shelves by the door for masks, keys or any other essentials you need when you leave the house will help you make mask-wearing a habit.

Put extra masks in your coat pockets. I bought a pack of disposable masks and always have a half-dozen stuffed in the pockets of my coats. You never know when you might drop a mask on the ground, decide you want to double mask or offer a mask to someone in need. Over the summer my daughter rode a bike to meet me for an outdoor dinner and her mask blew away. She knew I’d have a replacement handy.

Stand on one leg while brushing your teeth. Standing on one leg while brushing your teeth is a way to practice balance. (Change legs after a minute of brushing.) Or use tooth-brushing time to practice mindfulness. You can find a tooth-brushing meditation here. When you add a new habit (like meditation or a balance exercise) to an old habit (like brushing your teeth) it’s called “stacking.” Stacking your habits makes them easier to remember.

Buy kitchen tongs. You’ll be amazed how much easier it is to cook, toss a salad or serve noodles with the right set of tongs. In general, having the right gadgets for your kitchen is a way to make cooking easier, and easy is good. Read “These Are the Only Kitchen Tools You’ll Need,” from Julia Moskin, or check out Wirecutter’s advice for the best kitchen tools.

Organize your refrigerator. Often the tipping point in a kitchen is the refrigerator. When your fridge is a mess, it’s hard to know what you have available to cook, what food might spoil soon and what you need from the store. Wirecutter has the best fridge organization advice from Marguerite Preston, a former pastry chef, who knows how professional chefs organize a kitchen. “In restaurants, organization is important not only because it helps cooks move quickly and smoothly, but also because wasted food is wasted money,” she writes. “The same is true at home. You may not see the effects of a chaotic fridge in a bad Yelp review or a balance sheet, but they will show in the time it takes to cook dinner and the stress involved.”

Watch the jellyfish. One of the best mindfulness tips I came across this year was from Cord Jefferson, the television writer who thanked his therapist on national television when he won an Emmy. Mr. Jefferson told me he struggled with traditional meditation, but he enjoys watching the feed from a web camera showing the jellyfish at the Monterey Bay Aquarium. Bookmark the jelly-cam on your phone or laptop browser and get lost in the jellyfish for a short mindfulness break during your workday.

Do the Standing 7-Minute Workout. All you need is a wall and a chair nearby for balance. You don’t even have to change your clothes. Our new workout video is a friction-busting workout for anyone who avoids exercise because it’s hard to get up from the floor after a push-up, plank or situps.

Complete a 1-minute task. One of my favorite health tips for dealing with stress is the one-minute rule. It comes from Gretchen Rubin, author of “Better Than Before,” a book about forming new habits. This simple advice helps you decide what to tackle on a long to-do list. Just do the one-minute tasks first. Hang up a coat. Read some emails. Clear and wipe the kitchen counter. Tidy a book shelf. Whenever you take on a one-minute task, you’ll get a sense of accomplishment and quick boost of happiness.

Do a five-finger meditation. This is an easy way to calm yourself, no matter where you are. (I tried it in a dentist chair, and it worked for me!) Start by holding your hand in front of you, fingers spread. Using your index finger on the other hand, start tracing the outline of your hand. Trace up your pinkie, and down. Trace up your ring finger and down. As you do this, breathe in as you trace up, and out as you trace down. Continue finger by finger until you’ve traced your entire hand. Now reverse the process and trace from your thumb back to your pinkie, making sure to inhale as you trace up, and exhale as you trace down. You can find more tips for beating stress in my story, “Peak Anxiety? Here Are 10 Ways to Calm Down.”

Create a Sunday basket. I learned this tip from Lisa Woodruff, author of “The Paper Solution.” She suggests dumping your bills, receipts and various papers into a basket. (She sells a product for this, but I just use a regular basket.) Once a week, sort your actionable papers (those that need attention) from your archive papers (those that can be filed.) The Sunday basket approach (she claims it will add five extra hours to your week) is part of a larger system proposed by Ms. Woodruff that uses three-ring binders rather than a filing cabinet. (She suggests five binders for financial information, medical needs, household reference, school items and daily operations.) For me, the Sunday basket is enough, but if you feel chronically overwhelmed by paper, you can learn more on the Organize365.com website.

Buy partially prepared food. Buying chopped up food and meal kits costs more, but it does save time. “I always used to avoid buying cut fruits and vegetables in the grocery store, but I found I actually use them sooner, so in the end it kind of pays off,” said Dr. Wood.

Keep a tip jar. Tipping in person (rather than by credit card) is an easy way to add a gratitude practice to a delivery day. Pandemic life has meant a lot more deliveries to my door, but I never had cash, so I usually just added the tip to the card. I decided to create the tip jar and make an effort to tip in cash. What I didn’t anticipate is that I would get so much more enjoyment out of tipping in person. (I always wash my hands first, wear a mask at the door and keep it brief.)

Put a notebook and pen by your bed. Keeping pen and paper by your bedside allows you to do a nightly stress-dump of all the things on your mind that might otherwise keep you up at night. You get a head start on tomorrow by creating a to-do list. And you can end your day with a simple gratitude practice — writing down three things for which you are grateful.

Create a device charging station outside your bedroom. The blue light in your screen has the same effect on your brain as sunlight, which means it wakes you up just when you want to be drifting off. If you’re trying to cut back on screens at bedtime, add some friction by setting up a charging station in your work area, the kitchen — anywhere but your bedroom. “If it’s in the bedroom, it’s easier to use,” said Dr. Wood. “That’s part of the temptation of always staying online. Keep devices out of the bedroom.”

Some Covid Survivors Haunted by Loss of Smell and Taste

Some Covid Survivors Haunted by Loss of Smell and Taste

As the coronavirus claims more victims, a once-rare diagnosis is receiving new attention from scientists, who fear it may affect nutrition and mental health.

Katherine Hansen used to be able to recreate a restaurant recipe just from tasting a dish. “I’m like someone who loses their eyesight as an adult,” she said.
Katherine Hansen used to be able to recreate a restaurant recipe just from tasting a dish. “I’m like someone who loses their eyesight as an adult,” she said.Credit…Jovelle Tamayo for The New York Times
Roni Caryn Rabin

  • Jan. 2, 2021, 10:26 a.m. ET

Until March, when everything started tasting like cardboard, Katherine Hansen had such a keen sense of smell that she could recreate almost any restaurant dish at home without the recipe, just by recalling the scents and flavors.

Then the coronavirus arrived. One of Ms. Hansen’s first symptoms was a loss of smell, and then of taste. Ms. Hansen still cannot taste food, and says she can’t even tolerate chewing it. Now she lives mostly on soups and shakes.

“I’m like someone who loses their eyesight as an adult,” said Ms. Hansen, a realtor who lives outside Seattle. “They know what something should look like. I know what it should taste like, but I can’t get there.”

A diminished sense of smell, called anosmia, has emerged as one of the telltale symptoms of Covid-19, the illness caused by the coronavirus. It is the first symptom for some patients, and sometimes the only one. Often accompanied by an inability to taste, anosmia occurs abruptly and dramatically in these patients, almost as if a switch had been flipped.

Most regain their senses of smell and taste after they recover, usually within weeks. But in a minority of patients like Ms. Hansen, the loss persists, and doctors cannot say when or if the senses will return.

Scientists know little about how the virus causes persistent anosmia or how to cure it. But cases are piling up as the coronavirus sweeps across the world, and some experts fear that the pandemic may leave huge numbers of people with a permanent loss of smell and taste. The prospect has set off an urgent scramble among researchers to learn more about why patients are losing these essential senses, and how to help them.

“Many people have been doing olfactory research for decades and getting little attention,” said Dr. Dolores Malaspina, professor of psychiatry, neuroscience, genetics and genomics at Icahn School of Medicine at Mount Sinai in New York. “Covid is just turning that field upside down.”

Smell is intimately tied to both taste and appetite, and anosmia often robs people of the pleasure of eating. But the sudden absence also may have a profound impact on mood and quality of life.

Studies have linked anosmia to social isolation and anhedonia, an inability to feel pleasure, as well as a strange sense of detachment and isolation. Memories and emotions are intricately tied to smell, and the olfactory system plays an important though largely unrecognized role in emotional well-being, said Dr. Sandeep Robert Datta, an associate professor of neurobiology at Harvard Medical School.

“You think of it as an aesthetic bonus sense,” Dr. Datta said. “But when someone is denied their sense of smell, it changes the way they perceive the environment and their place in the environment. People’s sense of well-being declines. It can be really jarring and disconcerting.”

Many sufferers describe the loss as extremely upsetting, even debilitating, all the more so because it is invisible to others.

“Smell is not something we pay a lot of attention to until it’s gone,” said Pamela Dalton, who studies smell’s link to cognition and emotion at the Monell Chemical Senses Center in Philadelphia. “Then people notice it, and it is pretty distressing. Nothing is quite the same.”

British scientists studied the experiences of 9,000 Covid-19 patients who joined a Facebook support group set up by the charity group AbScent between March 24 and September 30. Many members said they had not only lost pleasure in eating, but also in socializing. The loss had weakened their bonds with other people, affecting intimate relationships and leaving them feeling isolated, even detached from reality.

“I feel alien from myself,” one participant wrote. “It’s also kind of a loneliness in the world. Like a part of me is missing, as I can no longer smell and experience the emotions of everyday basic living.”

Another said, “I feel discombobulated — like I don’t exist. I can’t smell my house and feel at home. I can’t smell fresh air or grass when I go out. I can’t smell the rain.”

Loss of smell is a risk factor for anxiety and depression, so the implications of widespread anosmia deeply trouble mental health experts. Dr. Malaspina and other researchers have found that olfactory dysfunction often precedes social deficits in schizophrenia, and social withdrawal even in healthy individuals.

“From a public health perspective, this is really important,” Dr. Datta said. “If you think worldwide about the number of people with Covid, even if only 10 percent have a more prolonged smell loss, we’re talking about potentially millions of people.”

The most immediate effects may be nutritional. People with anosmia may continue to perceive basic tastes — salty, sour, sweet, bitter and umami. But taste buds are relatively crude preceptors. Smell adds complexity to the perception of flavor via hundreds of odor receptors signaling the brain.

Many people who can’t smell will lose their appetites, putting them at risk of nutritional deficits and unintended weight loss. Kara VanGuilder, who lives in Brookline, Mass., said she has lost 20 pounds since March, when her sense of smell vanished.

“I call it the Covid diet,” said Ms. VanGuilder, 26, who works in medical administration. “There no point in indulging in brownies if I can’t really taste the brownie.”

But while she jokes about it, she added, the loss has been distressing: “For a few months, every day almost, I would cry at the end of the day.”

Michele Miller developed anosmia following a bout with Covid-19 in March. She did not smell the gas from the oven filling up her kitchen.
Michele Miller developed anosmia following a bout with Covid-19 in March. She did not smell the gas from the oven filling up her kitchen.Credit…Joshua Bright for The New York Times

Smells also serve as a primal alarm system alerting humans to dangers in our environment, like fires or gas leaks. A diminished sense of smell in old age is one reason older individuals are more prone to accidents, like fires caused by leaving burning food on the stove.

Michele Miller, of Bayside, N.Y., was infected with the coronavirus in March and hasn’t smelled anything since then. Recently, her husband and daughter rushed her out of their house, saying the kitchen was filling with gas.

She had no idea. “It’s one thing not to smell and taste, but this is survival,” Ms. Miller said.

Humans constantly scan their environments for smells that signal changes and potential harms, though the process is not always conscious, said Dr. Dalton, of the Monell Chemical Senses Center.

Smell alerts the brain to the mundane, like dirty clothes, and the risky, like spoiled food. Without this form of detection, “people get anxious about things,” Dr. Dalton said.

Even worse, some Covid-19 survivors are tormented by phantom odors that are unpleasant and often noxious, like the smells of burning plastic, ammonia or feces, a distortion called parosmia.

Eric Reynolds, a 51-year-old probation officer in Santa Maria, Calif., lost his sense of smell when he contracted Covid-19 in April. Now, he said, he often perceives foul odors that he knows don’t exist. Diet drinks taste like dirt; soap and laundry detergent smell like stagnant water or ammonia.

“I can’t do dishes, it makes me gag,” Mr. Reynolds said. He’s also haunted by phantom smells of corn chips and a scent he calls “old lady perfume smell.”

It’s not unusual for patients like him to develop food aversions related to their distorted perceptions, said Dr. Evan R. Reiter, medical director of the smell and taste center at Virginia Commonwealth University, who has been tracking the recovery of some 2,000 Covid-19 patients who lost their sense of smell.

One of his patients is recovering, but “now that it’s coming back, she’s saying that everything or virtually everything that she eats will give her a gasoline taste or smell,” Dr. Reiter said.

The derangement of smell may be part of the recovery process, as receptors in the nose struggle to reawaken, sending signals to the brain that misfire or are misread, Dr. Reiter said.

After loss of smell, “different populations or subtypes of receptors may be impacted to different degrees, so the signals your brain is used to getting when you eat steak will be distorted and may trick your brain into thinking you’re eating dog poop or something else that’s not palatable.”

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Patients desperate for answers and treatment have tried therapies like smell training: sniffing essential oils or sachets with a variety of odors — such as lavender, eucalyptus, cinnamon and chocolate — several times a day in an effort to coax back the sense of smell. A recent study of 153 patients in Germany found the training could be moderately helpful in those who had lower olfactory functioning and in those with parosmia.

Dr. Alfred Iloreta, an otolaryngologist at Mount Sinai Hospital in New York, has begun a clinical trial to see whether taking fish oil helps restore the sense of smell. The omega-3 fatty acids found in fish oil may protect nerve cells from further damage or help regenerate nerve growth, he suggested.

“If you have no smell or taste, you have a hard time eating anything, and that’s a massive quality of life issue,” Dr. Iloreta said. “My patients, and the people I know who have lost their smell, are completely wrecked by it.”

Mr. Reynolds feels the loss most acutely when he goes to the beach near his home to walk. He no longer smells the ocean or salt air.

“My mind knows what it smells like,” he said. “And when I get there, it’s not there.”

For a Healthier 2021, Keep the Best Habits of a Very Bad Year

For a Healthier 2021, Keep the Best Habits of a Very Bad Year

Our 7-Day Well Challenge will show you how to build on the healthy habits you learned during pandemic life.

Credit…Andrew B Myers
Tara Parker-Pope

  • Jan. 1, 2021, 5:00 a.m. ET

Here’s a better way to start the new year: Skip the traditional January resolutions and make time for some New Year’s reflection instead.

Take a moment to look back on the past 365 days of your life. Years from now, when you talk about 2020, what stories will you tell? Will it be clapping for health care workers every night at 7 p.m.? Or perhaps it will be a memory from the months spent mostly at home with family members — or the pandemic “bubbles” you formed that helped friendships grow stronger. Maybe you will tell the story of losing someone you loved or remember finding strength and resilience you didn’t know you had.

While reliving much of 2020 may sound like a terrible idea, psychologists say it’s a better way to start the new year. Looking back will help you build on the lessons you learned, and you may even discover some hidden positive habits you didn’t realize you had started.

“I don’t think we’ve given ourselves enough credit,” said Kelly McGonigal, a health psychologist and lecturer at Stanford University and author of “The Willpower Instinct.” “I don’t think we have had the emotional appreciation that we need and deserve for the kind of year many people have had. The reflection that’s needed right now is a real, honest and self-compassionate look at what’s been lost, who’s been lost and what it is that you want to choose to remember about 2020. Reflection is a way of being ready to move forward into the new year. I say that every year, but I think that it’s especially true for this year.”

Reflections vs. Resolutions

Reflecting on what you accomplished in 2020 — and what you missed or lost — is also a healthier path toward self-improvement than the typical New Year’s resolution. Studies consistently show that New Year’s resolutions don’t work. By February, most people have abandoned them.

The problem with many resolutions is that they tend to be inherently self-critical and stem from a sort of magical thinking that with one big change — some weight loss, regular exercise, more money — life will be transformed. “It’s just too easy to look for a behavior that you regularly criticize yourself for, or feel guilty about,” Dr. McGonigal said. “It’s that false promise of, ‘If you change this one thing, you’ll change everything.’”

Studies show that one of the best ways to change behavior and form a new habit is to bundle it with an existing behavior — what in the science of habit formation is called “stacking.” It’s the reason doctors, for example, suggest taking a new medication at the same time you brush your teeth or have your morning coffee: You’re more likely to remember to take your pill when you piggyback it onto an existing habit. Adding steps to your daily commute often is a better way to add exercise to your day than trying to carve out a separate time for a daily walk.

By reflecting on the lessons of the past year, we can stack and build on the good habits we started in 2020. Maybe that involved figuring out new ways to exercise when gyms were closed, strengthening friendships forged through our social bubbles, organizing our homes for 24-7 living and learning, learning to cook healthier meals or making ourselves accountable for the care of others.

Now, with the distribution of vaccines and the end to the pandemic in sight, you don’t need to abandon those changes — instead, try building on them. The first challenge is listed below. Then, starting Monday and every day next week, the 7-Day Well Challenge will identify a popular quarantine habit and offer a new strategy for turning it into a healthy lifelong habit. Just sign up for the Well newsletter, and you’ll receive a daily email reminder to join that day’s challenge.

Day 1

Build on Your Gratitude Habit

Credit…Andrew B Myers

Quarantine clapping became a nightly ritual in many parts of the United States and around the world as a collective thanks to health care workers. It was both a show of community and a show of gratitude. The experience was what sociologists call “collective effervescence,” which happens when people simultaneously come together and take part in a group ritual.

Clapping for essential workers had the effect of “both unifying and energizing the group for action toward a common cause, such as persevering through the pandemic,” said Joshua W. Brown, professor in the department of psychological and brain sciences at Indiana University Bloomington. “Group expressions of gratitude can be empowering for both those expressing it and those receiving it.”

Perhaps you showed gratitude in other ways. Did you offer larger tips than usual to delivery and restaurant workers? Did you find yourself saying a heartfelt thank you to the grocery and pharmacy workers at checkout? When things got tough at home, did you remind yourself and your children of all the things for which you felt grateful? I adopted a regular gratitude hand-washing ritual, thinking of 10 things to be grateful for — one for every finger I washed.

Why it matters: Numerous studies show that people who have a daily gratitude practice, in which they consciously count their blessings, tend to be happier, have lower stress levels, sleep better and are less likely to experience depression. In one study, researchers recruited 300 adults, most of them college students seeking mental health counseling. All the volunteers received counseling, but one group added a writing exercise focused on bad experiences, while another group wrote a letter of gratitude to another person each week for three weeks. A month later, those who wrote gratitude letters reported significantly better mental health. And the effect appears to last. Three months later the researchers scanned the brains of students while they completed a different gratitude exercise. The students who had written gratitude letters earlier in the study showed greater activation in a part of the brain called the medial prefrontal cortex, believed to be related to both reward and higher-level cognition.

Take the Gratitude Challenge

This week, try one or more of these simple gratitude exercises.

Start small. Send an appreciative email or text, thank a service worker or tell your children, your spouse or a friend how they have made your life better. “A great way to develop more gratitude would be regular small steps — an extra email or note of appreciation to a colleague, or an extra in-person thank-you, and a focus on how rewarding it is to brighten someone’s day with appreciation,” Dr. Brown said.

Create a gratitude reminder. Dr. McGonigal keeps a sticky note on her desk lamp that reads:

1. Someone
2. Something
3. Yourself

It’s a daily reminder to express gratitude not only for the people, events and gifts in her life but also for her own accomplishments. She might feel gratitude for completing a workout, for a healthy body or for taking on a new challenge. “Gratitude is really good when what you need is a belief in your ability to create a more positive future and a willingness to trust others to help you do that,” Dr. McGonigal said. “And that feels like a really good mind-set for right now.”

Express your gratitude in writing. You can send emails or post feelings of gratitude on social media or in a group chat. Or think of someone in your life and write them a letter of gratitude. (You don’t have to mail it.) Fill your letter with details describing how this person influenced your life and the things you appreciate about them. Or keep a daily gratitude journal.

“I think the full potential of gratitude is realized when people are able to express gratitude in words,” says Y. Joel Wong, chairman of the department of counseling and educational psychology at Indiana University. “When we are able to say what we’re grateful for and explain why, it shifts our attention from what’s negative to what’s positive in our lives.”

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Soothing Anxiety and Stress: Advice From the Year in Well

Soothing Anxiety and Stress: Advice From the Year in Well

Exercise, new news habits, even dipping your face into an icy plunge pool are among the steps you can take for a mellower new year.

CreditCredit…By Till Lauer

  • Dec. 28, 2020, 5:00 a.m. ET

For many of us, 2020 was an exceptionally stressful year, dominated by fears about the coronavirus pandemic. Even with the vaccine on the horizon, we’re likely to need some stress management strategies to carry us into 2021. There’s lots of advice in this guide by Tara Parker-Pope, How to Be Better at Stress. Stress doesn’t have to get you down, she writes: “Approach it the right way, and it won’t rule your life — it can even be good for you. Here are ways to deal with stress, reduce its harm and even use your daily stress to make you stronger.”

Following are more tips from the past year’s stories by Well writers.

In Stressful Times, Make Stress Work for You

By Kari Leibowitz and Alia Crum

These are stressful times. As a result of coronavirus and the disease it causes, Covid-19, millions of Americans aren’t just worried about their health, but also about their livelihoods and their futures. At the same time, warnings abound that stress itself is bad for our health and might even make us more susceptible to the illness. The irony is obvious.

Fortunately, there is an alternative approach: We can actually use that stress to improve our health and well-being. Over a decade of research — ours and that of others — suggests that it’s not the type or amount of stress that determines its impact. Instead, it’s our mind-set about stress that matters most.

Exercise May Make It Easier to Bounce Back From Stress

By Gretchen Reynolds

Exercise makes it easier to bounce back from too much stress, according to a fascinating new study with mice. It finds that regular exercise increases the levels of a chemical in the animals’ brains that helps them remain psychologically resilient and plucky, even when their lives seem suddenly strange, intimidating and filled with threats.

The study involved mice, but it is likely to have implications for our species, too, as we face the stress and discombobulation of the ongoing pandemic and today’s political and social disruptions.

Five-Minute Coronavirus Stress Resets

By Jenny Taitz

Rather than dealing with anxiety and uncertainty by getting lost worrying, then chasing short-term fixes with longer-term consequences, like procrastinating, using food or marijuana to cope or relying on benzodiazepines — the anti-anxiety drugs like Xanax — it’s helpful to experiment with quick strategies that will empower you. These strategies are not necessarily a cure, but can help lower the intensity of overwhelming emotions, allowing you to recalibrate to better deal with challenges you face.

My patients often reflect that an additional perk of strategic coping is boosting your sense of mastery — the hope that arises when you stretch yourself and accomplish something difficult, like coping with your anxiety in a productive way.

Managing Coronavirus Fears

By Jane E. Brody

Covid-19, the invisible enemy now bearing down on 328.2 million Americans, is tailor-made to induce fear and anxiety, prompting both rational and irrational behavior and, if the emotional stress persists, perhaps causing long-lasting harm to health.

A psychotherapist I know has advised his patients to limit their exposure to the news and discussions about Covid-19 to one hour a day and, if possible, in only one location, then use the rest of the day and other parts of the home for productive or pleasurable activities.

Helping Children With Anxiety in the Pandemic

By Perri Klass, M.D.

Yes, this is an anxious time, and yes, everyone is anxious, but it is particularly hard to be an anxious kid in an anxious time. Anxiety disorders are the most common mental health disorders in children and adolescents (and this was true before the pandemic), and they can be linked to other mental health issues, notably depression.

Anxiety can bring children into emergency rooms, and into psychiatric hospitalizations, and in a time of generally heightened stress and anxiety, parents with anxious kids find themselves worrying especially about the worriers, wondering how to talk with them about the complexities of life in 2020, and trying to assess when worry is, well, worrisome enough to need professional help.

New Year, Same Quarantine

How to Manage Your New-Year Expectations

A ‘Happy New Feels-The-Same Year’ isn’t too exciting a prospect. Here’s how to emotionally prepare yourself for the excitement lag.

Credit…Rose Wong

  • Dec. 26, 2020

Ah, New Year’s Eve is fast approaching, and it’s finally time to leave the wreckage of 2020 behind. Except for many people, it seems as if not much will change except the year on the calendar, making the new year feel about as much of a refresh as a frozen browser. There isn’t even another date you can count down to. If you’re wondering how to emotionally prepare for the groundhog-day months ahead — and maybe even find some joy in the coming season — here’s some advice.

Plan small treats.

If you’re the kind of person who delights in creating a spreadsheet on Jan. 1 to plot out the coming year, slow your roll. You can still plan small things to look forward to, said Bethany Teachman, a psychology professor at the University of Virginia. Because many of her family’s usual plans for the season have been upended — like everyone else’s — each person gets to choose an activity. For example: At the request of her older daughter, a fan of “The Great British Baking Show,” the family decided to “get a ton of baking ingredients and make something really complicated that will fall apart,” Dr. Teachman said. Plan “anything that is going to give you sparks of joy” as frequently as you can during the coming months, she said.

Define what matters.

With months to go until restrictions ease, the pandemic may seem like a never-ending punishment. While staying home and avoiding travel is not even remotely like actual prison time, there is one thing you can learn from inmates who adapt best to long sentences: They define (or redefine) what matters, said Mitch Abrams, a psychologist who oversees mental health services for New Jersey state prisons.

Dr. Abrams often asks his patients a series of questions, like what and who is important to you? What would you want your legacy to be? And what are you willing to do to make your reality as best you can under these circumstances? And this one: “We are social beings. Circumstances sometimes make it more challenging to build, foster and nurture relationships. How can you nurture your relationship with yourself, so that you can then do the same for your relationships with others?”

Dr. Abrams said working in prisons for 21 years has taught him two things. The first is that human beings are incredibly resilient and adaptable; the second is that happiness comes from within. “The more you are able to appreciate what you have, the better off you’ll be,” he said. “I don’t necessarily mean material things. It could be your sanity, it could be your health.”

Stay in the moment.

Endurance sports psychology tells us that the body is capable of far more than the brain believes. (If someone had told you in March how long the pandemic would last, would you have thought you could handle it?) So focus on the moment, not the big picture.

Anxiety comes from casting yourself into the future, but “if you keep your energy in the present moment, and you’re not contemplating how many more miles you have, it can feel easy at times,” said Jo Daniels, a senior lecturer in clinical psychology at the University of Bath, in England, and an author on a study about what causes anxiety and depression in lockdown.

How do you stay in the moment? There are all kinds of mindfulness exercises, but one is to list five things for which you’re grateful, however small — yes, a hot cup of coffee counts. When you’re feeling overwhelmed, think only about what you need to do to get through the next hour or the next day — not the next week or the next month.

Dr. Daniels’ pandemic study found negative coping strategies — like repeatedly overeating and excess drinking — had more of an impact on people’s levels of anxiety and distress than more positive coping strategies, like seeking support. “The message is, ‘Try to do the good things, but definitely don’t do the bad things,” Dr. Daniels said. No one is suggesting your end-of-day cocktail or afternoon cake needs to go. Problems arise if you use these things repeatedly to change your mood — and you feel guilty about that afterward, she said.

Take control.

If you feel as if you’re a hostage to the pandemic, well, that’s because it does have one thing in common with actually being held captive. It presents a fundamentally uncertain fate, said Emma Kavanagh, a former police and military psychologist in South Wales who has taught about the psychology of hostage negotiation. Those who mentally fare best in hostage situations often work to regain some measure of control over their environment, whether it’s declaring, “I will walk 100 steps around my cell today” or “I will do 50 push-ups.”

“Having something we can decide upon and activate can help restore that sense of control,” Dr. Kavanagh wrote in an email. Exercise is a good choice because it boosts endorphins, but your something doesn’t have to involve sweating. It can be anything that makes you feel in control of your own daily experience, whether that is a routine or a small daily ritual.

Find flexibility and tolerance.

In a case of science confirming common sense, a series of studies published in October in the journal Frontiers in Psychology looked at how uncertainty makes it hard to persevere. In one study, some participants were told they would be giving a speech (meant to be an anxiety-inducing task in itself), others that they would be rating speeches and a third group that there had been a glitch and they’d find out later what they were doing. All the groups then worked on complex anagrams, and the group that didn’t know what task they had to do made the fewest attempts to solve the puzzles. (Those who thought they had to give a speech made the next fewest.)

One theory explains this by assuming that when things are uncertain “people are saving all their energy for the thing they don’t know is coming,” said Jessica Alquist, an associate professor of psychology at Texas Tech University and the study’s lead researcher. “Uncertainty might just be a cue to our brains to lock everything up.”

People who experience the least brain freezing, who handle uncertainty best, are those who are flexible, said Dr. Teachman, who has also studied uncertainty. If you find yourself spinning out, ask yourself if you’re jumping to conclusions or assuming the worst. Is there another way you might think about your situation? You can also think about somebody who you admire in terms of the way they handle stress, and ask yourself how they might respond to this situation. Glass-half-empty people, don’t worry: This doesn’t mean you always need to assume things will go well. “There is no one right way to think about situations because our context is constantly changing and the demands are constantly changing,” Dr. Teachman said.

Uncertainty tolerance is also something you can improve — even in lockdown. (New Year’s resolution, anyone?) Here’s how: Try something new you haven’t tried before, preferably something that scares you a little. Dr. Teachman has tried skydiving and bungee jumping in an effort to push herself, but you don’t have to go that far. It could be something like messaging someone you met who you thought might become a friend but never followed up on, or giving feedback to someone when you’d normally stay quiet. The idea is to do something where you don’t quite know how it’s going to turn out, because this forces you to tolerate uncertainty.

“You can do it,” Dr. Teachman said. “It’s uncomfortable but it’s not dangerous.” (Well, not unless you choose skydiving.)

Turn Your Sex Life Around

Take Back Your Sex Life

With all its stress and uncertainty, this year hasn’t exactly been a banner year for intimacy. But that can change.

Credit…Rose Wong
Meaghan O’Connell

  • Dec. 26, 2020, 10:57 p.m. ET

Melissa Petro is a 40-year-old writer who lives in New York with her husband of four years and two children. She and her husband switch off between working and kid duty. According to Ms. Petro, the always-on nature of parenting a 12-month-old and a 3-year old in a pandemic has been “relentless, exhausting and not sexy.” Recently her husband has been sleeping on the family room couch.

“It’s not that I don’t want to,” she said, “It’s just that there’s so many things to do besides have sex with my partner, who I do hypothetically find attractive and theoretically want to have sex with. It feels pretty — at times — hopeless, our sex life.”

Ms. Petro is not alone. A Kinsey Institute study on the impact of Covid-19 on marital quality found that 24 percent of married people reported having less frequent sex than they did before the pandemic, and 17 percent of women reported a decrease in both sexual and emotional satisfaction since the pandemic began. Another study from the spring suggested that a third of couples were experiencing pandemic-related conflict and that many of their sex lives were suffering.

“We are missing out on many parts of our former lives,” Maya Luetke, a researcher at the Center for Sexual Health Promotion at Indiana University who led the study, wrote in an email. “Just as this is the lost year in other ways, it may also be the lost year in terms of sex.”

Likewise, Emily Nagoski was not surprised by the data. A sex educator, researcher and author of “Come as You Are: The Surprising New Science That Will Transform Your Sex Life,” Dr. Nagoski describes sexual desire and inhibition like the accelerator and brake in a car. And while right now there are more factors in couples’ lives hitting their brakes than their accelerators, all hope is not lost. There is still a lot you can do to take your foot off the brake and hit the sexuality accelerator.

Shift your perspective.

Self-criticism and judgment of your partner are classic ways to dampen sexual desire. More than half of women report that stress, depression and anxiety decrease their interest in sex, as well as their sexual arousal and ability to orgasm. Dr. Nagoski said it’s normal to feel less desire during a crisis, like a pandemic. “You feel like the entire world, literally the air you breathe, is a potential threat to yourself and your family. That’s going to hit the brake.”

The first step to improving your sex life might be a shift in attitude rather than behavior. “If you have sex because you have to or you feel like you’re supposed to, you won’t have much sex and you probably won’t enjoy it,” Dr. Nagoski wrote in her book. “Don’t just decide to have sex, try on the identity of a person who loves sex.”

Make a plan.

Ms. Petro said she and her husband still make time for sex, even if it’s just, say, every third Sunday. “I shove thoughts of chores undone out of my mind and just try to relax into my body and be present for my partner,” she said. Afterward, they take each other less seriously. “We’re lighter.”

“People get very wrapped up in the idea of spontaneously desiring sex,” Dr. Nagoski said, but, especially in women, it’s fairly rare. Based on a wide body of research on gender and sexual desire, Dr. Nagoski estimates that roughly 15 percent of women experience spontaneous desire, whereas most experience responsive desire — wanting sex when something erotic is happening.

“When we study people who have great sex over the long-term in a relationship, they do not describe spontaneous desire as a characteristic,” she said.

So what do they describe? When the clinical psychologists Peggy Kleinplatz and A. Dana Menard conducted a study for their book “Magnificent Sex: Lessons from Extraordinary Lovers,” they found that the components of great sex were consistent across gender, sexuality and a host of other descriptors and tastes. They included things like communication, empathy, vulnerability, connection and being present in the moment. They stressed ignoring notions of romantic spontaneity and, instead, embracing deliberateness and making a plan.

Great sex, they found, doesn’t just happen. It requires intentionality. Don’t be afraid to put it in your calendar if you have to. Because while you can’t plan on great sex, you can, as Dr. Kleinplatz and Dr. Menard put it in their book, “intentionally create the conditions in which the magic might occur.”

Pursue novelty.

While experiencing low sexual desire during a pandemic might be normal and understandable, there are things you can do to increase desire in a relationship. One thing that science says increases arousal is a novel experience. Not just the sexual kind, but anything to get your heart rate up.

This might be a good time for people to “open a dialogue with their partner(s) about their relationship overall as well as their personal desires, fantasies, needs, etc.,” Dr. Luetke, who studies the link between conflict and sexual intimacy at Indiana University, wrote in an email. If these conversations are awkward for you, she recommended engaging a therapist specializing in sex.

Or find another way to raise your heart rate. You might not be able to ride a roller coaster or dance at a crowded concert, but you could still do a YouTube workout, go for a hike with your partner or watch a scary movie together after the kids are in bed. Some research suggests that being excited around your partner makes that person seem more novel and thus more sexually attractive, by association.

Complete the stress cycle.

When your brain senses a threat (a lion, say, chasing you), your body activates the sympathetic nervous system, which sends chemicals like adrenaline and cortisol to help you run faster or fight harder. Once the threat is gone (you ran away; you killed the lion), the parasympathetic nervous system kicks in, taking you out of fight-or-flight mode and returning your body to a calm state.

That calm state activated by the parasympathetic nervous system is also responsible for sexual arousal. In other words, your brain knows that when the lion is chasing you, you won’t want sex.

Modern-day stressors, however, are more ambiguous than a lion. It’s less clear to your brain when the threat has passed — when your paycheck has been deposited or your child’s remote school day is over. So Dr. Nagoski recommended “completing the stress cycle,” or doing things that will signal to the body that the danger has passed. When you go for a run after a long day of work, you’re moving through fight-or-flight mode by jogging away from the figurative lion, and telling your body that the stress is over, at least until tomorrow.

And even if you still don’t feel safe enough to experience desire, you can still touch your partner and intimately connect. Lying in the dark watching a movie with your partner, going for a walk, exercising, practicing self-acceptance — these things all have their own benefits, even when they don’t lead to sex.

Meaghan O’Connell is a freelance writer and the author of “And Now We Have Everything: On Motherhood Before I Was Ready.”

Knit to Improve Your Mood

Pick Up the Knitting Needles for a Mood Booster

This inexpensive hobby abounds with benefits. And once you get good, you’ll be a mitten machine.

Credit…Ryan Mcgurl/EyeEm, via Getty Images

  • Dec. 19, 2020, 11:43 p.m. ET

Already an excellent winter activity in an ordinary year, knitting is even better suited to 2020, when we’re being encouraged to stay home and restrict our social circles.

Picking up needles and yarn to create scarves, hats, mittens and sweaters is an inexpensive hobby and easy to take up, given the wealth of free, online resources.

But the craft can also trigger mental health benefits. Many studies have been published that show knitting helps to manage chronic pain, improve cognitive function and even increase happiness. Perhaps most relevant to these uncertain times, a survey of knitters taken last year by the Abo Akademi University in Finland indicated that they felt knitting “can be a counterbalance to a stressful job, hectic lifestyle or other demanding situations in life.”

Soothing stitching

Amy Reddinger, a dean at Bay de Noc Community College in Escanaba, Mich., came back to knitting after a long hiatus in March, when the campus closed and she needed a way to get away from screens. Her first project was an ambitious one — a complicated shawl using some fairly advanced techniques.

“I almost quit a lot of times,” Ms. Reddinger, 45, said. “But I kept at it, and I was both miserable and joyful at times — it was a good emotional process for me.”

She valued the level of challenge as a “great distraction from the chaos and stress of the unknown.”

It’s well known in knitting circles that there are two types of knitters: those who focus on the results — a comfortable sweater, mittens to match a new winter coat, a gift for an upcoming baby shower — and those who focus on the process. Process knitters knit for knitting’s sake. They value the soothing repetitive motions and the feel of the yarn running through their fingers, relish the colors, the act of creation. They enjoy the good things that come with it, without having to fuss about their work being perfect, or their scarf being stylish.

If you are considering picking up knitting, think of it as meditation with a little bit of equipment. Approach it for the joy of the process and to take some pressure off. (Also, it’s a good way to keep your hands out of the candy bowl if you want to change your eating habits.)

Warm outputs

And if the result is something that can keep you (or a friend or family member) warm, it’s a fantastic bonus. Just think: scarves! Hats! Mittens! Sweaters! Stylish statements, gifts for loved ones, blankets to welcome new babies. Once you become more accomplished, you’ll be a mitten machine.

Ruhee Dewji, a Canadian software developer who lives on her own, took up knitting in early spring at the encouragement of some friends. Before the pandemic, Ms. Dewji, 31, filled her spare time playing music in bands; she found playing on her own during lockdown just emphasized her loneliness.

She finds knitting an uncomplicated joy with many benefits, but one stands out.

“I’ve mostly made things for other people, and I realized that when you are making something for someone you love, you are thinking about them with every single stitch, and somehow that feels less lonely even though I am doing it all alone,” she said.

Supportive communities

Although knitting is a single-person activity, many knitters enjoy gathering, both online and in person, to share the successes, laugh about the mistakes and learn from one another. The portability of knitting is crucial, and as knitting doesn’t require one’s full focus or attention, you are able to engage with the people around you. In the Before Times, yarn shops would hold knit-nights and libraries had crafting groups. There are also formal knitting guilds, and most major cities seem to have at least one group of self-identified “drunken knitters” who meet in bars.

Most knit-nights and classes went virtual early this year, making them accessible to faraway members and those nearby with physical or other limitations that may not let them appear in person.

Before the pandemic, Seattle Yarn hosted three regular in-person gatherings every week. Destiny Itano, a co-owner, said that when travel and gathering restrictions were put in place, both staff members and customers were “devastated” at the thought that these groups might not continue. Within a couple of weeks of the city’s lockdown, they set up online sessions and have been hosting two events a week ever since. Ms. Itano said that she was “surprised how well they work — not only as social gatherings, but as a way for knitters to offer and get help with their stitching.”

And the local knitting community has expanded: Ms. Itano’s mother joins from her home in Alaska, and a regular attendee to their Saturday morning group lives in Germany. They plan to keep these groups going even after the shop is fully operational again.

How to get started

Before you begin, know that focusing on the end result means that many beginners are often too impatient with the inevitably imperfect results of their first projects. The first of anything you make will not be great. (Admit it, there was some disastrously inedible sourdough this past spring.) And it doesn’t matter one bit. You still get all the benefits (virtuous or not) whether or not you come away with a wearable scarf. You’re still going to be relaxed and mindful whether or not the beanie fits.

But to make that hat, you’ll need balls of yarn and knitting needles. Look to specialized local yarn shops (L.Y.S.’s), big-box craft stores and online retailers like knitpicks.com and yarn.com, the website of the knitting retailer WEBS. Yarn and craft stores also offer instruction and specific learn-to-knit kits for beginners.

Know that yarn comes in different thicknesses, and needles are sized to suit. Always choose your yarn first — beginners might want something on the thicker side, and in a lighter color so you can see what you’re doing and make fast progress. The yarn label indicates the size of needle to use.

If you prefer learning with books, introductory manuals are easy to find in thrift and used-book stores, and the instructions themselves don’t change. But it might be worth investing in a newer one: The projects are more modern, and they use the readily available materials. “Vogue Knitting: The Learn To Knit Book” or “Knit How” are two good choices.

There are plenty of free online and video resources, too. The video lessons at knittinghelp.com are well presented, accurate and clear, while ModernDailyKnitting.com has articles, lessons, patterns and other goodies for knitters of all levels.

To meet other knitters, check out the online classes, virtual knit-nights and other social gatherings hosted by a yarn shop in your area. Even if you can’t visit in person, their websites and social media will give you a sense of who they are and what they do.

In New York City, Knitty City and String Thing Studio are two shops that are striving to maintain and bolster knitting communities, even under this year’s necessary restrictions.

Felicia Eve, owner of String Thing Studio in Brooklyn, sells a standard kit for novices, and offers one-on-one appointments, both in-person and online, to teach the basics. She urges beginners to be soothed by knitting’s colors and textures, and to value its meditative nature, but also to embrace mistakes as part of the learning process.

“Cherish the wonkiness,” she said.

How to Combat Pandemic Loneliness

Combating an Epidemic of Loneliness

Ways to seek support while social distancing.

Credit…Andrea Chronopoulos

  • Dec. 18, 2020, 12:36 p.m. ET

Human can survive three minutes without air, three days without water, three weeks without food and three months without companionship, according to survival lore. Whether true or not, what’s clear is that people need people. And pandemics, many of us are learning, can be lonely times.

After months of lockdowns and shelter-in-place orders, some experts worry about a rise in the number of people feeling alone, especially young people. But resilience is also widespread, and studying loneliness can reveal a variety of ways to combat it.

“In light of the pandemic, there are ways that we can increase that sense of connection or reduce feelings of loneliness in ways that we may be able to do safely at a distance,” said Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University. “One of the things that research has shown is that social support is incredibly helpful in times of stress.”

Loneliness is more than being alone.

Loneliness is a complicated emotion. You can feel lonely in a crowded room or feel content in solitude. And people vary widely in how much human connection they need, Dr. Holt-Lunstad said. A useful way to think about loneliness, she said, is as the difference between how much social connection people want and how much they are getting.

It’s a subjective feeling, but researchers have begun to find signals in the brain that put the need for social interaction on par with the need to eat. In a study published in November, scientists deprived participants of contact with other people and then scanned their brains. After just 10 hours of isolation in a lab — where they could read or draw but had no access to their phones or computers — people reported feeling lonely and craving social interaction. When they then looked at pictures of people engaged in social activities, scans showed midbrain activation identical to that of people who looked at pictures of food after 10 hours of fasting.

“It was surprisingly consistent across people,” said Livia Tomova, a cognitive neuroscientist at the University of Cambridge in Britain, and co-author of the study. “Social interaction is not just something that’s kind of fun or comforting. It’s something that we really need in order to function.”

Without that social connection, people often become depressed, which further feeds feelings of loneliness. Chronic loneliness is also linked to higher rates of heart disease, Alzheimer’s disease, suicide and even death.

Find a friend.

If loneliness is interfering with your ability to function, or if you’re thinking about self-harm, seek professional help. The National Suicide Prevention Lifeline offers free and confidential support at 1-800-273-8255, and many therapists are offering virtual appointments. For milder forms of loneliness, decades of research suggest a number of strategies to ease the toll of pandemic lockdowns.

The most obvious is seeking support from friends. Across a number of studies, people with strong social relationships had a higher likelihood of living longer than people with weaker connections. Just knowing that people are there for them, Dr. Holt-Lunstad said, leads to a reduction in stress. In one small study, subjects could complete a stressful task (giving a speech that they were told was being recorded and judged) while maintaining lower heart rate and blood pressure by simply thinking about a good friend instead of a casual acquaintance.

In a time of social distancing, this might mean calling, texting to check in, dropping off a gift or driving by and waving. “By providing support to others, it can provide a sense of meaning and purpose,” Dr. Holt-Lunstad said. “It can strengthen social bonds, and in turn lead to less loneliness.”

When seeking out connections, focus on your most unconditionally supportive friends and family. Some research shows that people feel more stressed and disconnected when their friendship networks include people who have betrayed them, weren’t there for them during tough times, frequently argue with them or otherwise cause negative feelings. A call with a close friend, in other words, will probably help more than a college reunion over Zoom.

“Simply increasing social contact is not sufficient,” said Bert Uchino, a professor of psychology at the University of Utah in Salt Lake City. “You need to increase contact in the relationships that are important and very positive to you. I think those are relationships that will get people through.”

Help a stranger.

This might also be a good time to help out in the neighborhood. Using the neighborhood social app NextDoor to randomly assign people to perform small acts of kindness — like delivering groceries, chatting over a fence or participating in a neighborhood cleanup event — Dr. Holt-Lunstad and her colleagues found that loneliness rates dropped from 10 percent of people to 5 percent of people who did the kind acts.

Research suggests you don’t even need to know the people you’re helping. Just donating money to a good cause can help, Dr. Uchino said. In a series of experiments, researchers found that people who gave money to others were happier than if they spent it on themselves.

But if you’re overwhelmed by giving, it can become detrimental. Instead, try hobbies like cooking, gardening, writing in a journal or even listening to music. Creative arts can reduce loneliness, too, and while singing in person in a choir might not be possible right now, singing from balconies or through virtual groups can be powerful.

Reach out in real life.

Loneliness can strike at any age, but young people may bear the brunt of canceled activities and lost social time. An estimated 73 percent of Generation Z adults reported feeling lonely in a survey released by the American Psychological Association in October.

Although group video calls and social media conversations have taken over many people’s lives during the pandemic, we still don’t know how virtual communication affects loneliness. A 2012 study found that phone or in-person conversations between mothers and daughters led to hormonal changes that reduced stress, while text messages did not. And heavy social media use has been linked with higher rates of loneliness.

For young people, who were already used to digital forms of communication like texting, it may turn out to be an adequate substitute for in-person interaction. And some types of social media use can help people feel more connected, added Dr. Tomova, who is working to figure out what most satisfies our hunger for social interaction and why. “It’s not clear yet,” she said. “We don’t know a lot of things.”

For now, many people are waiting out the tough reality of a unique situation, including Henry, 96, a resident of Grand Oaks Assisted Living Community in Washington, D.C. Initially he was doing well while waiting out the pandemic. Then, over the summer, his closest friend died from non-Covid-19 causes.

Now he feels isolated and alone. His closest relatives and friends live in England and in other parts of the United States, and the pandemic has kept them from visiting him. Even if they could, they would have to talk to him through a window overlooking the courtyard.

For social interaction, he depends on phone calls and visits to the street, where he can interact with strangers walking by. “I wish I could have closer contact with some people,” said Henry who, due to the nature of his career in government, didn’t want his last name published. “The isolation is inevitable, so you have to adjust to it. That’s what I’m doing.”

Emily Sohn is a freelance journalist in Minneapolis.

This Is Your Skin on Stress

Skin deep

This Is Your Skin on Stress

Psychological strain can show up as “stress skin.” Treating it is easier (and more affordable) than you think.

Credit…Chloe Zola


  • Dec. 8, 2020, 4:00 p.m. ET

It starts in utero.

A mass of cells divides and develops, splits and stretches, and from a single layer of embryonic tissue, two seemingly separate but inherently interconnected systems are born: the brain and the skin.

They are bound for life. When one senses embarrassment, the other blushes. When one senses pain, the other processes it. And when one bears the burden of a pandemic, political unrest, systemic racism and the ever worsening effects of climate change … well, the other gets a pimple.

Or perhaps, depending on your genetic predispositions, it’s not a pimple but an eczema outbreak. A psoriasis flare-up. A bout of rosacea. A dehydrated, dull, oily or even — gasp — older-looking appearance. General blahness, if you will.

This is your skin on stress.

“There are two different types of stress: acute stress and chronic stress,” said Dr. Whitney Bowe, a dermatologist and the author of “The Beauty of Dirty Skin.” A quick surge of stress can be a good thing. It may heighten your senses, enhance mental clarity and help create collagen to facilitate wound repair. It’s there and it’s gone.

It’s the chronic, continuing stress, the kind that every sentient being is likely experiencing right now, that takes a toll on the skin.

It takes a toll on the entire being, of course, and a compromised complexion is the least of its consequences. But “the skin is the organ that we see,” as Dr. Loretta Ciraldo, a dermatologist and founder of the Dr Loretta skin-care line, put it. And in a society where unsustainable stress is not only the norm, but sometimes a celebrated sign of success, what better way for the subconscious to cry out than “stress skin”? (It is, after all, easier to ignore your feelings than your face.)

Here’s How Stress Affects Your Skin

Much of the skin-psyche connection comes down to the overproduction of cortisol, the primary stress hormone, and its effect on the skin barrier.

“The barrier traps moisture in and keeps allergens, irritants and pollutants out,” Dr. Bowe said. It effectively does the job of most skin-care products on the market, sans products, and needs three things in order to thrive: oil, water and the microbiome. Cortisol depletes them all.

During times of stress, cortisol slows the production of beneficial oils. “We get dry, rough and much more irritated because those healthy oils act as a protective layer for us,” Dr. Ciraldo said. Without adequate lipids to seal in hydration, the skin starts to “leak” water in a process known as transepidermal water loss (TEWL).

At the same time, cortisol stimulates the overproduction of sebum, the oil that is implicated in acne. “So for many of us, our skin seems more oily when we’re under stress, and it’s more acne prone,” she said.

All of this alters the skin’s pH, which compromises the acid mantle and creates an inhospitable environment for the one trillion symbiotic micro-organisms that exist on and in the skin barrier — a.k.a., the microbiome.

Under ideal conditions, the microbiome renders topical skin care all but superfluous. There are microbes that feed off sebum, which helps sustain healthy oil levels. There are microbes that feed off dead skin cells — the original exfoliators! There are microbes that produce peptides and ceramides, two buzzed-about beauty ingredients that keep skin firm and moisturized. There are microbes that offer protection from pollution, sunlight and invading pathogens.

“If you’re not producing enough of those healthy fats and not maintaining a healthy barrier, though, you’re altering the terrain on which these microbes grow and thrive,” Dr. Bowe said. “Imagine stripping the soil of all the nutrients and seeing if your vegetable garden is going to grow. It’s the same for the skin.”

In turn, the microbiome may experience an overgrowth of so-called bad bacteria (like C. acnes, the strain associated with acne) and a dearth of good bacteria. The microbiome becomes more prone to infection, irritation, inflammation and hyperpigmentation. It becomes more sensitive to outside aggressors, like the free radicals generated by pollution.

Stress prompts the body to produce internal free radicals, as well. “You can think of free radicals like little missiles,” Dr. Bowe said, in that they target cells for destruction and cause oxidative stress. When free radicals target DNA, it leads to skin cancer. When free radicals target elastin and collagen, it leads to fine lines and wrinkles. When free radicals target lipids, it leads to dehydration and skin barrier damage and acne.

Chronic exposure to cortisol also inhibits the production of hyaluronic acid and collagen. “These are what keep the skin plump and youthful,” Dr. Bowe said. “When you can’t make enough, the skin gets thinner.”

Sadly, hyaluronic acid serums and collagen creams can’t counteract cortisol. Topical ingredients don’t serve the same biological purpose as those produced in the body and rarely penetrate to the lower layer of the dermis, where collagen and hyaluronic acid naturally occur.

In fact, skin-care products aren’t the answer to stress skin at all.

“Most products are meant for consumers who have a healthy skin barrier,” said Ron Robinson, a cosmetic chemist and founder of BeautyStat Cosmetics. Exposing an already broken barrier to active ingredients — or too many ingredients — only exacerbates existing issues.

For this reason, Dr. Ciraldo recommends removing barrier-degrading ingredients like glycolic acid, salicylic acid, benzoyl peroxide and retinol from your stress skin routine. “They are very drying, and they really do deplete the normal, healthy barrier function,” she said.

Dr. Bowe advises that you avoid any leave-on products with essential oils in them, because they can cause irritation. “A lot of people think they’re calming and soothing, but for the skin, that’s not the case,” she said.

Exceptions can be made for barrier-boosting ingredients, like glycolipids (found in Dr Loretta Intense Replenishing Serum), fatty acids (found in Symbiome Respond Postbiomic Oil) and ceramides (found in BeautyStat Pro-Bio Moisture Boost Cream).

To Heal Stress Skin, Address the Stress. Here’s How.

Managing stress may seem nearly impossible, considering that so many modern stressors are systemic. Yet according to Dr. Heather Woolery-Lloyd, a dermatologist, “90 percent of our stress is not the stressor itself, but how we deal with that stressor.”

In other words: While meditation can’t mitigate global warming, it can, at the very least, clear your complexion.

Meditating, Dr. Woolery-Lloyd said, initiates “the relaxation response,” which activates the body’s parasympathetic nervous system and decreases cortisol and inflammation. With consistent practice, the skin barrier can stop leaking and start locking in moisture, suggesting that the fabled inner glow is less symbolic than scientific.

Dr. Ciraldo tells her patients to think of meditation as “The Life-Changing Magic of Tidying Up” for the mind. “Try to find a spot when you’re going to sit quietly for 20 minutes a day and really go through your thoughts like you would your closet,” she said. “If something comes into your mind that doesn’t give you joy, put energy into discarding that thought.”

Not into meditation? No matter. Breathing, which may beat drinking water as the most eye-rollingly simple yet undeniably effective skin-care tip, is enough. Research from Dr. Herbert Benson at Harvard Medical School shows that taking slow, deep breaths triggers the relaxation response and, Dr. Bowe said, “can stop psychological stress from being translated to physical inflammation in the skin.” Breath work classes, like those offered on the holistic healing hub ALTYR, can help with technique.

“Do not put on CNN with John King up there five minutes before bed,” Dr. Ciraldo said, which is to say, beware the blue light emitted from electronics. It interrupts your circadian rhythm and leads to lower-quality sleep, which is linked to increased cortisol, free radical damage and inflammation.

“Something as simple as sleep can change the skin barrier,” Dr. Woolery-Lloyd said.

To address and prevent free radical damage, fill your plate with antioxidants, which stabilize these unstable molecules to leave skin clearer, calmer, brighter and more even toned. Vitamins A and C (abundant in fruits and vegetables), lycopene (found in tomatoes), astaxanthin (salmon) and polyphenols (green tea, dark chocolate) are all great options, according to Dr. Bowe.

Exercise increases antioxidants, as well. (Behold, the body produces yet another popular skin-care ingredient on its own.) It lowers cortisol levels, meaning fewer breakouts and a stronger skin barrier. And if you’re exercising outdoors? Even better.

“I’m a big believer in the healing power of nature,” Dr. Woolery-Lloyd said. “People say, ‘I don’t have the time,’ but it doesn’t have to be this drawn out thing. Just going outside and seeing a tree and looking at a few birds is proven to lower inflammatory markers in our body.”

If all else fails, cry.

“Crying is a stress reliever and helps decrease cortisol levels,” said Dr. Purvisha Patel, a dermatologist and the founder of Visha Skincare. “This can result in fewer breakouts.” She notes that orgasms have a similar effect on cortisol (and are, by all accounts, more enjoyable).

“This isn’t B.S.,” Dr. Ciraldo said. “These are things we can do for our skin and ourselves that don’t cost anything, but the reward is great.”

A Rare Pandemic Silver Lining: Mental Health Start-Ups

A Rare Pandemic Silver Lining: Mental Health Start-Ups

Using teletherapy, metrics and matching algorithms, entrepreneurs are focusing on addressing aspects of the mental health care system that they view as broken.

Credit…Romy Blümel


  • Dec. 7, 2020, 5:00 a.m. ET

Ariela Safira was on a mission. Shaken by the attempted suicide of a friend during her freshman year at Stanford University in 2013, Ms. Safira sought to understand the opaque mental health care system. She soon learned of the shortage of qualified therapists and, even where they are more plentiful, of the hurdles to obtaining care. Although a computer science and math major, she eventually enrolled in a clinical psychology graduate program at Columbia University.

But she kept coming back to a fundamental view: that there is often a mismatch between need and services, an essential supply-and-demand question. “It’s very difficult to start and keep up a therapy business,” Ms. Safira said. “It’s a 10-person job, not a one-person job, from marketing yourself, doing your own financing and managing your own rent. But even before you get to a place where you manage all those things, what’s so challenging is making a name for yourself so that people want to go to you.”

And so, in 2019, she founded Real Therapy, a small business designed to tackle mental health and overall wellness by easing access and offering a range of services to answer clients’ needs.

Driven by personal experience — and further motivated by the pandemic, which has caused an increase in anxiety and depression among the general population, including among young adults — entrepreneurs like Ms. Safira are focusing on addressing aspects of the mental health care system that they view as broken. They seem undeterred by the complicated nature of that system: a byzantine insurance process, a wide range of provider types, and elusive fits between patient and therapist.

“It’s a crowded space,” Alex Katz, the founder of Two Chairs, which opened its doors with a single clinic in San Francisco in 2017, said of the mental health start-up scene. Nonetheless, he said, “because the problems are massive, we need a lot of great companies working in innovative ways to address the different populations, diagnoses and delivery of care.”

Mr. Katz, another Stanford graduate, began working at Palantir, the data analytics and software company, but sought to understand mental health services when his partner “was going through a tough time in her life.” He eventually quit his job and began to tap into his network of friends and family to understand the mental health care system.

He soon learned that one of the system’s biggest challenges was matching a therapist with a patient, something he thought technology could solve. Yet, after interviewing clinicians, he chose to start a physical clinic, rather than a virtual one. In trying to raise funds for his fledgling business, “I joke that I had three strikes against me: I was a first-time, solo founder of a bricks-and-mortar company in health care.” But from its inception, Two Chairs has relied on technology, using a frequently updated proprietary algorithm to match client and therapist after a prospective client’s first intake meeting.

Although both Ms. Safira and Mr. Katz initially focused on in-person care, with virtual therapy as a long-term goal, they had no choice but to change direction once the pandemic hit. Ms. Safira and her small team quickly had to shift from the Manhattan space they carefully designed and renovated, but never opened, to go completely remote. Within eight long days, she produced a remote platform to provide five types of services, largely group-oriented (one-on-one sessions will wait until the in-person location opens). Mr. Katz — whose company had grown to seven locations in the Bay Area, with a new one set to open in Los Angeles next year — also made the decision in March to continue his business by going fully virtual.

Because both had planned, eventually, to offer remote services, they already knew that the efficacy of remote sessions was already proven. David Mohr, the director of the Center for Behavioral Intervention Technologies at Northwestern University’s Feinberg School of Medicine, who has studied the issue, said that researchers had long found that teletherapy could be as effective as in-person therapy.

“There are no substantial differences in outcomes between remote and face-to-face” therapy, he said, adding that a remote option can solve issues of distance and time constraints that often discourage people from seeking therapy. (Dr. Mohr, through his work at Northwestern, is the principal investigator for IntelliCare, a university program that provides pre-therapy tools for anxiety and depression.) Practitioners have been resistant to this change, but the pandemic has forced their hands.

“We are at an inflection point,” he said. “There is a greater acceptance of the use of technology in mental health care, while at the same time there is a tremendous decrease in the stigma” that had been associated with emotional problems.

Like Ms. Safira, it was personal experience that propelled Kyle Robertson to explore a platform for virtual therapy. The son of a psychiatrist and therapist, Mr. Robertson had difficulty finding help in dealing with his own depression and anxiety while a student at Wharton School of the University of Pennsylvania. He said his parents were hands-off but “definitely pushed early on for making sure that there was integration across medication and therapy,” which they all viewed as sometimes lacking in current practice, whether remote or in-person (only psychiatrists can prescribe medication).

After running a beta test of roughly 100 users at the end of 2019, he co-founded Cerebral in 2019. His timing, of course, proved prescient, and he has secured significant venture funding as well an uptick in clients throughout the year.

As with Two Chairs, Cerebral clients can schedule individual therapy, though group sessions are not yet available. The platform asks clients to keep track of their symptoms and report them monthly. Those responses can trigger a notification to the clinician to alert them if there is any worsening of conditions. If someone doesn’t respond, then someone on the team will reach out to check in, Mr. Robertson said.

All three companies seek to provide access quickly — the first interviews can be the same day after a client has signed up, in an effort to pre-empt mental health emergencies. The goal, Mr. Robertson said, is for new clients to speak to someone “within 10 minutes, something we’re able to do with a network of clinicians across geographies.” (Some of the regulations regarding licensing have been relaxed during the pandemic to enable telemedicine across all specialties, not just mental health care.)

And though these providers must comply with the stringent privacy laws that govern medical care, they are able to use data that they gather to analyze outcomes. “It’s been hard to aggregate data and use it in an effective way in the past,” Mr. Robertson said. “Many therapists are in the equivalent of mom-and-pop shops who don’t have the resources, or the time, to analyze the data.”

The three entrepreneurs are all working with insurance companies to have their services covered. Ms. Safira said that clients could use funds in their health savings or flexible spending accounts, and Mr. Robertson is negotiating with insurers. Mr. Katz said that while his company’s services have been out of network, “we will begin working with insurance companies more broadly in 2021.”

Their platforms welcome all ages. Mr. Robertson says that though some older clients seem less comfortable with the remote format, there are many who adapt.

Ultimately, all three companies hope to connect clients with the right type of therapy and to possibly contribute to the understanding of how to make a match.

“There’s not much research on how to make a match, but there’s a lot that speaks about the importance of the alliance” between therapist and patient, Mr. Katz said. “At the end of the day, if you form a great bond, the quality of care is so much higher.”

Yes, Many of Us Are Stress-Eating and Gaining Weight in the Pandemic

Yes, Many of Us Are Stress-Eating and Gaining Weight in the Pandemic

A global study confirms that during the pandemic, many of us ate more junk food, exercised less, were more anxious and got less sleep.

Credit…Lorenzo Gritti
Anahad O’Connor


  • Dec. 4, 2020, 5:00 a.m. ET

Not long ago, Stephen Loy had a lot of healthy habits. He went to exercise classes three or four times a week, cooked nutritious dinners for his family, and snacked on healthy foods like hummus and bell peppers.

But that all changed when the pandemic struck. During the lockdowns, when he was stuck at home, his anxiety levels went up. He stopped exercising and started stress eating. Gone were the hummus and vegetables; instead, he snacked on cookies, sweets and Lay’s potato chips. He ate more fried foods and ordered takeout from local restaurants.

“We were feeding the soul more than feeding the stomach,” said Mr. Loy, 49, who lives in Baton Rouge and is the executive director of a tech incubator. “We were making sure to eat things that made us feel better — not just nutritional items.”

Now a global survey conducted earlier this year confirms what Mr. Loy and many others experienced firsthand: The coronavirus pandemic and resulting lockdowns led to dramatic changes in health behaviors, prompting people around the world to cut back on physical activity and eat more junk foods. It drove anxiety levels higher and disrupted sleep. And those who are obese, who already face increased health risks, may have fared the worst, the researchers found. While they tended to experience improvements in some aspects of their diets, such as cooking at home more and eating out less, they were also the most likely to report struggling with their weight and mental health.

The findings, published in the journal Obesity, offer a cautionary lesson for many of us as coronavirus cases continue to surge and renewed calls for lockdowns and other restrictions again take hold. With months to go before a vaccine becomes widely available and we can safely resume our pre-pandemic routines, now might be a good time to assess the healthy habits we may have let slip and to find new ways to be proactive about our physical and mental health.

The study, carried out by researchers at the Pennington Biomedical Research Center in Louisiana, surveyed almost 8,000 adults across the globe, including people from 50 different countries and every state in America. The researchers found that the decline in healthy behaviors during the pandemic and widespread lockdowns was fairly common regardless of geography.

“Individuals with obesity were impacted the most — and that’s what we were afraid of,” said Emily Flanagan, an author of the study and postdoctoral fellow at the Pennington Biomedical Research Center. “They not only started off with higher anxiety levels before the pandemic, but they also had the largest increase in anxiety levels throughout the pandemic.”

The findings shed light on exactly how people altered their routines and behaviors in response to the lockdowns that were implemented in countries around the world this year to slow the spread of the virus. The pandemic disrupted everyday life, isolated people from friends and family, and spawned an economic crisis, with tens of millions of people losing jobs or finding their incomes sharply reduced.

Dr. Flanagan and her colleagues assumed many people were experiencing enormous levels of stress. But they were not sure how the pandemic and stay-at-home orders were impacting how people slept, how much they exercised and what they ate. So they designed an extensive survey and recruited people on social media to answer questions about how their mental and physical health had been affected.

“This was such a drastic and abrupt change to everyone’s daily life that we needed to see what was going on,” said Dr. Flanagan. “We wanted to put some data to the anecdotal behaviors we were seeing.”

From April through early May, about 7,750 people, most of them from the United States but also from countries such as Canada, Australia and Britain, completed the survey. The average age of the respondents was 51, and a majority were women. Based on their body mass indexes, about a third of the people were overweight, a third were obese, and a third were considered normal weight.

The researchers found that most people became more sedentary, which they said was probably related to less daily commuting and more time spent indoors. But even when people did engage in structured exercise, it tended to be at lower intensity levels compared to before the pandemic. Many people also said they had given in to their food cravings: Consumption of sugar sweetened beverages and other sugary snack foods, for example, went up.

That might explain another finding: About 27 percent of people said they had gained weight after the initial lockdowns went into effect. The figure was even higher among people classified as obese: About 33 percent said that they had gained weight, compared to 24.7 percent of people considered normal weight. People who gained weight also had the largest declines in physical activity.

There were some bright spots in the findings. About 17 percent of the study population actually lost weight during the pandemic; perhaps not surprisingly, they tended to be people who increased their physical activity levels and improved their diets. And despite snacking on more junk foods, many people showed an increase in their “healthy eating scores,” a measure of their overall diet quality, which includes things like eating more fruits and fewer fried foods. The researchers said that the overall improvements in diet appeared to be driven by the fact that the lockdowns prompted people to cook, bake and prepare more food at home. Other recent surveys have also shown a sharp rise in home cooking and baking this year, with many people saying they are discovering new ingredients and looking for ways to make healthier foods.

But social isolation can take a toll on mental wellness, and that was evident in the findings. On average, people reported significantly higher anxiety levels. About 20 percent said that their symptoms, such as experiencing dread and not being able to control or stop their worrying, were severe enough to interfere with their daily activities. About 44 percent of people said that their sleep had also worsened during the pandemic. People on average reported going to bed about an hour later than usual and waking up roughly an hour later than usual. Only 10 percent of people said that their sleep had improved since the pandemic began.

The greatest spikes in anxiety occurred among people who are obese. It was unclear why exactly, but one reason may have been concerns about the virus. The survey took place at a time when studies were first beginning to show that excess weight puts people at a much higher risk of being hospitalized with Covid-19. “We don’t have data to back this up, but our hypothesis is there was a lot more anxiety about their own health,” Dr. Flanagan said. “A heightened fear of the virus would most certainly increase their anxiety levels.”

Dr. Flanagan said it was perhaps not surprising that people tended to engage in less healthful habits during the pandemic, as so many aspects of health are intertwined. Stress can lead to poor sleep, which can cause people to exercise less, consume more junk foods, and then gain weight, and so on. But she said she hoped that the findings might inspire people to take steps to be more proactive about their health, such as seeking out mental health specialists, prioritizing sleep and finding ways to exercise at home and cook more, in the event of future lockdowns.

“Being aware of how our health behaviors change during these stay-at-home orders could help us combat that if another lockdown is enforced,” she said. “Being aware is really the No. 1 thing here.”

‘Nobody Sees Us’: Testing-Lab Workers Strain Under Demand

April Abbott, director of microbiology at Deaconess Hospital in Evansville, Ind., a mother of three who keeps a bed in her office for when her duties keep her overnight. “There is always more work to be done than the hours to do it in,” she said.
April Abbott, director of microbiology at Deaconess Hospital in Evansville, Ind., a mother of three who keeps a bed in her office for when her duties keep her overnight. “There is always more work to be done than the hours to do it in,” she said.Credit…Kaiti Sullivan for The New York Times

‘Nobody Sees Us’: Testing-Lab Workers Strain Under Demand

Laboratory technologists have been working nonstop to help the nation diagnose an ever-growing number of coronavirus cases.

April Abbott, director of microbiology at Deaconess Hospital in Evansville, Ind., a mother of three who keeps a bed in her office for when her duties keep her overnight. “There is always more work to be done than the hours to do it in,” she said.Credit…Kaiti Sullivan for The New York Times

Katherine J. Wu


  • Dec. 3, 2020, 5:00 a.m. ET

In March, April Abbott dragged a hospital bed into her office at Deaconess Hospital in Evansville, Ind. In the nine months since, she has slept in it a half-dozen times while working overnight in her clinical microbiology laboratory, where a team of some 40 scientists toils around the clock running coronavirus tests.

These all-night stints in the lab pull Dr. Abbott, the director of microbiology at Deaconess, away from her husband and three children, the oldest of whom is 8. A couple of times a week, she heads home for dinner, then drives back to work after the kids have gone to bed. She is at the lab when machines break. She is there to vet testing protocols for the lab. She is there when new testing sites open, flooding the lab with more samples to process.

“I do it because there is always more work to be done than the hours to do it in,” she said.

Nearly a year into a pandemic that has claimed more than 272,000 American lives, some 192 million tests for the coronavirus have been processed nationwide. Millions more will be needed to detect and contain the virus in the months ahead. Behind these staggering figures are thousands of scientists who have been working nonstop to identify the coronavirus in the people it infects.

Across the nation, testing teams are grappling with burnout, repetitive-stress injuries and an overwhelming sense of doom. As supply chains sputter and laboratories rush to keep pace with diagnostic demand, experts warn that the most severe shortage stymieing America’s capacity to test is not one that can be solved by a wider production line or a more efficient machine. It is a dearth of human power: the dwindling ranks in a field that much of the public does not know even exists.

When shortages arise, “there’s workarounds for almost everything else,” said Karissa Culbreath, the medical director and infectious disease division chief at TriCore Reference Laboratories in New Mexico. “But people are irreplaceable.”

In the absence of trained workers to process and analyze the nation’s tests, America’s diagnostic infrastructure will not merely wrinkle and slow, experts said. It will collapse.

“Doctors and nurses are very visible, but we work behind the scenes,” said Marissa Larson, a medical laboratory scientist supervisor at the University of Kansas Health System. “And we are underwater.”

‘I don’t even know where to start’

Darcy Velasquez, a medical technologist at Children’s Hospital Colorado in Aurora, begins her shifts at 5:30 a.m. with a refrigerator of up to 500 tubes, trying to clear a backlog before another shipment arrives at 8 a.m.
Darcy Velasquez, a medical technologist at Children’s Hospital Colorado in Aurora, begins her shifts at 5:30 a.m. with a refrigerator of up to 500 tubes, trying to clear a backlog before another shipment arrives at 8 a.m.Credit…Matthew Staver for The New York Times

The gold standard in coronavirus diagnostics hinges on a decades-old laboratory method called polymerase chain reaction, or P.C.R. The method is a signal amplifier: It can copy genetic material, including fragments of the genome of the coronavirus, over and over until it reaches detectable levels, making the virus discoverable even when it is extremely scarce in the body. P.C.R. is the metric against which all new testing techniques are compared; in the diagnostic landscape, few can match its ability to root out infection.

But such accuracy comes at a cost. Even highly automated forms of P.C.R. require people to handle tubes, babysit machines and scrutinize ambiguous results.

P.C.R.-based coronavirus tests also deal in DNA, the molecular language in which the human genome is written. The coronavirus, however, stores its genetic information in a close cousin called RNA, which must first be carefully extracted from virus particles, then converted to its more testable counterpart before diagnostics can proceed.

When laboratories are well stocked, P.C.R. diagnostics can run from start to finish in just a few hours. But since the spring, laboratories around the country have been hamstrung by severe, often unpredictable shortages of chemicals and plasticware needed for these protocols.

And caseloads have skyrocketed; America’s testing capacity has increased since March, but it has been vastly overtaken by the demand for tests.

“The spring pales in comparison to what we are experiencing now,” said Dr. Culbreath, of TriCore, which has run more than 600,000 coronavirus tests.

Amid the pandemonium, labs must still work through their queues for other infectious disease tests, including for sexually transmitted infections. “Labs are trying to maintain our standard of operation with everything else, with a pandemic on top of it,” Dr. Culbreath said.

Darcy Velasquez, a medical technologist at Children’s Hospital Colorado in Aurora, where cases continue to surge, is fighting to keep pace with some of her institution’s highest sample volumes yet. Her shifts in the lab begin at 5:30 a.m., sometimes to a double-door refrigerator already brimming with 500 tubes, each containing a fresh patient swab and a small volume of liquid — more than a full day’s work for one person.

Ms. Velasquez typically spends the first couple hours of her day frantically trying to clear as much of the backlog as she can before another batch arrives around 8 a.m., when the local clinic opens.

As much as an hour of that time might be spent simply de-swabbing samples: manually unscrewing and rescrewing caps and plucking out swabs, all without contaminating one sample with the contents of another.

“Sometimes you walk into these refrigerators full of specimens and you think, ‘I don’t even know where to start,’” Ms. Velasquez said.

Taylor Smith, a virologist and technologist for the Georgia Department of Public Health, with her dog, Spunk.Credit…Johnathon Kelso for The New York Times

At Georgia’s state public health laboratory, direct handling of patient samples must be done with extra safeguards to minimize the chances of exposing personnel to infectious virus. Taylor Smith, a virologist and technologist at the lab, spends a large fraction of her workday in a full-body gown, sleeve covers, two pairs of gloves, an N95 respirator and goggles.

Simply donning it all is exhausting. And although Ms. Smith has long been deft with lab instruments, the work always feels high-stakes, she said: “You’re constantly thinking about how to not contaminate yourself.”

To keep their experiments running, lab workers must be proficient mechanics. The instruments needed for diagnostic tests were not built to run continuously for months on end. But as more facilities transition to 24/7 testing, malfunctions and breakdowns have become more common, requiring people to fix them.

Tyler Murray, a clinical laboratory scientist at the University of Texas Medical Branch in Galveston, spends his days listening for telltale alarms — a sign that one of his instruments has failed or is low on chemical ingredients.

“I make sure I talk nicely to them,” Mr. Murray said of the lab’s machines, which he decorates with gleaming gold stars when they perform at their best. “I say, ‘Hey bud, you worked hard this week, I’m proud of you.’”

But morale is low among the humans. After 10-hour shifts at U.T.M.B., Mr. Murray heads home and lies on the floor beside his two cats, Arya and Cleo. “The fatigue builds,” he said. “You can’t help but feel it.”

Tyler Murray, a clinical laboratory scientist at the University of Texas Medical Branch in Galveston, with Cleo, one of his two cats.Credit…Go Nakamura for The New York Times

The invisible work force

The monotonous motions that lab workers engage in daily take a physical and mental toll. Technologists are nursing repetitive-use injuries, a result of hours of maneuvering tubes and pipettes, which take up and dispense liquids with the press of a plunger. Workers must also be vigilant sanitizers, pausing regularly to swap out soiled gloves, clear their workspaces of plastic debris and scour surfaces with harsh chemicals that leave their clothes freckled with stains.

“We’re accustomed to holding things up in the background,” said Natalie Williams-Bouyer, the director of the division of clinical microbiology at the University of Texas Medical Branch in Galveston. “We enjoy doing it because we know we’re helping people.”

But the enduring anonymity of testing labs has begun to splinter some spirits. Elizabeth Stoeppler, a senior medical technologist in the molecular microbiology lab at the University of North Carolina’s School of Medicine, said that an old volleyball injury, which inflamed a tendon in her elbow years ago, had flared up after months of long stints in the lab. A few of her co-workers are wrestling with carpal tunnel syndrome.

The strain has begun to affect Ms. Stoeppler outside of the lab. She bolts awake at 3 a.m., panicked about the previous day’s work. She recently started a prescription medication to improve her chances of getting a full night’s sleep.

“There’s signs everywhere that say, ‘Heroes work here,’” she said of her hospital. She loves her job, she added. “But nobody sees us. We’re just in the basement, or in the back.”

On a good day in a diagnostics lab, the phone might ring only a few times, with messages from clinicians inquiring about samples. But when “things are going poorly, it just rings off the hook,” said Rachael Liesman, the director of clinical microbiology at the University of Kansas Health System, where she frequently clocks 15-hour shifts.

To keep the lab on track, Dr. Liesman has put in some hours running tests herself — a task that is not a part of her normal job description. “It’s very strange to have your director on the bench,” said Ms. Larson, a supervisor in the lab. “When you see that, some flare guns should be going up.”

Marissa Larson, left, a medical laboratory scientist supervisor at the University of Kansas Health System, and Rachael Liesman, its director of clinical microbiology.Credit…Barrett Emke for The New York Times

In mid-November, Dr. Liesman’s lab suffered a three-day stretch during which a supply of chemicals nearly ran dry on a Friday, then a pair of machines failed on Saturday and Sunday.

“We were basically drowning in specimens” by Monday, she said. “I was paged by three different providers while brushing my teeth.”

Morale in the labs has flagged as the country continues to shatter records for caseloads, hospitalizations and deaths. The nation’s testing experts know these statistics better than anyone: They count the numbers themselves, sample by sample. But they are also easy targets of criticism and complaint.

“There is always this undercurrent of, it’s never good enough,” said Dr. Abbott, of Deaconess Hospital in Indiana. “It’s devastating. We’re working as hard as we can.”

Chelsa Ashley, a medical laboratory scientist at Deaconess, aches to be home with her three children, to whom she is a single mother, after 13-hour shifts in the lab. Once there, she struggles to leave her work behind.

“There’s that panicked feeling that I should have stayed to take care of our community samples,” she said. “There’s guilt, when you walk away.”

In the past few months, Ms. Ashley’s children, who are 18, 13 and 10, have had to become substantially more self-sufficient. Shaylan, her youngest, rouses herself from bed at 5:50 a.m. every day to spend a few moments with her mother before she heads off to work.

“Even if it’s only 10 minutes, it’s 10 minutes that we talk,” Ms. Ashley said. “That is one thing that has not changed.”

‘A dying breed’

For some, the tidal wave of stress brought on by the pandemic has proved untenable. Since March, scientists have trickled out of laboratories, leaving chasms of expertise in a field that for years has struggled to recruit fresh talent.

Joanne Bartkus, the former director of the Minnesota Department of Public Health Laboratory, retired from her position in May after a dozen years on the job. She pinned one of the pandemic’s crucial inflection points to March 6, the day President Trump publicly remarked that “anybody that wants a test can get a test.”

“That was when the poop hit the fan,” Dr. Bartkus said. Within about a week, her team went from receiving fewer than a dozen coronavirus testing samples each day to being inundated with roughly 1,000 daily specimens.

It was unlike anything Dr. Bartkus had seen in her years at the institution. In 2009, the year of the H1N1 flu pandemic, Minnesota’s public health laboratory tested about 6,000 patient samples. This spring, it broke that record in a couple of weeks.

Dr. Bartkus, who is 65, had already planned to retire before the year was up. By the time April came, she had hastened her timeline to May: “It didn’t take me long before I said, ‘OK, I’m done with this.’”

In interviews, several scientists noted that they were struggling to fill vacancies in their labs, some that were left open by overwhelmed technologists who had recently quit their jobs. While the need for such workers has grown in recent years, the number of training programs that build these skill sets has dropped.

“Medical technologists are a dying breed,” Ms. Stoeppler, of the University of North Carolina, said.

Natalie Williams-Bouyer, the director of the division of clinical microbiology at the University of Texas Medical Branch in Galveston. “I hope people can see us now,” she said.Credit…Go Nakamura for The New York Times

In Indiana, Dr. Abbott, of Deaconess Hospital, said her team had already performed more than 100,000 tests for the coronavirus. But the most chaotic months are most likely still ahead.

For the first time in nine years, Dr. Abbott is doing hands-on work in the lab to help her staff cope with rising demand. She has yet to take more than a day off at a time since the pandemic’s start, but insists that she can soldier on: “This is out of the sheer will of not wanting to be beaten by this pandemic.”

In the mini-refrigerator in her office, next to rotating bags of salad greens and a small cavalry of Diet Cokes, sits an unopened bottle of champagne that she purchased in March, intending to uncork it upon reaching a worthy testing milestone. Nothing has yet felt like enough.

“I can’t tell you what will feel like a reason to celebrate at this point,” Dr. Abbott said. “Ask me after the next 100,000 tests.”

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How Teenagers Use Free Time Affects Mood


How Teens Use Downtime to Connect, Distract or Reflect

Different choices for how young people use free time lead to different kinds of relief.

Credit…Antonio Giovanni Pinna
Lisa Damour


  • Dec. 3, 2020, 5:00 a.m. ET

When pandemic-weary adolescents get to take a break, what should they do with themselves? The main aim, of course, should be to feel better after the break than before it. But different downtime choices lead to different kinds of relief. Adolescents (and adults) might want to reflect on the options for how they spend their free time — whether they’ve got 20 spare minutes today or can anticipate more unscheduled time in the weeks ahead.

Here’s a look at three ways teenagers tend to spend their downtime, and the particular benefits and challenges that come with each.

Connecting With the World Digitally

Young people often use their downtime to text with friends or check their social media accounts — and with good reason. Particularly under the restrictions of the coronavirus pandemic, teenagers rely on these platforms to connect with peers and to keep up with headlines. Spending time online might deliver the boost of an amusing exchange with a friend, a clever meme or good news about a favorite sports team. If it does, that makes for a restorative break.

But, of course, it can go another way.

Checking in on social media or the 24-hour news cycle is the psychological equivalent of sidling up to a slot machine. Hitting the jackpot — receiving digital love from a friend or finding an encouraging update about a vaccine — feels good. Pulling the lever and losing — whether that’s your messages being “left on read,” meaning the recipient doesn’t respond, or catching a depressing headline — is pretty much bound to happen from time to time.

For teenagers, especially in the context of the pandemic, turning to social media as a way to recharge can be a high-stakes gamble. Jill Walsh, a Boston University sociologist who studies technology use among adolescents, finds that having fewer in-person interactions has left many teenagers feeling “incredibly uncertain about their friendships.” Previously tolerable ambiguity in communications can now be highly distressing. Dr. Walsh notes that “getting a text that simply reads ‘k,’” — shorthand for OK that can be read as friendly, curt or angry — “can create a huge amount of emotional labor as a kid tries to figure out what it means.”

Before defaulting to downtime scrolling, teens might weigh the possibility of seeing a mood-lifting post against the chance that they’ll run into something distressing. A well-spent break should help to ease the mind; it shouldn’t open new tabs to worry over in our mental browsers.

Getting Lost in Distractions

There’s a lot to be said for taking occasional, all-consuming mental vacations, especially during a pandemic. Research on chronic stress shows that engrossing, happy distractions, such as competing in a sport or losing oneself in a movie or a book, can help young people weather persistently difficult circumstances.

Happy distractions may be a particularly apt choice when teenagers find themselves dogged by worries about school, peers, rising Covid-19 rates or anything else. Peggy Zoccola, an associate professor of psychology at Ohio University who studies the impact of stress and coping on the body, has found that ruminating over unpleasant events raises blood pressure and heart rate and triggers the ongoing release of stress hormones. Distraction, however, stops or attenuates the biological stress response. “It’s important,” she says, “to be able to recover and not always be pumping out these stress hormones.”

In fact, transporting diversions can be useful in two ways at once. According to Dr. Zoccola, they both draw our minds away from negative events that can trigger our biological stress response and at the same time pull them toward positive experiences that may prompt the release of natural mood-improving substances in the body that work much like opioids to help us feel better.

That said, it’s possible to have too much of a good thing. While pleasant distractions provide valuable mental and physiological breaks from stressful conditions, “my hesitation with recommending distraction,” Dr. Zoccola said, “is that while it can get people out of the moment, if it goes on too long, that might prevent folks from addressing an issue, or might create a new one.” Teenagers can run an easy check for themselves by asking, “Are my distractions getting in the way of what I need to do?”

Creating Space for the Mind to Wander

As a third option, young people sometimes use openings in their schedule for pursuits that are engaging, but only to a degree. Researchers use the term “soft fascination” in connection with activities that require attention but don’t entirely occupy the mind, such as spending time in nature or taking a long shower. More absorbing endeavors, such as playing a video game or solving a puzzle, recruit what’s known as “hard fascination.”

Compared to hard fascination, soft fascination uses less mental bandwidth and leaves more room for the mind to wander and reflect. Avik Basu, an environmental psychologist at the University of Michigan who researches soft fascination, explains that activities that “don’t swamp the mind” are more likely to be restorative because “a softly fascinating environment allows for reflection — and that’s when the problem-solving part of our brains can really get to work.”

In other words, soft fascination relieves stress by helping us close those mental browser tabs; unhurried reflection lets us sift through mental clutter, quiet internal noise and come up with fresh, useful solutions. According to Dr. Basu, “the ‘aha’ moments you have in your shower — that’s the problem-solving mechanism of the mind working. The answer just bubbles up!”

Unfortunately, for many young people, the pandemic has swept away previously routine occasions for soft fascination. Indeed, many of us have come to appreciate how much mental housekeeping we used to do as we made our daily commute or walked along a familiar route to work or school. Teenagers might now have to go out of their way to seek low-key activities when their minds feel cluttered. And they may need adults’ encouragement to do so, because simply going for a stroll or looking out a window can seem boring compared to the allure of online catching up or consuming distractions.

When it comes to self-restoration, we all have options — with connection, distraction and reflection being chief among them. Caring for our mental and emotional health matters now even more than usual, so it’s essential for people of all ages to take the breaks that best address the needs of the moment.

Building Emotional Safety Nets for Men

Building Emotional Safety Nets for Men

Support networks with other men can help fend off the loneliness and isolation many men experience.

Credit…Leonardo Santamaria


  • Dec. 3, 2020, 5:00 a.m. ET

On the surface, Sean Kushigian and Jeff Compton didn’t have a lot in common before the pandemic. Mr. Kushigian, a 37-year-old banking analyst and self-described “extrovert,” surrounded himself with like-minded friends who didn’t discuss their problems and such “negative” feelings as fear and sadness, he told me, because they were a form of “weakness.” Mr. Compton, a 37-year-old chief technology officer for an online retailer and self-professed introvert, loved “being a good listener for friends’ problems,” he said.

Three months into the pandemic, these men — who live in different cities and have never met — both faced a common, defining struggle. Mr. Kushigian experienced a depth of sadness and depression he had never before known, his alcohol consumption spiked and he began having suicidal thoughts. Every time Mr. Compton went into a grocery store, “I found myself weeping,” he said, because the “panic and anxiety” he read on other shoppers’ faces mirrored back his own.

Mr. Kushigian and Mr. Compton are like many of the men I interviewed for my book on the need for greater emotional resiliency in boys and men.

As both men have discovered, the solution to their loneliness and emotional isolation is something few men have but many need: emotional support networks — with each other.

It’s no coincidence that men are at the fore of the public health crises filling our newsfeeds. Think: unemployment, opiate addiction and overdose, sexual violence, alcohol-related deaths and, of course, loneliness and spikes in suicide. This was before the pandemic hit. In a 2020 meta-analysis, Indian sociologists suggested that the “excessive pressure to conform to traditional modes of masculinity increases the risk of men’s suicidal behavior” amid the profound isolation of the pandemic.

We already know that men are far less likely than women to seek mental health help when they are struggling, even though studies prove that avoiding “negative emotions” leads to symptoms of mood disorders, including depression. What we may not know: Men, it turns out, suffer from anxiety and depression far more than we realize or like to believe. The diagnostic scales commonly used speak to symptoms that typically manifest in women (e.g., sadness, sullen behavior, loss of appetite). In men, however, depression is often masked beneath greater anger and irritability, risky behaviors, alcohol and substance abuse and leaning more heavily into such sanctioned escape valves as exercise regimens and work.

A 2013 study published in JAMA Psychiatry revealed that, when metrics were used that considered these differences across gender lines, “men and women met criteria for depression in equal proportions: 30.6 percent of men and 33.3 percent of women … When alternative and traditional symptoms are combined, sex disparities in the prevalence of depression are eliminated.” Perhaps not surprisingly, even when men do seek help, they are less likely to receive “adequate follow-up care” because health care professionals often misdiagnose their symptoms. These little-known breakthroughs change the conversation.

This jibes with the findings of a 2015 survey of 1,000 men conducted by Priory, a British mental health awareness organization, which found that 77 percent of men polled suffered from anxiety and depression. Forty percent of these respondents said that mental illness undermines their performance in jobs, parenting and relationships, but it would take thoughts of suicide or self-harm for them to consider seeking help.

All of this wouldn’t be such a problem if men were as effective as women at creating social support networks that double as therapy. (The gender disparity is evident in the numbers and types of support groups on Meetup.com.) A 2018 study among 15 New Zealand men ages 20 through 40 published in the American Journal of Men’s Health observed that, while some men do have diverse social networks, compared with women they “typically have smaller social networks and less frequent exchanges of social support with family and friends.”

Many boys and men I interviewed for my book assured me they didn’t need support networks, because they had a close friend or two in whom they confided. What these boys and men ultimately sought from male friends wasn’t emotional support; they used what I call “targeted transparency” for solutions to the few, carefully vetted problems they willingly shared. The truth is, many men can count on close friends when it comes to counsel and physical safety — but not their emotional safety.

The 2016 book “The Psychology of Friendship which explores the wide-ranging role of friends in our lives, observes that boys are “trained” to follow a form of competition early on that defines their male-male friendships, discouraging honest emotional sharing “at all cost while encouraging direct competition and ‘one-upmanship.’” This ritualistic competition ultimately tends to create a profound deficit in many males, planting a deep seed of distrust in other boys and men. This is the reason Mr. Compton — as is true for most men — has more female confidantes with whom he shares his deeper emotional life. His male friends and family members “can’t be trusted,” he said, “to accept or engage with emotional honesty.” The last time he had male friends with whom he shared this kind of trust was during middle school.

The recent rise of men’s groups mirrors what researchers are discovering — that many men want safe spaces, or “containers” as groups call them, where they can practice emotional transparency and diminish their isolation, while relearning how to trust other men. The 2005 Irish study “Death Rather Than Disclosure” found that emotionally distressed young men “desperately wanted closer social connections and support from family members and friends,” but “they feared being judged as emotionally vulnerable, weak and un-masculine.” The lack of emotional networks has “negative implications for men’s social connectedness and mental well-being,” the researcher observed, putting younger men, especially, at “heightened risk of suicide.”

Mr. Compton eventually sought therapy and joined a men’s group online last spring. When the group began meeting in-person outside, his anxiety was so overwhelming he vomited before the meetings. Eventually, he shared with the group the deeper reasons for his severe reaction — the perceived threats of violence and rejection from other males whenever he revealed emotional honesty. To his surprise, one group mate texted Mr. Compton when he missed the next meeting, checking in on him and thanking him for his disclosure.

“That was powerful for me, to have another man accept my honest, deeper feelings,” he said. His isolation is gradually abating, as is his anxiety, and he’s starting to realize that his inability to “connect with other men emotionally was stunting my ability to find peace within myself.”

Mr. Kushigian also sought assistance — from a less conventional but increasingly popular outlet: online discussion forums geared toward mental health support. Online forums are “a good incremental first step toward reaching out for help,” John Naslund, an instructor in Global Health and Social Medicine at the Harvard School of Medicine, told me. “They’re great for guys to build confidence with sharing and asking questions” about their struggles.

Such platforms also offer anonymity. Early qualitative research shows that they can help men create connection and learn important coping strategies from people with similar struggles, promoting “self-seeking behavior, which is really important,” said Dr. Naslund, who studies digital mental health. He added that reputable organizations, such as the National Alliance for Mental Illness and Mental Health America, are good places to find such groups.

As for Mr. Kushigian, he spent the summer and autumn on the free platform tethr.men, which started last June and bills itself as the world’s first online peer-to-peer support group for men seeking emotional support. Matthew Zerker, the site’s founder, said it was developed in partnership with the Men’s Health Research Program at the University of British Columbia and the site HeadsUpGuys.org.

Mr. Kushigian said he now feels “much more comfortable” discussing his struggles. And he has noticed a sharp decrease in emotional isolation — in large part because of the power of commiserating with other men, something missing from his usual friendships.

“I feel like I’m never alone now,” he said.

Andrew Reiner is the author of “Better Boys, Better Men: The New Masculinity That Creates Greater Courage and Emotional Resiliency.”

Doctors and Nurses Are Running on Empty

About 2 a.m. on a sweltering summer night, Dr. Orlando Garner awoke to the sound of a thud next to his baby daughter’s crib. He leapt out of bed to find his wife, Gabriela, passed out, her forehead hot with the same fever that had stricken him and his son, Orlando Jr., then 3, just hours before. Two days later, it would hit their infant daughter, Veronica.

Nearly five months later, Dr. Garner, a critical care physician at the Baylor College of Medicine in Houston, is haunted by what befell his family last summer: He had inadvertently shuttled the coronavirus home, and sickened them all.

“I felt so guilty,” he said. “This is my job, what I wanted to do for a living. And it could have killed my children, could have killed my wife — all this, because of me.”

With the case count climbing again in Texas, Dr. Garner has recurring nightmares that one of his children has died from Covid. He’s returned to 80-hour weeks in the intensive care unit, donning layers of pandemic garb including goggles, an N95 respirator, a protective body suit and a helmet-like face shield that forces him to yell to be heard.

As he treats one patient after another, he can’t shake the fear that his first bout with the coronavirus won’t be his last, even though reinfection is rare: “Is this going to be the one who gives me Covid again?”

Frontline health care workers have been the one constant, the medical soldiers forming row after row in the ground war against the raging spread of the coronavirus. But as cases and deaths shatter daily records, foreshadowing one of the deadliest years in American history, the very people whose life mission is caring for others are on the verge of collective collapse.

In interviews, more than two dozen frontline medical workers described the unrelenting stress that has become an endemic part of the health care crisis nationwide. Many related spikes in anxiety and depressive thoughts, as well as a chronic sense of hopelessness and deepening fatigue, spurred in part by the cavalier attitudes of many Americans who seem to have lost patience with the pandemic.

“This is my job, what I wanted to do for a living. And it could have killed my children, could have killed my wife — all this, because of me,” said Dr. Orlando Garner, a critical care physician in Houston.
“This is my job, what I wanted to do for a living. And it could have killed my children, could have killed my wife — all this, because of me,” said Dr. Orlando Garner, a critical care physician in Houston.Credit…Michael Starghill Jr. for The New York Times

Surveys from around the globe have recorded rising rates of depression, trauma and burnout among a group of professionals already known for high rates of suicide. And while some have sought therapy or medications to cope, others fear that engaging in these support systems could blemish their records and dissuade future employers from hiring them.

“We’re sacrificing so much as health care providers — our health, our family’s health,” said Dr. Cleavon Gilman, an emergency medicine physician in Yuma, Ariz. “You would think that the country would have learned its lesson” after the spring, he said. “But I feel like the 20,000 people that died in New York died for nothing.”

Many have reached the bottom of their reservoir, with little left to give, especially without sufficient tools to defend themselves against a disease that has killed more than 1,000 of them.

“I haven’t even thought about how I am today,” said Dr. Susannah Hills, a pediatric head and neck surgeon at Columbia University. “I can’t think of the last time somebody asked me that question.”

Dreading the darkness of winter

For Dr. Shannon Tapia, a geriatrician in Colorado, April was bad. So was May. At one long-term care facility she staffed, 22 people died in 10 days. “After that number, I stopped counting,” she said.

A bit of a lull coasted in on a wave of summer heat. But in recent weeks, Dr. Tapia has watched the virus resurge, sparking sudden outbreaks and felling nursing home residents — one of the pandemic’s most hard-hit populations — in droves.

“This is much, much worse than the spring,” Dr. Tapia said. “Covid is going crazy in Colorado right now.”

Dr. Tapia bore witness as long-term care facilities struggled to keep adequate protective equipment in stock, and decried their lack of adequate tests. As recently as early November, diagnostic tests at one home Dr. Tapia regularly visits took more than a week to deliver results, hastening the spread of the virus among unwitting residents.

Some nursing home residents in the Denver area are getting bounced out of full hospitals because their symptoms aren’t severe, only to rapidly deteriorate and die in their care facilities. “It just happens so fast,” Dr. Tapia said. “There’s no time to send them back.”

The evening of Nov. 17, Dr. Tapia fielded phone call after phone call from nursing homes brimming with the sick and the scared. Four patients died between 5 p.m. and 8 a.m. “It was the most death pronouncements I’ve ever had to do in one night,” she said.

Before the pandemic, nursing home residents were already considered a medically neglected population. But the coronavirus has only exacerbated a worrisome chasm of care for older patients. Dr. Tapia is beleaguered by the helplessness she feels at every turn. “Systematically, it makes me feel like I’m failing,” she said. “The last eight months almost broke me.”

At the end of the summer, Dr. Tapia briefly considered leaving medicine — but she is a single parent to an 11-year-old son, Liam. “I need my M.D. to support my kid,” she said.

Dr. Shannon Tapia, a geriatrician based in Denver, mourns the nursing home residents she cares for. “It just happens so fast,” Dr. Tapia said of patients whose conditions deteriorated after being discharged from hospitals. “There’s no time to send them back.”Credit…Daniel Brenner for The New York Times

It goes on and on and on

For others, the slog has been relentless.

Dr. Gilman, the emergency medicine physician in Yuma, braced himself at the beginning of the pandemic, relying on his stint as a hospital corpsman in Iraq in 2004.

“In the military, they train you to do sleep deprivation, hikes, marches,” he said. “You train your body, you fight an enemy. I began running every day, getting my lungs strong in case I got the virus. I put a box by the door to put my clothes in, so I wouldn’t spread it to my family.”

The current crisis turned out to be an unfamiliar and formidable foe that would follow him from place to place.

Dr. Gilman’s first coronavirus tour began as a resident at New York-Presbyterian at the height of last spring. He came to dread the phone calls to families unable to be near their ailing relatives, hearing “the same shrill cry, two or three times per shift,” he said. Months of chaos, suffering and pain, he said, left him “just down and depressed and exhausted.”

“I would come home with tears in my eyes, and just pass out,” he said.

The professional fallout of his Covid experience then turned personal.

Dr. Gilman canceled his wedding in May. His June graduation commenced on Zoom. He celebrated the end of his residency in his empty apartment next to a pile of boxes.

“It was the saddest moment ever,” he said.

Within weeks, he, his fiancée, Maribel, their two daughters and his mother-in-law had relocated to Arizona, where caseloads had just begun to swell. Dr. Gilman hunkered down anew.

They have weathered the months since in seclusion, keeping the children out of school and declining invitations to mingle, even as their neighbors begin to flock back together and buzz about their holiday plans.

There are bright spots, he said. The family’s home, which they moved into this summer, is large, and came with a pool. They recently adopted a puppy. Out in the remoteness of small-town Arizona, the desert has delighted them with the occasional roadrunner sighting.

Since the spring, Dr. Gilman has become a social media tour de force. To document the ongoing crisis, he began publishing journal entries on his website. His Twitter wall teems with posts commemorating people who lost their lives to Covid-19, and the health workers who have dedicated the past nine months to stemming the tide.

It’s how he has made sense of the chaos, Dr. Gilman said. What he’s fighting isn’t just the virus itself — but a contagion of disillusionment and misinformation, amid which mask-wearing and distancing continue to flag. “It’s a constant battle, it’s a never-ending war,” he said.

Reaching the breaking point

Nurses and doctors in New York became all too familiar with the rationing of care last spring. No training prepared them for the wrath of the virus, and its aftermath. The month-to-month, day-to-day flailing about as they tried to cope. For some, the weight of the pandemic will have lingering effects.

Shikha Dass, an emergency room nurse at Mount Sinai Queens, recalled nights in mid-March when her team of eight nurses had to wrangle some 15 patients each — double or triple a typical workload. “We kept getting code after code, and patients were just dying,” Ms. Dass said. The patients quickly outnumbered the available breathing support machines, she said, forcing doctors and nurses to apportion care in a rapid-fire fashion.

“We didn’t have enough ventilators,” Ms. Dass said. “I remember doing C.P.R. and cracking ribs. These were people from our community — it was so painful.”

“We’re there to save a person, save a life, stabilize a person so they can get further management,” said Shikha Dass, an emergency room nurse at Mount Sinai Queens. “And here I am, not able to do that.”Credit…Kholood Eid for The New York Times

Ms. Dass wrestled with sleeplessness and irritability, sniping at her husband and children. Visions of the dead, strewn across emergency room cots by the dozens, swam through her head at odd hours of the night. Medical TV dramas like Grey’s Anatomy, full of the triggering sounds of codes and beeping machines, became unbearable to watch. She couldn’t erase the memory of the neat row of three refrigerated trailers in her hospital parking lot, each packed with bodies that the morgue was too full to take.

One morning, after a night shift, Ms. Dass climbed into her red Mini Cooper to start her 20-minute drive home. Her car chugged onto its familiar route; a song from the 2017 film “The Greatest Showman” trickled out. For the first time since the pandemic began, Ms. Dass broke down and began to cry. She called her husband, who was on his way to work; he didn’t pick up. Finally, she reached her best friend.

“I told her, ‘These people are not going to make it, these people are not going to survive this,’” she said. “We’re there to save a person, save a life, stabilize a person so they can get further management. And here I am, not able to do that.”

Shortly after, she phoned a longtime friend, Andi Lyn Kornfeld, a psychotherapist who said Ms. Dass was in the throes of “absolute and utter acute PTSD.”

“I have known Shikha for 13 years,” Ms. Kornfeld said. “She is one of the strongest women I have ever met. And I had never heard her like this.”

The sounds of silence

Long gone are the raucous nightly cheers, loud applause and clanging that bounced off buildings and hospital windows in the United States and abroad — the sounds of public appreciation at 7 each night for those on the pandemic’s front line.

“Nobody’s clapping anymore,” said Dr. Jessica Gold, a psychiatrist at Washington University in St. Louis. “They’re over it.”

Health workers, once a central part of the coronavirus conversation, have in many ways faded into the background. Some, like Dr. Gilman, in Arizona, have had their salaries slashed as hospitals weigh how to cover costs.

Many have guiltily recoiled from the “hero” label emblazoned in commercials or ad campaigns, burdened by the death march of the people they could not save and the indiscriminate path of the coronavirus.

The word “hero” evokes bravery and superhuman strength but leaves little room for empathy, said Dr. Nicole Washington, a psychiatrist in Oklahoma. When portrayed as stalwart saviors, health workers “don’t have the room or right to be vulnerable.”

But the trope of invincibility has long been ingrained into the culture of medicine.

Dr. Tapia, the Colorado geriatrician, began taking an antidepressant in September after months of feeling “everything from angry to anxious to furious to just numb and hopeless.” The medication has improved her outlook. But she also worries that these decisions could jeopardize future employment.

Many state medical boards still ask intrusive questions about physicians’ history of mental health diagnoses or treatments in applications to renew a license — a disincentive to many doctors who might otherwise seek professional help.

“I don’t want to be a hero,” said Dr. Cleavon Gilman, an emergency medicine physician in Yuma, Ariz. “I want to be alive.”Credit…Caitlin O’Hara for The New York Times

Being on the front lines doesn’t make health workers stronger or safer than anyone else. “I’m not trying to be a hero. I don’t want to be a hero,” Dr. Gilman said. “I want to be alive.”

As social bubbles balloon nationwide in advance of the chilly holiday months, health care workers fret on the edges of their communities, worried they are the carriers of contagion.

Dr. Marshall Fleurant, an internal medicine physician at Emory University, has the sense that his young children, 3 and 4 years old, have grown oddly accustomed to the ritual of his disrobing out of work clothes, from his scrubs to his sneakers, before entering his home.

“I do not touch or speak to my children before I have taken a shower,” Dr. Fleurant said. “This is just how it is. You do not touch Daddy when he walks in the door.”

A week of vacation with his family startled him, when he could scoop the little ones up in his arms without fear. “I think they must have thought that was weird,” he said.

Bracing for the next wave

Trapped in a holding pattern as the coronavirus continues to burn across the nation, doctors and nurses have been taking stock of the damage done so far, and trying to sketch out the horizon beyond. On the nation’s current trajectory, they say, the forecast is bleak.

Jina Saltzman, a physician assistant in Chicago, said she was growing increasingly disillusioned with the nation’s lax approach to penning in the virus.

While Illinois rapidly reimposed restrictions on restaurants and businesses when cases began to rise, Indiana, where Ms. Saltzman lives, was slower to respond. In mid-November, she was astounded to see crowds of unmasked people in a restaurant as she picked up a pizza. “It’s so disheartening. We’re coming here to work every day to keep the public safe,” she said. “But the public isn’t trying to keep the public safe.”

Since the spring, Dr. Gilman has watched three co-workers and a cousin die from the virus. Ms. Dass lost a close family friend, who spent three weeks at Mount Sinai Queen’s under her care. When Dr. Fleurant’s aunt died of Covid, “We never got to bury her, never got to pay respects. It was a crushing loss.”

In state after state, people continue to flood hospital wards, where hallways often provide makeshift beds for the overflow. More than 12 million cases have been recorded since the pandemic took hold in the United States, with the pace of infection accelerating in the last couple months.

Jill Naiberk, a nurse at the University of Nebraska Medical Center, has spent more of 2020 in full protective gear than out of it. About twice a day, when Ms. Naiberk needs a sip of water, she must completely de-gown, then suit up again.

Otherwise, “you’re hot and sweaty and stinky,” she said. “It’s not uncommon to come out of rooms with sweat running down your face, and you need to change your mask because it’s wet.”

It’s her ninth straight month of Covid duty. “My unit is 16 beds. Rarely do we have an open one,” she said. “And when we do have an open bed, it’s usually because somebody has passed away.”

Many of her I.C.U. patients are young, in their 40s or 50s. “They’re looking at us and saying things like, ‘Don’t let me die’ and ‘I guess I should have worn that mask,’” she said.

Sometimes she cries on her way home, where she lives alone with her two dogs. Her 79-year-old mother resides just a couple houses away.

They have not hugged since March.

“I keep telling everybody the minute I can safely hug you again, get ready,” she said. “Because I’m never letting go.”

Why Thunder and Fireworks Make Dogs Anxious


Allene Anderson said her foster dog, Wrigley, a golden retriever, quaked for hours after a storm.

Allene Anderson said her foster dog, Wrigley, a golden retriever, quaked for hours after a storm.Credit NYTCREDIT: Whitten Sabbatini for The New York Times

It is entirely possible that no one dreads the dog days of summer more than dogs themselves.

Sodden heat gathers itself into sudden barrages of pounding thunder, crackling lightning and pane-rattling rain. Drives dogs crazy, all that noise.

And then, on the Fourth of July: fireworks.

By some estimates, at least 40 percent of dogs experience noise anxiety, which is most pronounced in the summer. Animal shelters report that their busiest day for taking in runaway dogs is July 5.

Veterinarians tell of dogs who took refuge in hiding places so tight that they got stuck, who gnawed on door handles, who crashed through windows or raced into traffic — all desperate efforts to escape inexplicable collisions of noise and flashing light. Ernie, a wired-hair pointer, was so terrified by thunderstorms that he would vault fences at his Maryland farm and run in a straight line for miles.

“It’s very serious,” said Dr. Melissa Bain, an associate professor of clinical animal behavior at the University of California, Davis, School of Veterinary Medicine. “It’s a true panic disorder with a complete flight response.”

Over the years, a mishmash of remedies for noise anxiety have sprung up: homeopathic blends; a calming pheromone; CDs of thunderstorms mixed with Beethoven; swaddling jackets ; even Prozac and Valium. But this month, the first drug approved by the Food and Drug Administration for canine noise aversion (a term encompassing mild discomfort to phobia) came on the market. The drug, Sileo, inhibits norepinephrine, a brain chemical associated with anxiety and fear response.

In the coming days, the annual onslaught of calls will pour into vets: “‘The fireworks are happening and my dog will freak out, so I need something to stop that, and I need it right now!’” Dr. Bain said.

Some vets prescribe strong sedatives, but even if the immediate crisis is averted, the underlying phobia remains untreated.

Being startled by a loud noise is normal, for dogs as well as humans. But these dogs cannot settle back down. Even if most reactions are not as extreme as the dog who tears out its nails while frantically scratching a door, many dogs will cower, pace and defecate indoors.

Cats can have noise aversion, though reports are less common. Animal behavior experts say cats often seem more self-reliant and understated than dogs, so when they hide under beds during storms, owners may not read that response as unusual.


Storms frighten Stella, a miniature breed.

Storms frighten Stella, a miniature breed.Credit Gabriella Demczuk for The New York Times

Veterinary behaviorists say that as years pass, dogs with noise aversion may associate one sensation with another: storm-phobic tremors can be set off merely by dark clouds.

And thunderstorms are complicated beasts. “There are significant pressure changes, frantic winds, massive electrical discharges, concussive sounds: Dogs can hear above and below our auditory range,” said Dr. Peter H. Eeg, a veterinarian in Poolesville, Md., who has been reporting Sileo results in patients to Zoetis, the company that distributes the drug.

Wrigley, a 10-year-old golden retriever in Naperville, Ill., started trembling three hours before a recent storm, said Allene Anderson, a foster caretaker of abandoned dogs.

“She was desperate to climb down my throat,” Ms. Anderson said. “I got down on the floor with her, and she clawed me. She couldn’t get close enough.” After the storm passed, Wrigley quaked for hours.

“If owners don’t understand what’s going through the dog’s mind,” Ms. Anderson said, “they shout and throw them in the basement. That just makes it worse.”

Countless other noises set off dogs: jackhammers, lawn mowers, coffee grinders. One vet said that even garments designed to cocoon dogs in a secured wrap can irritate some by the sound of Velcro flaps being ripped apart. A toddler’s shrieks freaked out Winnie, an Indiana bulldog; her owner, Dr. Sara L. Bennett, a veterinary behaviorist, taught Winnie to relax with yoga breaths.

During a thunderstorm two years ago, Rebecca Roach was awakened at 3 a.m. by Stella, her 6-year-old miniature Australian shepherd, clambering on her chest, panting, whining and shaking.

“My instinct was to comfort her,” said Ms. Roach, who lives in Boyds, Md. “so I held her until the storm passed.”

But behavior specialists disagree about whether owners should comfort animals. Dr. Daniel S. Mills, a veterinarian at the University of Lincoln in England who is an expert on canine noise aversion, suggests that owners “acknowledge the dog but not fuss over it. Then show that the environment is safe and not compatible with threat, by playing around and seeing if the dog wants to join you. But don’t force it. Let it make a choice.”

Other experts say that soothing a spooked animal, bred to seek safety with its human, is just fine. “You can’t reinforce anxiety by comforting a dog,” Dr. Bain said. “You won’t make the fear worse. Do what you need to do to help your dog.”

Other tips include muffling noise with quiet music and, if possible, staying with the dog in a windowless, interior room. Because a dog’s flight response is on overload, it is seeking a haven.

For years, veterinarians treated noise phobia with acepromazine, a tranquilizer. It sedates the dog but is not an anti-anxiety medication. During a thunderstorm, the dog can still see and hear everything. But like someone having a nightmare in which he or she cannot run from danger, the frightened dog can’t move to escape. So veterinary behaviorists say that acepromazine can exacerbate noise aversion.

Some dogs function better with Prozac, but as with humans, the daily medicine takes four to six weeks to become effective.

Stella was impervious to prescriptions. During thunderstorm season, she and Ms. Roach lost hours of sleep. Ms. Roach tried positive reinforcement: When Stella’s symptoms would begin, she would be given treats from the night stand.

“Then Stella started climbing on my chest at 3 a.m., whimpering, whining and looking at the night stand,” Ms. Roach said. “And no thunderstorm! That was the end of that.”

The new canine noise aversion drug, Sileo, is actually a micro-amount of a medication approved as a sedative for minor veterinary procedures —- a flavorless gel, measured in a syringe, that is squeezed between the dog’s cheek and gum and absorbed within 30 minutes.

Orion, the Finnish company that developed it, tested it on several hundred noise-averse dogs during two years of New Year’s fireworks. Three-quarters of the owners rated the dogs’ response as good to excellent; their pets remained unperturbed. The drug lasts several hours, after which another dose can be administered.

A syringe costs about $30 and holds several weight-dependent doses. Sileo’s main side effect, in 4.5 percent of dogs, is vomiting.

“I’m not naïve enough to think this is the miracle cure,” said Dr. Emily Levine, a veterinary behaviorist in Fairfield, N.J. But she considered it a worthy option.

The optimal solution, vets say, is catching the response early, and desensitizing the dog with calibrated recordings of the offending noise, and positive conditioning.

But training takes time, patience and consistency.

“And humans,” Dr. Eeg said, “are one of the most inconsistent species on the planet.”

Using Meditation to Help Close the Achievement Gap


Students meditating at Phillip and Sala Burton Academic High School in San Francisco.

Students meditating at Phillip and Sala Burton Academic High School in San Francisco.Credit

Closing the so-called achievement gap between poor inner-city children and their more affluent suburban counterparts is among the biggest challenges for education reformers. The success of some schools’ efforts suggests that meditation might significantly improve children’s school performance – and help close that gap.

In 2007, James Dierke, then the principal of the Visitacion Valley Middle School in a troubled neighborhood in San Francisco, was determined to improve both the quality of education and student behavior in his school. He adopted a system called the Quiet Time Program, developed by the David Lynch Foundation for Consciousness-Based Education and World Peace. The program, implemented in partnership with the nonprofit Center for Wellness and Achievement in Education, involved introducing two 15-minute periods of quiet into the school day. During those times students could either practice Transcendental Meditation, which is taught as part of the program, or engage in other quiet activities like silent reading.

A major factor preventing underserved children from learning is the stress they encounter on a daily basis – from factors like poverty, deprivation, lack of steady parental input, physical danger and constant fear. Research shows that chronic stress can impair healthy brain development and the ability to learn, and that Transcendental Meditation, a stress-reducing technique that involves thinking of a mantra, can reduce stress and its manifestations – for example, anxiety, high blood pressure and cardiovascular disease. Mr. Dierke wondered whether meditation might reduce students’ stress levels and help them learn.

Over the next three years, Visitacion Valley’s suspensions dropped by 79 percent, attendance rose to 98 percent, and students’ grade point averages rose each year. Of even greater interest, the increase in G.P.A. for the lowest performing demographic was double that for the overall student group.

Anecdotally, favorable feedback poured in from both students and staff members. One seventh grader at Visitacion Valley said, “I used to be really fidgety, couldn’t stay in my seat for very long. Now, after meditating, I can sit down for a whole class without standing up.” Barry O’Driscoll, the school’s director of physical education for the past 14 years, said, “In the first seven years of my tenure, the school was dominated by stress and fighting.” But in the last few years, he said, “we have had very few fights.”

One other middle school and two high schools in the Bay Area adopted the program. And a 2015 review of the program, issued by the Center for Wellness and Achievement in Education in collaboration with the San Francisco Unified School District research department, had more good news.

The results of 17 studies conducted to date in the Bay Area, varying in duration from three months to one year, showed benefits across parameters including reduced stress, increased emotional intelligence, reduced suspensions, increased attendance and increased academic performance.

Although controlled studies are difficult to perform in an academic setting, collectively the results of the Bay Area studies are encouraging. Two controlled studies have been published so far; others are in submission for publication. In one, the effects of the Quiet Time Program, conducted over half the academic year, were evaluated in public middle school students performing below proficiency level. Annual math and English scores improved in the students who meditated, while they declined in those who didn’t meditate. Given that the students in the study were performing below par at baseline, these results are promising.

The second controlled study, authored by WestEd, an independent evaluator, found that after seven months of the Quiet Time Program, ninth grade students who meditated showed a significant decrease in anxiety and a significant increase in resilience compared to nonmeditating students. In addition, meditating students reported sleeping better as well as higher levels of self-confidence and happiness.

It would be naïve to think that meditation alone could erase the effects of the many factors, like poverty, that are barriers to educational achievement. But Quiet Time is a relatively inexpensive intervention that teachers and students enjoy and which preliminary data suggest is effective.

And although this program has focused on schools in low-income areas, adolescents from middle-class and affluent families could benefit from stress reduction as well. Why shouldn’t all our students have access to meditation?

Norman E. Rosenthal is a psychiatrist and the author of “Super Mind: How to Boost Performance and Live a Richer and Happier Life Through Transcendental Meditation.”


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The Breakup Marathon


Brian Eastwood during the Boston Marathon in 2016.

Brian Eastwood during the Boston Marathon in 2016.Credit Zeth Weissman

Brian Eastwood was a pretty good runner, but he’d always come up a bit short in trying to reach his goal of qualifying for the Boston Marathon.

When he set out to train for the 2015 Vermont City Marathon, though, his 12th try at qualifying, he had something new in his life: a divorce.

“The day my wife and I went to court was the first day of 16 weeks of training,” said Mr. Eastwood, 35, of Somerville, Mass. His life was, to put it mildly, in flux. Not only was he on the verge of divorce, but he was in the middle of trying to make a career shift, too.

But his training paid off: Mr. Eastwood ran the race of his life in Vermont, finishing in 3 hours, 1 minute, 17 seconds, more than seven minutes under his best time, and more than eight minutes under the Boston Marathon qualifying standard for men his age.

His divorce, he says, most likely made the difference. During that difficult time, “running was my only real constant,” he said.

For some people, a life trauma like a breakup or divorce might mean curling up in bed and shutting down. But others find more active ways to cope.

Those people “are better at compartmentalizing or utilizing some of the energy that surrounds the emotions they’re experiencing — maybe it’s anger, maybe it’s sadness — and channeling that into another venue or arena,” said Trent Petrie, director of the University of North Texas Center for Sport Psychology. For runners, that could mean challenging themselves to run better and faster, or to shoot for a longer distance.

“Chronic or traumatic stress leads to structural and functional alterations in the traumatized brain,” said Ken Yeager, director of the stress, trauma and resilience program at the Ohio State University Wexner Medical Center. And while a breakup or divorce may feel like a single traumatic event, it is often the culmination of months or even years of “mini-traumas” and ongoing stress.

“You had those tensions building up in your body,” Dr. Yeager said. “Most people don’t realize the way you release those tensions is movement.” He compares the situation to the nervous tension that builds up at the start of a race. “Before any major race, you have this release of tension, and that movement is what releases the trauma and tension,” he said.

Maya Harmon, 32, ran seven half-marathons in 2015 — the year that she and her husband of seven years divorced. She’d picked up running in 2009 when she moved to Phoenix, but started doing it more when the marriage started to unravel in 2011.

“When things really started to go bad, I started to focus on trying to do something to stay active because I knew that as long as I stayed active, it would keep me slightly happy,” she said. Even though her time was limited between work, graduate school and becoming a single mother, she still got out there, trained and ran races.

Her mother asked if she was trying to run away from her problems. Maybe, she said, though the escape that running provided was at least a healthy one, and kept her from feeling overwhelmed.

“If I had time to sit and think about it, I probably wouldn’t have made it through that time,” Ms. Harmon said. “Running gave me something to focus on that was positive.”

Dr. Petrie says that while there’s a risk that running might be used as an escape that prevents people from confronting the issues that are causing their stress, it can also be a useful tool for processing painful events. “Sometimes in the moment, these escapes into running or exercising or finding a slightly different focus is a way for us to garner the psychological resources we need to circle back and face the other stuff in a more productive way,” he said.

For Ms. Harmon, who had been casually involved with the Black Girls RUN! group via Facebook before her divorce, running gave her a chance to expand her social horizons. She dove in to the local activities of that national group’s Phoenix chapter and is now their running ambassador, a journey that may have helped to strengthen her psychological resilience.

When people are “depressed or stressed out, they tend to isolate themselves, and that facilitates negative moods,” said Jasper Smits, a professor of psychology at the University of Texas at Austin and a co-author of “Exercise for Mood and Anxiety: Proven Strategies for Overcoming Depression and Enhancing Well-Being.” Studies he and his colleagues have conducted suggest that exercise may help to lessen anxiety and panic attacks and provide other benefits for mental health.

This past April, Mr. Eastwood ran that Boston Marathon for which he had worked so hard to qualify. Now his life is very different: He has a new girlfriend, a new job. He was recovering from a calf injury when he started training this time, so he set a more moderate goal. He finished in 3 hours, 24 minutes, 37 seconds, more than 20 minutes slower than his post-divorce performance, but he has no complaints.

“Everyone who saw me along the course said I looked happy and strong, which is exactly what I wanted,” he said.

Jen A. Miller is the author of “Running: A Love Story.”


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Worried? You’re Not Alone


Credit Oliver Munday

I’m a worrier. Deadlines, my children, all the time they spend online — you name it, it’s on my list of worries. I even worry when I’m not worried. What am I forgetting to worry about?

Turns out I’m not alone. Two out of five Americans say they worry every day, according to a new white paper released by Liberty Mutual Insurance. Among the findings in the “Worry Less Report”: Millennials worry about money. Single people worry about housing (and money). Women generally worry more than men do and often about interpersonal relationships. The good news: Everyone worries less as they get older.

“People have a love-hate relationship with worry,” said Michelle Newman, a professor of psychology and psychiatry at Pennsylvania State University, who was not involved in the writing of the report. “They think at some level that it helps them.”

The belief that worrying somehow helps to prevent bad things from happening is more common than you might think. Researchers say the notion is reinforced by the fact that we tend to worry about rare events, like plane crashes, and are reassured when they don’t happen, but we worry less about common events, like car accidents.

But that doesn’t mean all worrying is futile. “Some worry is actually good for you,” said Simon A. Rego, the author of the new report and a cognitive behavioral psychologist who specializes in anxiety disorders and analyzed decades of research on worrying for the paper. “It’s what we call productive or instructive worry, that can help us take steps to solve a problem.”

One study published in 2002 recruited 57 young adults and asked them to list their worries in a diary for seven days and rate each worrying episode.

When the researchers analyzed the results, they determined that about 20 percent of the worries were about anticipating a negative outcome in the future. But nearly half of all the documented worries reflected a process of problem solving. While that can be constructive, people who worried a lot and couldn’t control their worrying were less likely to find a solution to their problem. The researchers, Marianna Szabo, now at the University of Sydney, and Peter F. Lovibond of University of New South Wales in Australia, concluded that failing to come up with solutions may actually lead to more pathological worrying.

In 2007, the same researchers tried to correlate aspects of worrying with specific components of problem-solving, like defining the problem, gathering information, generating solutions, evaluating and choosing a solution. Once again, they concluded about half the cognitive content of the worry episodes included attempts to solve a problem. Once people devise a solution, they quit worrying one-third of the time. But people found it hard to stop worrying if they weren’t satisfied with the solution they came up with.

People “get caught up in the worry itself,” Dr. Newman said. “It becomes so habitual, I call it ‘a process looking for content.’”

That kind of worrying can get out of hand. “Excessive worriers have multiple domains that they worry about, and if something triggers a worry in one domain, it can seep into other areas,” Dr. Rego said, “and things can move back and forth like wildfires — once one gets going, it can start other fires as well.”

Worrying, a cognitive process, should not be confused with anxiety, which generally refers to an emotional state of unease that also includes worry. While 38 percent of people worry every day, most of them do not have anxiety. Generalized anxiety disorder, the primary feature of which is excessive and uncontrollable worrying, affects only 2 to 5 percent of the population.

Liberty Mutual Insurance officials commissioned the report to better understand how Americans can “break the worry cycle,” since the insurance business is designed “around helping people live with less worry,” said Margaret Dillon, the company’s executive vice president and chief customer officer for the United States, adding that it could also help them develop the most appropriate products. The report noted, for example, that top worries for people ages 25 to 44 are about finances and housing, she said.

If you’re worried about your worrying, the report suggests some coping strategies, including:

Divide and conquer Try to come up with a solution to a worrisome problem by breaking it down into four parts: defining the problem, clarifying your goals, generating solutions and experimenting with solutions. Grab a pen and paper and brainstorm, the report suggests.Studies have shown this approach can help ease depression and anxiety.

Practice mindfulness Choose a routine activity or part of the day and try to experience it fully. Set aside concerns, and try to be “in the moment.”

Schedule a worry session Pick a designated time of day to mull your problems. If a worrying thought enters your mind outside of your scheduled worry session, jot it down so you can think about it during your scheduled worry time. Then get back to your day.

Practice accepting uncertainty Notice your thoughts and label them (as in “there is the thought that I can’t manage”). Let go of tension in your body; soften your forehead, drop your shoulders and relax your grip.


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Parents, Stop Feeling That Everything You Do Is Wrong


Credit iStock

When was the last time you heard a curmudgeonly adult complain that kids today have it easy?

Results from this year’s National Poll on Children’s Health were released in April, suggesting that many adults — both parents and nonparents — think that children today are experiencing more stress, and worse mental health, than when they themselves were young.

This is a striking reversal of the traditional dynamic, in which adults recall the hardships and dangers of the old days, and conclude that kids today have it easy, said Dr. Matthew M. Davis, a pediatrician who is director of the poll at C.S. Mott Children’s Hospital at the University of Michigan.

Not that the curmudgeons have shut up. Everyone knows that first world, privileged kids today are cushioned, shielded, protected from the literal and figurative bumps and bruises of the real-world playground. Everyone gets a trophy. We monitor children’s social interactions and if someone says something harsh, we call it bullying and we intervene. Parents are helicopter parents (hover hover), or worse, snowplow parents (pushing all the obstacles out of their children’s way). Kids are overprotected, spoiled, entitled and lazy.

And everyone knows, of course, that kids today are overscheduled, highly stressed, burdened by completely unrealistic and hypercompetitive parental expectations of all-around achievement and success at a prestigious college. Few get that all-important trophy because the odds are so incredibly poor. Parents are would-be tigers, entitled demanding perfectionists, kids are stressed, pushed past what they can do, and miserably aware that they aren’t measuring up.

So our children aren’t turning out right because we are dangerously overprotective in our parenting or too strict and demanding. To sum up, everything you do is wrong.

Can we really be getting it so wrong at both ends? Can we be this bad at it?

It’s time to put an end to the everything-you-do-is-wrong school of parent criticism, which puts us all in an impossible bind. You helped your kid with a difficult school assignment? You helicopter, you! You referred to the importance of your child’s high school G.P.A.? You hyper-critical, prestige-minded stress machine! (Even back in the 1970s, my parents were known to do both things.)

Parents also feel stressed by this perception that children are so stressed. “There are some real challenges for parents today in terms of encouraging them to be protective while at the same time not be overprotective,” Dr. Davis said. “That can be a very hard balance for parents to strike and it’s also a hard balance for communities to find.”

Dr. Kenneth Ginsburg, a pediatrician specializing in adolescent medicine at the Children’s Hospital of Philadelphia drew a specific connection between the apparent extremes of what he called “self-esteem parenting” and the high stress and anxiety of children who feel the weight of parental expectations. The problem, he said, is that if we praise children for being smart, they may become anxious about losing that label, and therefore less likely to take on hard tasks.

But parents can help children become more willing to work hard, more perseverant, even more creative, he said. “We have this enormous amount of research on what kind of parenting produces the best effect.”

The model that Dr. Ginsburg has put forward in his book, “Raising Kids to Thrive: Balancing Love With Expectations and Protection With Trust,” published through the American Academy of Pediatrics, is what he calls lighthouse parenting.

“You should look down at the rocks and make sure they never crash against them, and prepare them to ride the waves.”

This is the style of parenting described as authoritative, often contrasted with the extremes of permissive parenting and authoritarian parenting, and there is a lot of research to back it up. “The authoritative or balanced parent essentially says, I love you so much but I’m your daddy, I’m not your friend,” Dr. Ginsburg said, “I’m going to give you lots of opportunity to grow, a deep sense of connection so that you’re going to be firmly rooted. I’m going to give you lots of opportunity to make mistakes. But when something comes down to safety or morality, you’re going to do what I say because I know best.”

I hope I have my lighthouse days, when I get the balance right. I know I also have my tiger days and my helicopter days, and for all I know, my free-range moments and my snowplow episodes, maybe in rapid succession. Everything I did when my kids were growing up was probably wrong, except when it was right.

As parents, we all make decision after decision after decision — stand back and let a kid take a chance or interfere. Watch a kid struggle or offer help; encourage perseverance or say it’s O.K. to quit sometimes. Sympathize and reprove, console or tell them to suck it up. And the balance changes with the particular kid involved, but also with the day of the week and the month of the year.

Except for the crazy people (and yes, there have to be some crazy people, or what would be the dirty fun of P.T.A. meetings and open school nights), most parents are somewhere in the middle, trying our best, getting it right sometimes, getting it wrong sometimes, and often unsure, especially as our children get older, whether today is a right day or a wrong day.

When my oldest child was born and my husband was feeling swamped by the (predictable and appropriate) terror of this new responsibility and all the decisions to be made, my own father very kindly told him to stop worrying. There was no one thing that we would do or not do that would matter all that much, no individual decision or speech or act, he said.

Our child would understand who we were by everything we did and how we lived, our tones, our values, our random eccentricities, not just by what we said parent-to-child, but by how we lived in the world. Eventually, our son would know us better than we knew ourselves.

And somehow, that was a comforting thought, that parenting was not something we could purposefully decide, that it was who we were and how we lived that would inevitably constitute the family environment that would shape our child.


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Why Do Girls Tend to Have More Anxiety Than Boys?


Credit iStock

The laid-back, underachieving boy; the hyperachieving, anxious girl. Over the three decades since I graduated from medical school, and especially over the past 10 years, this pattern has become increasingly common in my practice.

In one case, which is pretty typical, my patient’s parents are concerned about their son. He’s not working hard at school and his grades are sliding. At 16, he spends most of his free time playing video games like Grand Theft Auto or Call of Duty, or surfing the Web for pictures of girls. He’s happy as a clam.

Both parents are actually quite proud of their 14-year-old daughter, who is a straight-A student, an athlete and has many friends. But when I met with her, she told me that she isn’t sleeping well. She wakes up in the middle of the night, feeling remorseful about having eaten a whole slice of pizza for dinner. She often has shortness of breath. Recently she has begun cutting herself with razor blades, on her upper inner thigh where her parents won’t see. She hasn’t told her parents any of this. On the surface, she is the golden girl. Inside, she is falling apart.

Why is it that girls tend to be more anxious than boys?

It may start with how they feel about how they look. Some research has shown that in adolescence, girls tend to become more dissatisfied with their bodies, whereas boys tend to become more satisfied with their bodies. Another factor has to do with differences in how girls and boys use social media. A girl is much more likely than a boy to post a photo of herself wearing a swimsuit, while the boy is more likely to post a photo where the emphasis is on something he has done rather than on how he looks. If you don’t like Jake’s selfie showing off his big trophy, he may not care. But if you don’t like Sonya’s photo of herself wearing her bikini, she’s more likely to take it personally.

Imagine another girl sitting in her bedroom, alone. She’s scrolling through other girls’ Instagram and Snapchat feeds. She sees Sonya showing off her new bikini; Sonya looks awesome. She sees Madison at a party, having a blast. She sees Vanessa with her adorable new puppy. And she thinks: I’m just sitting here in my bedroom, not doing anything. My life sucks.

Boys are at lower risk for the toxic effects of social media than girls are, for at least three reasons. First, boys are less likely to be heavily invested in what you think of their selfies. “Does this swimsuit make me look fat?” is a question asked by girls more often than by boys. Second, boys tend to overestimate how interesting their own life is. Third, the average boy is likely to spend more time playing video games than Photoshopping his selfie for Instagram. And in video games, unlike social media, everybody truly can be a winner, eventually. If you play Grand Theft Auto or Call of Duty long enough, you will, sooner or later, complete all the missions, if you just keep at it.

Parents can’t easily change any of those factors. You can’t easily get a girl to be less concerned about her looks; or to overestimate how interesting her own life is; or to care more about completing all the missions in Grand Theft Auto than about how many likes she’s getting on Instagram (nor is it clear that this last change, even if accomplished, would be a change for the better). So what can you do, to improve the odds for your daughter?

If your daughter is the girl sitting in her bedroom looking at other girls’ social media, maybe she shouldn’t be in her bedroom at all. In the typical American household today, when kids go home, they go to their bedrooms and aren’t seen again except perhaps for meals. That’s crazy. A family can’t be a family if the kids spend more time alone in their bedrooms than with their family members. Insist that your daughter, or son, do whatever they’re doing online in a public space: in the kitchen or the living room. There should be nothing in the bedroom except a bed: no TV, no PlayStation, no screens. That’s the official recommendation of the American Academy of Pediatrics.

Another suggestion: fight for suppertime. And don’t allow phones at the table. In a 2013 Canadian survey of kids across a range of backgrounds, those who had more meals with parents were much less likely to have been feeling sad, anxious or lonely. They were more likely to help others and more likely to report being satisfied with their own lives. But be mindful of what you say at the table. Discussions of poor grades or disappointing test scores are out of bounds. The Palestinian-Israeli conflict? Of course. The origin of the universe and the meaning of life? Certainly. But the personal shortcomings of your child are, as a rule, not appropriate suppertime conversation in a loving family.

A third suggestion: No headsets and no earbuds in the car. When your child is in the car with you, you should be listening to her and she should be listening to you – not to Justin Bieber or Miley Cyrus or Akon or Eminem. Teach the art of face-to-face conversation. Or play a word game. Or have the whole family sing a song. Or make up a limerick, as my family and I did last night. It sounds corny, but it helps.

If your daughter is not sleeping at night, or is cutting herself with razor blades, then limericks at the dinner table are not likely to be a sufficient cure. I do prescribe medication, cautiously and judiciously, for the clinically anxious girl. There is also a role for professional counseling, alongside or sometimes in place of medication. Regardless, medication should never be the most important part of the treatment. The most important part of the treatment is to prioritize the family, to give your child a secure grounding in a loving home.

Leonard Sax is a psychologist and a practicing family physician in West Chester, Pa., and the author, most recently, of “The Collapse of Parenting.”


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