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Access to Mental Healthcare (Argumentative)

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Access to Mental Healthcare (Argumentative)

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Beware the bias of this article since it is published by a lobby organization

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Study Reveals Lack of Access as Root Cause for Mental Health Crisis in America

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American mental health services are insufficient and the root of the problem is lack of access to care.

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Racial Trauma

Racism and racial discrimination may impact emotional well-being. This is racial trauma. Such experiences can affect physical and mental health. In some cases, they may lead to PTSD. Learn about the impact of racial trauma and tips for active coping to reduce stress.

Reading time: minutes

Racial trauma can negatively affect physical, mental and emotional health, and in some cases, lead to PTSD. This information may also be useful for those who experience discrimination or trauma based upon other aspects of identity, such as gender, sexuality, religion, etc.

What Is Racial Trauma?

Racial trauma refers to the emotional impact of stress related to racism, racial discrimination, and race-related stressors, such as being affected by stereotypes, hurtful comments, or barriers to advancement. Racial trauma can refer to a specific incident of racial discrimination or the ongoing, harmful emotional impact of racial discrimination that builds up over time. People can experience racial trauma from something that happens directly to them or from seeing others mistreated because of their race. Coverage of events caused by racial discrimination in the media can also be upsetting, and repeated viewing or frequent media accounts can amplify those feelings.

What Are the Impacts of Racial Trauma?

Racial trauma can lead to an increased risk of physical and mental health problems. Emotional difficulties, such as stress, anxiety, depression or PTSD, can impact daily functioning in school, work or at home. Relationships with others may also be affected; people may worry that others dismiss their concerns about racial trauma. It is normal and understandable to be negatively affected by racial trauma.

How Can Racial Trauma Incidents Lead to PTSD?

Racial trauma incidents that involve actual or threatened death, serious injury or sexual violence may lead to PTSD. Any experiences of racial trauma can make existing PTSD and other mental health problems worse. There are many similarities between PTSD symptoms and symptoms related to the emotional impacts of racial trauma. After experiencing racial discrimination, people may have unwanted memories and may avoid thoughts, feelings and reminders of racial trauma. In addition, racial trauma can lead to negative thoughts about oneself, others and the world, and contribute to negative moods. Finally, people may feel on guard and on high alert, and have trouble with concentration, sleep or irritability due to racial trauma.

Coping With Racial Trauma

Racial trauma is a broad problem that requires communities to work together to overcome it. At times, coping with racial trauma can feel overwhelming, so focusing on strategies for empowerment and healing can be helpful. Coping may not reduce or stop racial trauma, but taking active steps can help people reduce stress and let them redirect their focus back to living fulfilling lives.

Empowerment. Racial trauma can lead to feelings of helplessness. Focusing on ways to take control or have an influence can improve emotional health. Empowerment strategies can range from self-care to speaking up about issues that are important. Some people may find advocacy for reducing discrimination or oppression meaningful.

Values-based goal setting. Identifying specific goals that align with personal values (e.g., family, community, equity, self-improvement, security) can be another way to feel more in control and enjoy life.

Self-care and lifestyle changes. Taking time to recuperate from racial trauma on a regular basis is important. Taking walks, listening to music or relaxation techniques may help. The specific activity is not important. The goal is to choose something that helps to reduce stress.

Taking charge of emotions. Relaxation and mindfulness strategies can be helpful in countering the effects of stress on the body and mind.

Social support. Talking to supportive others about thoughts and feelings related to racial trauma can be validating.

Media balance. While staying informed about current events is important, it may be helpful to limit exposure to "doomscrolling," or focusing on negative and discouraging media content.

For those people who continue to feel distressed, consider talking to a health care provider. Talking to a mental health provider can be helpful for people who are feeling overwhelmed, having difficulties with relationships, or struggling with day-to-day functioning at work, school or household responsibilities.

Conclusion

Racial trauma can negatively affect physical, mental and emotional health, and in some cases, lead to PTSD. If self-care is not enough to cope with the impact of racial trauma in daily life, seeking professional help can be valuable. A mental health provider can help to assess the negative impacts of racial trauma and to work with people to identify effective coping and treatment strategies. Some VA facilities offer Race-Based Stress and Trauma Empowerment groups designed to treat racial stress and trauma. Evidence-based talk therapies for PTSD-like Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) and Eye-Movement Desensitization and Reprocessing (EMDR)-can help to treat PTSD due to racial trauma.

While this article focuses on the impact of racial trauma, the information may also apply to discrimination or trauma due to other aspects of identity, such as sexual orientation, gender identity, religion, spirituality, ability status, socioeconomic status, age or generation.

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Apply for and manage the VA benefits and services you've earned as a Veteran, Servicemember, or family member-like health care, disability, education, and more.

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Many of us are facing challenges that can be stressful, overwhelming, and cause strong emotions in adults and children. Public health actions, such as physical distancing, can make us feel isolated and lonely and can increase stress and anxiety.

After a traumatic event, people may have strong and lingering reactions. Learning healthy ways to cope and getting the right care and support can help reduce stressful feelings and symptoms.

The symptoms may be physical or emotional. Common reactions to a stressful event can include:

Disbelief

Feelings of fear, shock, anger, sadness, worry, numbness, or frustration

Changes in appetite, energy, desires, and interests

Difficulty sleeping or nightmares, concentrating, and making decisions

Physical reactions, such as headaches, body pains, stomach problems, and skin rashes

Worsening of chronic health problems

Worsening of mental health conditions

Increased use of tobacco, alcohol, and other substances

It is natural to feel stress, anxiety, grief, and worry during traumatic events such as mass shootings, natural disasters, or pandemics. Below are ways that you can help yourself, others, and your community manage stress.

Healthy Ways to Cope with Stress

Feeling emotional and nervous or having trouble sleeping and eating can all be normal reactions to stress. Here are some healthy ways you can deal with stress:

Take breaks from watching, reading, or listening to news stories, including those on social media. It's good to be informed but hearing about the traumatic event constantly can be upsetting. Consider limiting news to just a couple of times a day and disconnecting from phone, tv, and computer screens for a while.

Take care of yourself. Eat healthy, exercise, get plenty of sleep, and give yourself a break if you feel stressed out.

Take care of your body.

Make time to unwind. Try to do some other activities you enjoy.

Talk to others. Talk with people you trust about your concerns and how you are feeling. Share your problems and how you are feeling and coping with a parent, friend, counselor, doctor, or pastor.

Connect with your community- or faith-based organizations.

Avoid drugs and alcohol. These may seem to help, but they can create additional problems and increase the stress you are already feeling.

Recognize when you need more help. If problems continue or you are thinking about suicide, talk to a psychologist, social worker, or professional counselor.

Check out Taking Care of Your Emotional Health for more information and resources.

Helping Others Cope

Taking care of yourself can better equip you to take care of others. Helping others cope with stress through phone calls or video chats can help you and your loved ones feel less lonely or isolated.

Helping Children and Youth Cope with Stress

Children and youth often struggle with how to cope with stress. Youth can be particularly overwhelmed when their stress is connected to a traumatic event-like a natural disaster, family loss, school shootings, or community violence. Parents, caregivers, and educators can take steps to provide stability and support that help young people feel better.

Tips

Tips for Parents and Caregivers
It is natural for children to worry when scary or stressful events happen in their lives. Talking to your children about these events can help put frightening information into a more balanced setting. Monitor what children see and hear about stressful events happening in their lives. Here are some suggestions to help children cope:

Maintain a normal routine. Helping children wake up, go to sleep, and eat meals at regular times provide them a sense of stability.

Talk, listen, and encourage expression. Listen to your child's thoughts and feelings and share some of yours. After a traumatic event, it is important for children to feel they can share their feelings and that you understand their fears and worries.

Watch and listen. Be alert for any change in behavior. Any changes in behavior may be signs that your child is having trouble and may need support.

Stressful events can challenge a child's sense of safety and security. Reassure your child about his or her safety and well-being. Discuss ways that you, the school, and the community are taking steps to keep them safe.

Connect with others. Talk to other parents and your child's teachers about ways to help your child cope. It is often helpful for parents, schools, and health professionals to work together for the well-being of all children in stressful times.

Tips for Kids and Teens
After a traumatic event, it is normal to feel anxious about your safety and security. Even if you were not directly involved, you may worry about whether this type of event may someday affect you. Check out the tips below for some ideas to help deal with these fears.

Talk to and stay connected to others. Talking with someone you trust can help you make sense out of your experience. If you are not sure where to turn, call your local crisis intervention center or a national hotline.

Take care of yourself. Try to get plenty of sleep, eat right, exercise, and keep a normal routine.

Take information breaks. Pictures and stories about a disaster can increase worry and other stressful feelings. Taking breaks from the news, Internet, and conversations about the disaster can help calm you down.

Tips for School Personnel
School personnel can help their students restore their sense of safety by talking with the children about their fears. Other tips for school personnel include:

Reach out and talk. Create opportunities to have students talk, but do not force them. You can be a model by sharing some of your own thoughts as well as correct misinformation.

Watch and listen. Be alert for any change in behavior. Are students withdrawing from friends? Acting out? These changes may be early signs that a student is struggling and needs extra support from the school and family.

Maintain normal routines. A regular classroom and school schedule can provide a sense of stability and safety. Encourage students to keep up with their schoolwork and extracurricular activities but do not push them if they seem overwhelmed.

Take care of yourself. You are better able to support your students if you are healthy, coping and taking care of yourself first. Eat healthy, exercise, get plenty of sleep, and give yourself a break if you feel stressed out.

Mental Health and Crisis

Resources and Social Support Services

If you are struggling to cope, there are many ways to get help. Call your healthcare provider if stress gets in the way of your daily activities for several days in a row.

During times of extreme stress, people may have thoughts of suicide. Suicide is preventable and help is available. More about the risk of suicide, signs to watch for, and how to respond if you notice these signs in yourself or a friend or a loved one, can be found here.

Free and confidential crisis resources can also help you or a loved one connect with a skilled, trained counselor in your area.

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Many of us are facing challenges that can be stressful, overwhelming, and cause strong emotions in adults and children. Public health actions, such as physical distancing, can make us feel isolated and lonely and can increase stress and anxiety. After a traumatic event, people may have strong and lingering reactions.

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Stress Management and Teens

No. 66; Updated January 2019

Teenagers, like adults, may experience stress every day and can benefit from learning stress management skills. Most teens experience more stress when they perceive a situation as dangerous, difficult, or painful and they do not have the resources to cope. Some sources of stress for teens include:

School demands and frustrations

Negative thoughts or feelings about themselves

Changes in their bodies

Problems with friends and/or peers at school

Unsafe living environment/neighborhood

Separation or divorce of parents

Chronic illness or severe problems in the family

Death of a loved one

Moving or changing schools

Taking on too many activities or having too high expectations

Family financial problems

Some teens become overloaded with stress. When this happens, it can lead to anxiety, withdrawal, aggression, physical illness, or poor coping skills such as drug and/or alcohol use.

When we perceive a situation as difficult or painful, changes occur in our minds and bodies to prepare us to respond to danger. This "fight, flight, or freeze" response includes faster heart and breathing rate, increased blood to muscles of arms and legs, cold or clammy hands and feet, upset stomach and/or a sense of dread.

The same mechanism that turns on the stress response can turn it off. As soon as we decide that a situation is no longer dangerous, changes can occur in our minds and bodies to help us relax and calm down. This "relaxation response" includes decreased heart and breathing rate and a sense of well-being. Teens that develop a "relaxation response" and other stress management skills feel less helpless and have more choices when responding to stress.

Parents can help their teen in following ways:

Monitor if stress is affecting their teen's health, behavior, thoughts, or feelings

Listen carefully to teens and watch for overloading

Learn and model stress management skills

Support involvement in sports and other pro-social activities

Teens can decrease stress with the following behaviors and techniques:

Exercise and eat regularly.

Get enough sleep and have a good sleep routine.

Avoid excess caffeine which can increase feelings of anxiety and agitation.

Avoid illegal drugs, alcohol, and tobacco.

Learn relaxation exercises (abdominal breathing and muscle relaxation techniques).

Develop assertiveness training skills. For example, state feelings in polite, firm, and not overly aggressive or passive ways: ("I feel angry when you yell at me." "Please stop yelling.")

Rehearse and practice situations which cause stress. One example is taking a speech class if talking in front of a class makes you anxious.

Learn practical coping skills. For example, break a large task into smaller, more attainable tasks.

Decrease negative self-talk: challenge negative thoughts - with alternative, neutral, or positive thoughts. "My life will never get better" can be transformed into "I may feel hopeless now, but my life will probably get better if I work at it and get some help."

Learn to feel good about doing a competent or "good enough" job rather than demanding perfection from yourself and others.

Take a break from stressful situations. Activities like listening to music, talking to a friend, drawing, writing, or spending time with a pet can reduce stress.

Build a network of friends who help you cope in a positive way.

By using these and other techniques, teenagers can begin to manage stress. If a teen talks about or shows signs of being overly stressed, a consultation with a child and adolescent psychiatrist or other qualified mental health professional may be helpful.

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Teenagers, like adults, may experience stress everyday and can benefit from learning stress management skills.

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There is both a video clip and a written article as options on this link

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centers for disease control and prevention

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health and health care (by demographic group)

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us department of health and human services

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Poor mental health in US teens exacerbated by negative experiences during Covid-19 pandemic, survey finds | CNN

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Poor mental health among teens in the United States was a concern before the Covid-19 pandemic, and major disruptions to school and social life since early 2020 have only exacerbated the situation.

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As the COVID-19 pandemic came with bouts of uncertainty and isolation for all, new research in a seemingly post-pandemic world has revealed evidence that the detrimental impact on adolescent mental health has persisted and points to multiple causes for concern.

These are some of the findings from a new study supported by the Icelandic Research Fund conducted by John Allegrante, Charles Irwin Lambert Professor of Health Behavior and Education at Teachers College and Professor of Sociomedical Sciences at the Columbia Mailman School of Public Health , along with a team of Icelandic and North American behavioral and social scientists with whom he has been collaborating for almost 20 years.

"One of the key challenges right now that we are facing in the United States and worldwide is the decline of adolescent mental health," says Allegrante. "If the pandemic has taught us anything, it's that we must support our youth."

John Allegrante, Charles Irwin Lambert Professor of Health Behavior and Education (Photo: TC Archives)

The recent study, published in The Lancet Child and Adolescent Health , sampled over 64,000 13-18-year-old Icelandic adolescents, and builds on Allegrante and his Icelandic colleagues' previous study , which monitored adolescents mental health during the height of the pandemic, the findings of which were published in Lancet Psychiatry in 2021.

As research continues to develop, Allegrante shares critical takeaways with us:

Post-Pandemic Mental Health Worsened for Girls and Boys

Perhaps the most striking finding of the newest study is that the elevated depressive symptoms and worsened mental health that were observed among adolescent girls and boys during the pandemic were maintained for up to two years into the pandemic. Another is that while alcohol intoxication initially declined during the pandemic, it has increased as social restrictions have been eased. "We wanted to follow up on what we observed initially during the pandemic, particularly substance use," says Allegrante. "We've seen a steady increase since we started monitoring this cause for concern in 2020."

He attributes the uptick in substance use, with alcohol in particular, to post-pandemic changes, noting that as communities opened back up and restrictions lessened, substances became more accessible. "During the pandemic, adolescents were under much stricter parental supervision and spent more time in their homes. As they have begun to move back into the world with less parental oversight, access to these substances is much easier."

But there is some good news: the same study also revealed a significant decrease in adolescent cigarette and e-cigarette use since the beginning of the pandemic. While the reason for this remains unclear, Allegrante notes that the trend is perhaps the "silver lining" of the pandemic's impact on youth.

"It is, of course, positive to see that the reduction in cigarette smoking and vaping remains constant," added Dr. Ingibjorg Eva Thorisdottir, lead author of the study and chief analytics officer at Planet Youth (who studied at Teachers College in 2009 as part of an exchange with Reykjavik University that Teachers College established through an institutional cooperative agreement that was recently renewed). "We will need to monitor alcohol intoxication among adolescents in years to come, especially given the increase in mental health problems."

Social Media is at Play

As teens looked for ways to pass the time and connect with peers, the pandemic ignited an era of TikTok dance challenges paired with an uptick in social media use.

"We are now seeing the ramifications of prolonged lack of social interaction paired with too much social media use, especially for girls," Allegrante explains.

This is evident in a supporting study that observed prolonged social media use in a group of 523 adolescents in Iceland during the height of the pandemic. The study uncovered a pronounced negative impact on females (56.5%) with significant behavioral changes and depressive symptoms. In comparison, males were found to have only a slight disruption in sleep patterns and spent more of their free time playing online games and video games.

Other takeaways from the study implied that factors like concerns about contracting COVID-19, changes in daily and school routines, and not seeing friends in person were among the primary contributors to poor mental health in young females.

"We're still learning from these findings, but the pandemic has certainly shown us that there are significant gender differences regarding mental health and social media use," explains Allegrante, noting that social media use often seems to lead to more harm than good, for example, contributing to negative perceptions of body image among girls.

Sleep and Parental Support are Crucial

While it's no surprise that a good night's rest has many health benefits, Allegrante's findings reveal that sleep is imperative for adolescent cognitive development, performance and mental well-being.

"At a minimum, adolescents need eight hours of sleep to maintain their mental hygiene," he shares. Increased sleep was associated with a lower likelihood of adolescent substance abuse.

"Unsurprisingly, we see it (sleep) linked to decreased substance use among teens because it helps with emotional regulation and mental clarity. They have a much clearer sense of discretion."

Research also shows that parental support is equally crucial to adolescent well-being, with the same links to lower substance use, particularly in males ages 13-15.

"The concept of parental support versus supervision is critical," notes Allegrante. "It's one thing to look over your child's shoulder constantly, but it's another to act as their social support system."

And with youth mental health at stake, parents are asking, "How can I help?" Allegrante explains that asking straightforward questions can make a huge difference. Parents should check in with their children about things they see on the news and inquire about social media use, asking them (adolescents) to limit where possible.

"It's not always easy for parents to recognize a decline in mental health, but it's worthwhile to inquire about behaviors that seem out of the ordinary. If anything, the pandemic has taught us to be more vigilant."

What's Next?

"I'm deeply concerned for our future generations," shares Allegrante. "There are so many factors weighing on their mental health, from political polarization to climate change to the issue of gun violence that we see happening daily."

He concludes from his study that policymakers should consider implementing much more robust and "large-scale evidence-based prevention and treatment efforts" focusing on depressive symptoms to mitigate the negative aftermath of the pandemic and broader issues that are leading to anxiety among young people.

"This timely study - and all of the previous work we have done in substance use prevention - would not have been possible without my long-standing collaboration with the Icelandic behavioral and social scientists with whom I have been privileged to work," he says. "There's a lot at stake, and a lot to be learned from this small Nordic nation. We'll certainly be monitoring these concerns far beyond the pandemic."
- Jacqueline Teschon

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What You Need to Know About the Pandemic's Lasting Effects on Adolescent Mental Health

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TC's John Allegrante shares key findings from new research

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Does Social Media Use Cause Depression? - Child Mind Institute

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Is using social media making our kids unhappy? Evidence is mounting that there is a link between social media and depression. How Instagram and Facebook may be negatively affecting teenagers and young adults.

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Omega-3 fatty acids are found primarily in fish oil and certain marine algae. Because depression appears less common in nations where people eat large amounts of fish, scientists have investigated whether fish oils may prevent and/or treat depression and other mood disorders. Two omega-3 fatty acids - eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) - are thought to have the most potential to benefit people with mood disorders.

How might omega-3s improve depression?

Different mechanisms of action have been proposed. For example, omega-3s can easily travel through the brain cell membrane and interact with mood-related molecules inside the brain. They also have anti-inflammatory actions that may help relieve depression.

More than 30 clinical trials have tested different omega-3 preparations in people with depression. Most studies have used omega-3s as add-on therapy for people who are taking prescription antidepressants with limited or no benefit. Fewer studies have examined omega-3 therapy alone. Clinical trials typically use EPA alone or a combination of EPA plus DHA, at doses from 0.5 to 1 gram per day to 6 to 10 grams per day. To give some perspective, 1 gram per day would correspond to eating three salmon meals per week.

Meta-analyses (research that combines and analyzes results of multiple studies) generally suggest that the omega-3s are effective, but the findings are not unanimous because of variability between doses, ratios of EPA to DHA, and other study design issues. The most effective preparations appear to have at least 60% EPA relative to DHA. While DHA is thought to be less effective as an antidepressant, it may have protective effects against suicide. Recent work at Massachusetts General Hospital and Emory University suggests that depressed individuals who are overweight and have elevated inflammatory activity may be particularly good candidates for EPA treatment.

Children and adolescents with depression may also benefit from omega-3 supplementation. At Harvard, there is a large study underway examining whether omega-3 supplementation (alone or in combination with vitamin D) can prevent depression in healthy older adults.

Omega-3s for other mental health conditions

Omega-3s have been studied in various mood disorders, such as postpartum depression, with some promising results. In bipolar disorder (manic depression), the omega-3s may be most effective for the depressed phase rather than the manic phase of the illness. The omega-3s have also been proposed to alleviate or prevent other psychiatric conditions including schizophrenia, borderline personality disorder, obsessive compulsive disorder, and attention deficit disorder. However, there is still not enough evidence to recommend the omega-3s in these conditions.

What dose of omega-3s is beneficial?

Doses for depression range from less than 1 g/day to 10 g/day, but most studies use doses between 1 and 2 g/day. In my practice, I recommend 1 to 2 g/day of an EPA+DHA combination, with at least 60% EPA, for major depression. I am more cautious in patients with bipolar depression, because the omega-3s may bring on mania, as can most antidepressants. In these individuals, I recommend using omega-3 cautiously, and preferably in combination with a prescription mood stabilizer.

Side effects and other safety considerations

Omega-3s are generally safe and well tolerated. Stomach upset and "fishy taste" have been the most common complaints, but they are less frequent now thanks to manufacturing methods that reduce impurities. Past concerns about omega-3s increasing the risk of bleeding have been largely disproven, but caution is still advised in people taking blood thinners or who are about to undergo surgery. As mentioned, caution is needed in people with bipolar disorder to prevent cycling to mania. Because omega-3s are important to brain development, and pregnancy depletes omega-3 in expectant mothers, supplementation should theoretically benefit pregnant women and their children. Fish consumption in pregnancy is supported by the FDA, but because we do not have long-term data on safety or optimal dosing of omega-3s in pregnancy, expectant mothers should consider omega-3 supplements judiciously.

The bottom line on omega-3s and mental health

Omega-3 fatty acids are promising natural treatments for mood disorders, but we need more research about how they work, how effective they really are, and their long-term safety before we can make conclusive recommendations for people managing mental health conditions or who wish to improve mood.

About the Author

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Omega-3 fatty acids for mood disorders - Harvard Health

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Growing evidence suggests consuming healthy foods and micronutrients fosters better mental health, while poor-quality diets diminish it

Cite this

DeAngelis, T. (2023, June 1). That salad isn't just good for your nutrition- It may help stave off depression. Monitor on Psychology, 54(4). https://www.apa.org/monitor/2023/06/nutrition-for-mental-health-depression

CE credits: 1

Learning objectives: After reading this article, CE candidates will be able to:

1. Explain how the right-or wrong-foods and nutrients affect mental health.

2. Discuss the biology behind good nutritional choices.

3. Describe which mental health conditions have the best research base and what that research is showing.

For more information on earning CE credit for this article, go to CE Corner.

We know that what we eat affects our physical health-that a diet loaded with French fries and burgers is worse for our hearts and waistlines than one that includes regular helpings of steamed broccoli and brown rice.

Less well known are the ways in which food can influence our mental health-not just our immediate mood but also symptoms of depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and other conditions. These discoveries come from a growing line of research known as nutritional psychology or nutritional psychiatry, part of a scientific discipline that recognizes the importance of lifestyle factors such as exercise, spiritual practices, and social support in promoting mental health ( Walsh, R., American Psychologist, Vol. 66, No. 7, 2011).

Researchers in this emerging field have not had it easy: They have encountered skepticism and dismissiveness from many health care professionals and researchers, including psychologists, who tend to downplay the importance of diet in health and mental health or to take issue with various aspects of the research. But findings in the area are becoming sufficiently robust that it is time to start taking them seriously, said clinical psychologist Julia Rucklidge, PhD, who directs the Mental Health and Nutrition Research Lab at the University of Canterbury in New Zealand.

In her view, "psychologists can no longer avoid talking about the relationship between nutrition and mental health."

The psychobiology of good nutrition

Examining the role of diet in mental health has been occurring since the late 1990s, when a cross-national comparison showed a correlation between high fish consumption in a given country and lower annual rates of major depressive disorder ( Hibbeln, J. R., The Lancet, Vol. 351, No. 9110, 1998).

Since then, researchers have been exploring potential influences of food and diet types, dietary patterns, and micronutrients and other supplements on psychological health. In 2005, California-based wellness consultant M. Ephimia (Ephi) Morphew-Lu developed and taught the first course in nutritional psychology at John F. Kennedy University in Pleasant Hill, California, and in 2013, she and Australian psychologist Amanda Hull, PhD, cofounded the Center for Nutritional Psychology, an online repository of information on the topic. And in 2015, members of the International Society for Nutritional Psychiatry Research wrote an influential article, "Nutritional Medicine as Mainstream in Psychiatry," highlighting emerging evidence in the area (The Lancet Psychiatry, Vol. 2, No. 3, 2015).

Since then, researchers have been conducting a range of studies-observational, epidemiological, prospective, clinical, and even "proof of principle" studies for clinical drug development-to examine how diet and nutrition may impact mental health.

They are finding that the same foods that promote physical health foster positive mental health: foods that are whole (versus processed or ultraprocessed); diverse in vitamins and minerals, or micronutrients; and contain enough fiber to help the digestive system effectively process what it takes in. Micronutrient supplements can also be part of the healthy nutrition equation, researchers are finding. Conversely, poor diets that contain a lot of ultraprocessed foods with little nutritional variety or micronutrients appear to exacerbate depression and other mental health problems, according to recent data (see, for example, Lane, M. M., et al., Nutrients, Vol. 14, No. 13, 2022). Alarmingly, Americans now derive most of their calories in a less-than-optimal way: According to the U.S. National Health and Nutrition Examination Survey, U.S. adults obtain 57% of their calories from ultraprocessed foods like packaged pizza and sugary beverages, and for children and teens, that share rises to 67% ( Wang, L., et al., JAMA, Vol. 326, No. 6, 2021; Juul, F., et al., Clinical Nutrition, Vol. 115, No. 1, 2022).

If our brain does not get the right nutrients, our mental health can suffer, noted research psychologist Bonnie Kaplan, PhD, a semiretired professor at the University of Calgary's Cumming School of Medicine and coauthor with Rucklidge of The Better Brain: Overcome Anxiety, Combat Depression, and Reduce ADHD and Stress with Nutrition (Houghton Mifflin Harcourt, 2021). "If you feed the brain what it needs every day, you will provide the foundation it needs for excellent functioning," she said.

An important aspect of her current work is educating health professionals and the public about how the brain processes nutrients. Otherwise, advice on healthy eating remains abstract and is easy to dismiss, Kaplan added. "You have to know why every bite that you put in your mouth feeds the metabolism of your brain," she said.

The brain uses nutrients to support the metabolic work of enzymes, the molecules that convert one chemical into another. Enzymes cannot do that work on their own: To perform their transformational feats, "they need an abundant supply of vitamins and minerals," also known as cofactors, Kaplan explained.

Take the example of serotonin, the "feel good" neurotransmitter that is the target of many antidepressants. To manufacture this neurotransmitter naturally, the brain's chemistry must undergo a complex chain of metabolic steps that depend on the presence of dozens of cofactors, including vitamin B1, riboflavin, copper, and calcium. That same general principle applies to the biochemical manufacturing process for all neurotransmitters, each of which needs its own set of specific cofactors to work efficiently.

Proper "feeding" of the brain leads to better mental health because the right fuel enables it to perform better all around. Eating a healthy, whole-foods diet also reduces excessive inflammation in the body; enhances the activity of the mitochondria, which produce ATP (adenosine triphosphate), the compound that provides cells with energy; and helps the gut microbiome by feeding it healthy digestive microbes, which in turn reduce the number of unhealthy microbes. All these systems are linked to brain health and are therefore probably good for mental health as well, Kaplan said. As one practical example, if therapy patients can think more clearly, they will be better able to understand and act on therapy interventions.

"When people understand that consuming minerals and vitamins enables all their pathways to work in their brains," Kaplan said, "then they're more motivated to pay attention to what they eat."

Diet, depression, and ADHD

Researchers are taking this basic information and studying how different diets impact various mental health conditions. They are finding that diets that feature whole foods and contain diverse nutrients-like those promoted in the Mediterranean, Japanese, and Norwegian diets-can have a positive impact on many conditions. They are also finding that high-quality vitamin and mineral supplements-as well as amino acids, herbal formulations, and probiotics-can help as well. (For recent clinical guidelines on this topic, see Sarris, J., et al., The World Journal of Biological Psychiatry, Vol. 23, No. 6, 2022).

Depression is the most widely examined condition in this research, with studies showing that improved nutrition can help people with both nonclinical and clinical levels of the disorder. For example, a meta-analysis of 16 randomized controlled trials-mostly with samples of people who had nonclinical depression-found that dietary interventions significantly reduced depressive symptoms though they had less effect on anxiety, found Joseph Firth, PhD, of the University of Manchester in the United Kingdom, and colleagues (Psychosomatic Medicine, Vol. 81, No. 3, 2019).

Similarly, a randomized controlled trial conducted by South Australia-based psychologist Natalie Parletta, PhD, and colleagues found positive effects of a healthy diet intervention for adults with self-reported depression. Ninety-five participants received either 3 months of biweekly cooking classes featuring a Mediterranean diet and 6 months of fish-oil supplements or 3 months of biweekly fun and stimulating social groups along with 3 additional months of fish-oil supplements.

The moods of all participants improved by the end of 6 months, but the diet group did better: Their depression scores fell by 45% compared with 26.8% in the social group. In addition, the diet group's reduced depression was related to specific types of food intake, including eating a diversity of vegetables, consuming nuts, and adhering to a Mediterranean diet overall (Nutritional Neuroscience, Vol. 22, No. 7, 2019).

High-quality diets also appear to have a positive effect on people with major depressive disorder, other studies are finding. In a randomized controlled trial known as SMILES (Supporting the Modification of Lifestyle in Lowered Emotional States), psychiatric epidemiologist Felice N. Jacka, PhD, director of the Institute for Mental and Physical Health and Clinical Translation (IMPACT)'s Food & Mood Centre at Deakin University in Victoria, Australia, and colleagues tested two interventions on adults with major depressive disorder. Thirty-three participants received seven individual nutritional consulting sessions delivered by a clinical dietitian, and 34 other participants received seven visits from trained personnel who "befriended" them-who chatted with them about subjects of interest and engaged with them in fun and positive activities. After 12 weeks, 32.3% of those in the dietary group had no reported symptoms of depression, compared with 8% of those in the social support group (BMC Medicine, Vol. 15, No. 1, 2017). Similar results were found in a randomized controlled trial by Jessica Bayes, PhD, of the University of Technology Sydney in Australia, and colleagues, who showed that a 12-week Mediterranean diet intervention improved moderate to severe depression symptoms in young men more than a befriending intervention (The American Journal of Clinical Nutrition, Vol. 116, No. 2, 2022).

Another condition that is showing promise with nutritional interventions is ADHD, a major focus of Rucklidge's work. In 2014, she and colleagues conducted the first blinded randomized controlled trial to examine the effects of a micronutrient supplement on adults with ADHD.

Compared with 38 participants who took a placebo, 42 participants who took the formula reported having fewer ADHD symptoms, including inattention, hyperactivity, and impulsivity, at the end of 8 weeks. Moreover, among participants who had moderate to severe depression at the beginning of the study, those who took the supplement were much more likely to report improved mood at the end of the study than those taking the placebo. But there were no differences between groups on clinician ratings of ADHD (The British Journal of Psychiatry, Vol. 204, No. 4, 2014).

In a second blinded randomized controlled trial, Rucklidge and colleagues compared how nonmedicated children diagnosed with ADHD fared over 10 weeks when they received a placebo or a broad-spectrum micronutrient formula.

At the end of the study, 32% of the children taking the supplement showed clinically meaningful improvement on symptoms of inattention, compared with 9% of kids taking the placebo. They also had greater improvements in emotional regulation, aggression, and general functioning (The Journal of Child Psychology and Psychiatry, Vol. 59, No. 3, 2018).

Those findings were replicated in another randomized controlled trial headed by psychologist Jeanette M. Johnstone, PhD, of the Oregon Health and Science University in Portland. Over the course of 8 weeks, 135 nonmedicated children with ADHD at three sites-Portland, Oregon; Columbus, Ohio; and Alberta, Canada-received either a placebo or a broad-spectrum multinutrient containing all known vitamins and essential minerals.

More than half of those who received the formula-54%-showed improved symptoms overall, compared with 18% of controls, based on blinded clinician ratings. The findings suggested another potential benefit as well: Children on the formula grew six millimeters taller over 8 weeks than kids on placebo when other basic factors were controlled for. That is a potentially important finding because suppressed height may be a concern with standard ADHD medications, Johnstone noted (Journal of the American Academy of Child & Adolescent Psychiatry, Vol. 61, No. 5, 2022).

Others are investigating the effects of nutritional interventions on more serious conditions as well, including bipolar disorder, eating disorders, and psychotic disorders, as well as autism. They are also looking into the effects of particular kinds of diets and foods on some of these disorders. These include potential impacts of the ketogenic (low-carb, high-fat) diet on bipolar disorder ( Campbell, I. H., & Campbell, H., BJPsych Open, Vol. 5, No. 4, 2019) and Alzheimer's disease ( Phillips, M. C. L., et al., Alzheimer's Research & Therapy, Vol. 13, No. 51, 2021), and of a gluten-free diet as an adjunctive treatment for people with schizophrenia ( Levinta, A., et al., Advances in Nutrition, Vol. 9, No. 6, 2018). While there is some promise in all these areas, more research is needed to demonstrate their effectiveness, according to these studies.

Researchers conducting this work also comment that it raises questions about what constitutes good treatment in general, including about the kinds of outcomes providers should be looking for.

For example, while Rucklidge's study on children with ADHD found improvements on symptoms like inattention, there were no group differences on parent and teacher reports of hyperactivity and impulsivity, some of the main hallmarks of the disorder. But parents and teachers did see a rise in other positive outcomes that are not specifically related to ADHD symptoms, such as reduced anger and a greater ability to regulate emotions and cope with stressors.

In addition, children in the study did not have to cope with side effects that can sometimes occur with traditional ADHD medications, such as dizziness, moodiness, loss of appetite, and trouble sleeping. Instead, by applying nutritional interventions that do not have these side effects, some kids can improve functioning and learn better. "So, when we think about treatments for these kids, I really do encourage a more holistic approach," Rucklidge said. In fact, she has applied for and received approval from Pharmac, New Zealand's equivalent of the Food and Drug Administration, for practitioners to prescribe the micronutrient formula used in her studies as a second-tier treatment. So if conventional medications have not worked or have intolerable side effects, practitioners can try these supplements instead. (There are still many steps that need to occur before Pharmac will actually pay for the use of the formula, however, Rucklidge noted.)

Microbiome research

In another line of inquiry, mental health investigators are entering the "hot" research area of the gut microbiome, finding early evidence that a good diet may influence the microbiome, which in turn may influence mental health.

Because of the microbiome's potential in the area, many of the studies at Deakin University's Food & Mood Centre include examining changes in the microbiome before and after a given intervention, mainly via stool samples, said research psychologist Amy Loughman, PhD, who heads the microbiome research team there.

A study by Samantha Dawson, PhD, also of Deakin University, Loughman, and colleagues, for example, tested the diets and gut microbiome diversity of 213 women in their third trimester of pregnancy and then looked at child outcomes at age 2. Children of women with greater gut microbiome diversity in pregnancy had fewer anxious, depressive, and withdrawn behaviors than toddlers whose moms had less diverse gut microbiomes during pregnancy. In addition, the team found that women with greater gut microbiome diversity had eaten healthier prenatal diets than women with less diverse gut microbiomes (eBioMedicine, Vol. 68, No. 103400, 2021).

Another recently completed study at the center involves "fecal transplantation"-taking bacteria from the gut of a healthy donor and transferring it into a person with depression. The procedure has been used successfully to treat medical patients with Clostridioides difficile (C. diff.), a painful intestinal condition associated with an unhealthy gut microbiome. Their study concluded that the intervention was possible to do and acceptable to participants, but that more research on larger sample sizes is needed to determine efficacy (Canadian Journal of Psychiatry, online first publication, 2023).

As these studies show, work on the microbiome is promising but still in the nascent stages, Loughman noted. "It's a balance between people being excited about the microbiome and seeing it as a different avenue through which to impact mental health and not getting swept up in the hype that we should all test our microbiomes and that's how we're going to do therapy from now on," she said.

Putting it into practice

Other areas of nutritional psychology and psychiatry need more investigation as well. One emerging area of interest is examining how to tailor micronutrients to specific individuals. That is because many variables-genetics, medication use, stress, and more-can influence the amount and sometimes types of nutrients a particular individual needs. In a similar vein, researchers are starting to examine how different types of diets may benefit different types of individuals.

That said, there is enough good information available that clinicians can safely incorporate it into their practices without concerns about scope of practice, particularly if they are giving general advice or guidance, these researchers added. (Understanding specialized diets and problems requires more expertise and study.)

"Psychologists can learn the basics of nutrition really simply," said Rucklidge, through continuing-education classes or other vetted online courses. Having conversations with patients about ultraprocessed foods and poorer mental health, she noted, is akin to talking about the harmful effects of alcohol or other substances.

Kaplan suggests starting by saying, "There is increasing evidence that what we eat affects how we feel," and then noting the health benefits of a whole-foods diet. She then recommends asking patients to describe what and how they eat-how many times a day or week they think they consume key elements of healthy or less healthy diets such as sugary drinks, refined carbohydrates, green vegetables, or fruit. "Don't evaluate or score this in any way," she said, "but ask them where they think they might want to make some changes."

Next, point out that eating whole foods does not need to be expensive, a common myth. Have patients keep track of weekly food expenses for 2 weeks, and then have them do the same after shopping for a whole-foods diet, she suggested. Beans, rice, and veggies are likely to be less expensive than a few trips to a fast-food chain, for example.

Some psychologists are opting for training in nutrition to further amplify this aspect of their practices. Lauren Broch, PhD, who also incorporates behavioral sleep medicine and other lifestyle approaches into her private practice at Greenwich Hospital in Greenwich, Connecticut, earned a master's degree in nutritional science to support her patients around nutrition. She uses psychoeducation on the basics of a healthy diet and lifestyle, as well as behavioral approaches like having patients keep food logs and use feedback systems to start changing their eating patterns.

She is seeing gratifying results: "Over time, people notice that they just feel lighter-less bloated, with fewer digestive issues," she said. "They also have better moods and report that they're sleeping better."

"We're starting to realize that what we eat is not just about the calories-it's also about the nutrition and the information that's in that nutrition," Broch added. "Food is information, and it's also medicine. Helping patients take advantage of that knowledge is an invaluable part of my practice."

Further reading

The better brain: Overcome anxiety, combat depression, and reduce ADHD and stress with nutrition
Kaplan, B. J., & Rucklidge, J. J., Houghton Mifflin Harcourt, 2021

Nutrition provides the essential foundation for optimizing mental health
Rucklidge, J. J., et al., Evidence-Based Practice in Child and Adolescent Mental Health, 2021

Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder
Marx, W., et al., The World Journal of Biological Psychiatry, 2022

Diet and mental health
Loughman, A., et al., In Cowan, C. S. M., & Leonard, B. E. (Eds.), Microbes and the Mind: The Impact of the Microbiome on Mental Health, Karger, 2021

Efficacy of low carbohydrate and ketogenic diets in treating mood and anxiety disorders: Systematic review, implications for clinical practice
Dietch, D., et al., BJPsych Open, 2023

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Key points

1. Growing evidence suggests that consuming healthy foods and micronutrients fosters better mental health, while poor-quality diets diminish it.

2. Depression and attention-deficit/hyperactivity disorder have the best evidence so far to support this link.

3. At a basic level, diets for mental health include whole foods, foods diverse in vitamins and minerals, and plenty of fiber-information that is safe to share with patients without concerns about scope of practice.

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That salad isn't just good for your nutrition-it may help stave off depression

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Growing evidence suggests consuming healthy foods and micronutrients fosters better mental health, while poor-quality diets diminish it.

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Image: iStock

If you suffer from anxiety, the constant, nagging feelings of worry can be troubling and hard to control. These feelings are usually intense and out of proportion to the actual troubles and dangers in your everyday life. They can make it hard to function at home, at work, or in social situations.

Anxiety can be treated with medication, but several mind-body approaches may also be effective.

Hypnosis is sometimes used along with cognitive behavioral therapy to treat anxiety. It can help people focus their attention, rethink problems, relax, and respond to helpful suggestions. Hypnosis relies mainly on your ability to concentrate and on the trust you have in the therapist. If you are interested in hypnosis, discuss it first with your psychiatrist or psychologist. She or he can help you find a qualified practitioner.

Biofeedback measures specific body functions, such as heartbeat or breathing, and feeds this information back to you in the form of sounds or lights. This can help you become aware of your body's responses and learn to control them using relaxation and cognitive techniques. You can practice different relaxation techniques while attached to biofeedback equipment and get immediate sensory input about which techniques produce the desired results, such as slowing the heart rate or relaxing tense muscles. The hope is that this extra feedback helps people find - and refine - techniques that can calm the body and reduce anxiety.

Other relaxation techniques that may ease anxiety include deep (diaphragmatic) breathing, visualization, and body scanning.

Deep breathing

To practice this technique, begin by finding a comfortable, quiet place to sit or lie down. Start by observing your breath. First, take a normal breath. Now try taking a slow, deep breath. The air coming in through your nose should feel as though it moves downward into your lower belly. Let your abdomen expand fully. Now breathe out through your mouth (or your nose, if that feels more natural). Alternate normal and deep breaths several times. Pay attention to how you feel when you inhale and exhale normally and when you breathe deeply. Shallow breathing often feels tense and constricted, while deep breathing produces relaxation.

Continue this for several minutes. Put one hand on your abdomen, just below your belly button. Feel your hand rise about an inch each time you inhale and fall about an inch each time you exhale. Your chest will rise slightly, too, in concert with your abdomen. Remember to relax your belly so that each inhalation expands it fully.

Try to practice this breathing technique for 15 to 20 minutes every day. You might also try shorter bouts lasting a few minutes when anxiety begins to build, to see if this feels calming.

To learn more about how to keep anxiety and phobias from interfering in your life, buy Coping with Anxiety and Stress Disorders, a Special Health Report from Harvard Medical School.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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Treating anxiety without medication - Harvard Health

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If you suffer from anxiety, the constant, nagging feelings of worry can be troubling and hard to control. Anxiety can be treated with medication, but several mind/body approaches may also be effect...

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How effective are antidepressants?

Antidepressants are the most effective medication for treating depression symptoms. But just like with many other medications, antidepressants may help some people more than others.

Studies show that the benefit of the antidepressant generally depends on the severity of the depression - the more severe the depression, the greater the benefit or "effectiveness" will be. Antidepressants are usually effective in moderate, severe and chronic depression. They don't tend to help mild depression.

It's important to remember that psychotherapy is another important part of depression treatment. Combining psychotherapy and depression medication will usually produce the largest improvement in your symptoms.

What are the side effects of antidepressants?

Each type (class) of antidepressant and each brand has different possible side effects. It's important to talk to your provider or a pharmacist about possible side effects of the specific medication you're taking or thinking of taking.

In general, common side effects of antidepressants include:

Side effects of antidepressants are usually mild and improve with time. Talk to your provider if you experience unpleasant side effects. They may recommend adjusting your dose or trying a different medication.

Do antidepressants cause weight gain?

Weight gain is a possible side effect of some antidepressants, though some are associated with no weight gain or even weight loss. It's important to remember that several factors can contribute to weight gain. For example:

Some people lose weight due to loss of appetite caused by untreated depression. Taking antidepressants to treat depression can improve your mood and appetite, which could lead to weight gain due to your appetite being restored.

Adults tend to gain weight as they age in general.

If you're concerned about this possible side effect, talk to your provider. Know that the benefits of taking an antidepressant may outweigh possible weight gain. There are also steps you can take to manage your weight, such as exercise or adjusting your eating patterns.

What are the possible complications of taking antidepressants?

Possible complications associated with antidepressants include:

SSRI medications are also associated with a modest increase in the risk of upper gastrointestinal bleeding. This risk is significantly elevated when you take an SSRI in combination with nonsteroidal anti-inflammatory drugs (NSAIDs). Talk to your healthcare provider about this risk.

Suicidal thoughts or behavior

In some cases, children, teens and adults under the age of 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially when they first start them or when they take a different dose.
If you or your child have suicidal thoughts or behavior, call the healthcare provider who prescribed the medication immediately. You can also dial 988 on your phone to reach the Suicide and Crisis Lifeline. Someone is available to help you 24/7.
Antidepressant discontinuation syndrome

Antidepressant discontinuation syndrome can happen if you suddenly stop taking your antidepressant if you've taken it for at least six weeks. It happens in about 20% of these cases.

Symptoms of antidepressant discontinuation syndrome include:

Flu-like symptoms, such as fatigue, headache, achiness and sweating.

Insomnia.

Nausea.

Dizziness and lightheadedness.

Sensory issues, such as burning, tingling or shock-like sensations.

Anxiety, irritability and agitation.

These symptoms are usually mild, but they can be unpleasant. They typically last one to two weeks.

Never stop taking your antidepressant without talking to your healthcare provider first. Safely stopping antidepressants is a process. It usually takes at least four weeks to taper off by slowly reducing your dose.

Serotonin syndrome

Serotonin syndrome is an extremely rare but potentially life-threatening drug reaction that results from having too much serotonin in your body.

Serotonin syndrome can happen when you either take a new antidepressant or take an increased dose. If your body processes serotonin differently or it can't process an increased amount of serotonin, serotonin syndrome can happen.

The syndrome most often happens when you take an antidepressant and other serotonergic drugs such as triptan migraine drugs or certain opioids such as meperidine.

Symptoms of serotonin syndrome include:

Nervousness.

Nausea and vomiting.

Diarrhea.

Dilated pupils.

Muscle issues, like twitching, involuntary contractions, spasms and rigidity.

Sweating and shivering.

Side-to-side eye movements.

Severe symptoms include:

Symptoms usually begin within a few hours of taking a new medication or increasing the dose of a drug you're already taking.
Get immediate medical help if you're experiencing these symptoms. Serotonin syndrome can be fatal if it's not treated in time.
Overdose

The toxicity of antidepressants varies greatly. It's important to talk to your healthcare provider or pharmacist about the risk of overdose. Always take your medication as prescribed and store your medications safely away from children and pets.

Tricyclic antidepressants are the class of antidepressants with the highest risk of fatality if they are taken in overdose. If you ever suspect an overdose - in yourself or a loved one - get medical help right away.

Signs and symptoms of an overdose of tricyclic antidepressants include:

Other classes of antidepressants can lead to overdose as well, but the symptoms may be different. For example, SSRI overdoses can cause high blood pressure and certain types of arrhythmias.

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Antidepressants are prescription medications that help treat depression. Healthcare providers prescribe them to treat other conditions as well, such as anxiety and OCD.

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Chances are good that you, or someone you know, is dealing with anxiety. One in five Americans over 18, and one in three teenagers 13 to 18, reported having a chronic anxiety disorder during the past year. And when I talk to college students, they're not at all surprised that a whopping 63% of students felt tremendous anxiety during their freshman year, according to a report by the National College Health Association.

The toll of anxiety can be high: it increases a person's risk for other psychiatric disorders like depression, and can contribute to diabetes and cardiovascular problems. One sobering study shows that people with anxiety tend to be more sedentary and do less intense forms of physical activity, if any. That's ironic, because lacing up your sneakers and getting out and moving may be the single best nonmedical solution we have for preventing and treating anxiety.

As a psychiatrist who studies the effects of exercise on the brain, I've not only seen the science, I've witnessed firsthand how physical activity affects my patients. Research shows aerobic exercise is especially helpful. A simple bike ride, dance class, or even a brisk walk can be a powerful tool for those suffering from chronic anxiety. Activities like these also help people who are feeling overly nervous and anxious about an upcoming test, a big presentation, or an important meeting.

How does exercise help ease anxiety?

Engaging in exercise diverts you from the very thing you are anxious about.

Moving your body decreases muscle tension, lowering the body's contribution to feeling anxious.

Getting your heart rate up changes brain chemistry, increasing the availability of important anti-anxiety neurochemicals, including serotonin, gamma aminobutyric acid (GABA), brain-derived neurotrophic factor (BDNF), and endocannabinoids.

Exercise activates frontal regions of the brain responsible for executive function, which helps control the amygdala, our reacting system to real or imagined threats to our survival.

Exercising regularly builds up resources that bolster resilience against stormy emotions.

The details

So exactly how much exercise does one need to protect against episodes of anxiety and anxiety disorders? While pinpointing this is not easy, a recent meta-analysis in the journal Anxiety-Depression found that people with anxiety disorders who reported high-level physical activity were better protected against developing anxiety symptoms than those who reported low physical activity. Bottom line: when it comes to treating anxiety, more exercise is better.

If you're just starting out, don't despair. Some research also shows that just a single bout of exercise can help ease anxiety when it strikes.

Which type of exercise you choose may not matter greatly. Studies point to the effectiveness of everything from tai chi to high-intensity interval training. People experienced improvement no matter which types of activity they tried. Even general physical activity is helpful. The important thing is to try activities and keep doing them.

To maximize the benefits:

Choose something enjoyable so you will do it repeatedly, building resilience.

Work toward getting your heart rate up.

Work out with a friend or in a group to reap the added benefit of social support.

If possible, exercise in nature or green space, which further lowers stress and anxiety.

While scientific studies are important, you don't need to consult a chart, statistics, or an expert to know how good you feel after working up a sweat. Remember those feelings and use them as motivation to do something physical every day. Time to get up and get moving!

Follow me on Twitter @jratey

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Can exercise help treat anxiety? - Harvard Health

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Millions of Americans report having an anxiety disorder. Evidence shows engaging in any sort of physical activity is one of the best ways to ease symptoms of anxiety. Regular activity is best, but even a single bout can help.

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All teens feel sad or moody at times. But when a sad or bad mood lasts for weeks or longer - and when there are other changes in how a teen acts - it could be a sign of depression.

Depression can get better with the right therapy. But problems can last or get worse if they are not treated. Besides therapy, teens who feel depressed need extra support from parents and other adults in their lives.

If you think your teen is depressed, talk with them. Let them know you want to understand what they are going through. Listen if they want to talk.

Schedule a visit with their doctor or a therapist to check for depression. If your teen is depressed, the doctor can explain what they (and you) can do to help. It's best to treat depression early.

How Can I Tell if My Teen Is Depressed?

When teens are depressed, parents may notice a sad or bad mood that lasts for weeks or longer. They may notice other changes, such as:

Negative outlook. Teens who feel depressed may be hard on themselves or on others. They might focus on failures and setbacks. It may be hard for them to see the good parts of things, or the good parts of themselves.

Low energy, effort, interest, enjoyment. Teens may lose interest in things they used to enjoy. They may not seem to care. They may put less effort into schoolwork or tasks at home. Things seem to take too much effort. Nothing seems fun or enjoyable.

Changes in sleep. Teens may sleep more or have trouble getting up when they need to. They may have trouble sleeping.

Changes in eating. Some teens with depression show less interest in food and may lose weight. Some eat more than before and may gain weight.

Doing poorly at school. When a teen feels depressed, school work can seem harder. They may not complete their work, show effort, or study as much for tests. Their grades may drop.

Pulling away from friends and family. Teens may spend more time alone, less time with friends, or seem distant.

Risky or harmful behaviors. Depression can lead some teens to misbehave, get in trouble, or argue more. They may show risky behaviors. Some turn to alcohol, drugs, or to self-harm.

Thoughts or talk of suicide. Some depressed teens have thoughts of suicide. If you think your teen is thinking of suicide, ask them about it - calmly and with love. Knowing they have someone they can turn to can help protect teens from acting on those thoughts. It also lets you know if your teen needs immediate help.

If your teen is thinking or talking of suicide, find help and guidance right away. Visit the 988 Suicide & Crisis Lifeline website, or call or text 988. You can also take your teen to a hospital emergency room or call 911.

Is Your Child Depressed?

How can parents know what's typical moodiness and when there is a problem? Learn the signs of depression and ways to help your child feel better.

Why Do Some Teens Feel Depressed?

Teens may become depressed for different reasons. There's no single cause. Genes, hormones, and life events can all play a role.

Some teens may be more sensitive to depression because of genes they inherit. Genes influence areas of the brain that affect mood and energy. Teens who feel depressed may have family members who have been depressed, too.

Hormone changes that happen with puberty can affect mood. Some teens are sensitive to hormone shifts that happen with seasonal changes in daylight. They may become depressed at the same time each year, in fall or winter, when daylight hours are shorter. This is called seasonal depression (or seasonal affective disorder).

Life events and personal events may play a role. Many teens have been through loss, family hardship, family conflict, or difficult health challenges. Some have lived with violence or faced trauma. These things don't always lead to depression. But they can - even when teens get good support and have plenty of inner strength.

No matter what plays a role in why teens become depressed, the right treatment can help them get better.

What Is the Treatment for Depression in Teens?

There are several evidence-based treatments that work for depression in teens. They include these types of talk therapy:

cognitive behavioral therapy (CBT)

dialectical behavior therapy (DBT)

interpersonal therapy (IPT)

attachment-based family therapy (ABFT)

Each of these therapies targets different aspects of depression. Therapists might use a few of these in a teen's treatment. The details of treatment depend on what the teen needs and how severe their symptoms are.

Therapists plan each teen's treatment after first doing a careful exam. They will talk with you and your teen to explain the treatment they recommend. Sometimes, doctors also prescribe medicines to help teens who are depressed.

How Does Therapy Help Teens Who Are Depressed?

Therapy helps teens explore and resolve their depression. In therapy, teens may learn to:

feel understood and closer to others

talk about their feelings, thoughts, and events that matter to them

manage strong emotions and moods

reduce harmful or risky behaviors

regain energy and motivation

improve their emotions, thoughts, and outlook

learn and practice coping skills

restore healthy family bonds or boundaries, as needed

build on their inner strengths

find hope and healing, increase their joy and optimism

What Should I Do if I Think My Teen Is Depressed?

If you think your teen might be depressed:

Talk with them. Show extra love and support. Let them know you care and want to hear what they're going through. When they're depressed, many teens feel alone, distant, or unlovable. Small gestures of caring can help them feel less alone.

Take them to see their doctor. Set up a visit with your teen's doctor or a mental health provider to check for depression. Medical providers also can check for other health or mental health issues that might be causing your teen's symptoms. They can explain what they (and you) can do to help your teen.

Date reviewed: September 2021

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Depression in Teens: How Parents Can Help

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All teens feel sad or moody at times. But when a sad or bad mood lasts for weeks or longer, and when there are other changes in how a teen acts, it could be a sign of depression. Find out what to do.

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By: Claire McCarthy, MD, FAAP

According to the National Institutes of Health, nearly 1 in 3 of all adolescents ages 13 to 18 will experience an anxiety disorder. These numbers have been rising steadily; between 2007 and 2012, anxiety disorders in children and teens went up 20%.

These stats combined with the rate of hospital admissions for suicidal teenagers also doubling over the past decade leaves us with many concerning questions.

What's causing the rise in teenagers with severe anxiety? How did we get here?

What's going on? While we don't know for sure, there are a number of factors that could be contributing. In addition to genetics, brain chemistry, personality, and life events, take the following into consideration:

High expectations and pressure to succeed. Between standardized testing and aculture of achievement, today's youth can feel pressure to succeed in ways previous generations did not. A survey done every year byHigher Education Research asks incoming college freshmen if they feel overwhelmed by all they have to do. In 2016, 41% of students said "yes" compared with 28% in 2000 and 18% in 1985.

A world that feels scary and threatening. We've seen an increase in school shootings, with resultant drills and lockdowns in schools. We've seen shootings in public places. There have been terrorist attacks here in the US and around the world taking many lives. From just watching or reading the news, it is reasonable for anyone to feel afraid in public spaces that previously would have felt safe.

Social media. Today's children and teens are constantly connected to social media. It's not surprising that their self-esteem―and worldview ―becomes connected to responses to social media posts. It's hard for them not to compare their life and social connections to what they see others posting on social media.

There are also some children who have unexpected and disproportionate reactions to normal developmental experiences like going to school, going to a party, doing a sleepover or going to camp; children who worry excessively about everyday life activities. This often starts in the years right before puberty.

Whatever the cause, this rise in anxiety is a real problem for our youth.

Chronic anxiety can lead to serious mental health problems― depression, substance use, and even suicide. It can interfere with the ability to focus and learn causing school problems that can have lifelong impact. It can also lead to physical problems, such as headaches, chronic pain, digestive problems, and later heart disease.

Anxiety disorders cut across all demographics―suburban, urban, and rural. They affect those who are college-bound and those who are not.

Be aware of the signs of anxiety. Sometimes children may say that they are anxious, but other times it is less clear―especially as they may not even realize it themselves. Signs can include:

Recurring fears and worries abo ut routine parts of every day life

Changes in behavior, such as irritability

Avoiding activities, school, or social interactions

Dropping grades or school avoidance

Trouble sleeping or concentrating

Substance use or other risky behaviors

Chronic physical complaints, such as fatigue, headaches, or stomachaches.

Talk with kids about potential stressors. Try to see the world the way they do-and help them to keep perspective and find ways to cope.

Be mindful of the expectations you set for children and teens. High expectations can help children reach their potential, but they need to be realistic ones. Not only that, remember that kids need time to relax, play, and be with friends-all of which are crucial for their mental and physical health. And it's important for all of us to remember that there is more to life than achievement.

Talk with kids about their social media use. Help them take breaks-and help them think critically and rationally about the effect of social media on their lives. See How to Connect with Your Teen about Smart & Safe Media Use.

So, what can parents, teachers, and anyone else who interacts with children and teens do?

How pediatricians screen kids for anxiety:

At visits―whether they are well child visits or appointments made because of a concern―pediatricians ask questions about a child's physical complaints, mood, behavior and activities, as well as what is going on at school, at home, and in other areas of life.

Pediatricians also use screening tools such as the Pediatric Symptom Checklist (PSC) that look for signs of various different mental health problems, including anxiety. Pediatricians often refer to mental health professionals, as well, in order to more fully evaluate children when there is a concern.

Know anxiety is treatable!

According to the Anxiety and Depression Association of America, 80% of kids with a diagnosable anxiety disorder are not getting treatment―and anxiety disorders are highly treatable! As with most problems, the earlier it is diagnosed the easier it is to treat.

CBT focuses on changing how the child thinks about his fear, increasing exposure to feared situations, and relaxation strategies such as deep breathing, muscle relaxation, and positive self‐talk (repeating positive or reassuring statements to oneself). Exposure therapy, a type of CBT, focuses on increasing exposure to feared objects or activities.

SSRIs (selective serotonin reuptake inhibitors) ―commonly prescribed antidepressants―are the medications most frequently used for treating anxiety disorders in children.

The most effective treatments with for anxiety disorders are cognitive‐behavioral therapy (CBT) and SSRI medications.

Studies have found a combination of CBT and medication for 12 weeks yields a positive response in 80% of children with anxiety disorders. In fact, 65% of those children had no or minimal anxiety symptoms after the 12 weeks of treatment. With CBT alone, 60% had a positive response―about 35% of those children having no or minimal anxiety symptoms. However, it is important to note that SSRI medications can be administered safely and be an important part of child's anxiety disorder treatment.

As with any mental health disorder, anything that supports general wellbeing is an important part of anxiety disorder treatment―regular sleep, exercise, meditation, relaxation apps or yoga can be helpful. However, these are not a substitute for CBT or medication.

The most important thing is to be aware of your children's mental health, ask questions, and ask for help!

Additional Information:

About Dr. McCarthy:

Claire McCarthy, MD, FAAP is a primary care pediatrician at Boston Children's Hospital, an Assistant Professor of Pediatrics at Harvard Medical School, a senior editor for Harvard Health Publications, and an official spokesperson for the American Academy of Pediatrics. She writes about health and parenting for the Harvard Health Blog, Huffington Post and many other online and print publications.

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Anxiety in Teens is Rising: What's Going On?

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The number of teens with anxiety disorders has been rising steadily―along with hospital admissions for teens who are suicidal. This leaves parents, teachers, and anyone who interacts with these kids with many concerning questions. Read on.

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Tailored in-person and app-based interventions for anxiety are allowing psychologists to expand their reach

Cite this

DeAngelis, T. (2022, October 1). Anxiety among kids is on the rise. Wider access to CBT may provide needed solutions. Monitor on Psychology, 53(7). https://www.apa.org/monitor/2022/10/child-anxiety-treatment

Learning objectives: After reading this article, CE candidates will be able to:

1. Identify the main anxiety disorders in children and teens, the best evidence-based treatment for them, and what that treatment looks like.

2. Discuss differences and similarities in how children and teens present with anxiety disorders.

3. Identify which youth are most at risk for these disorders, and how to help them.

For more information on earning CE credit for this article, go to CE Corner.

Even before the Covid-19 pandemic, growing numbers of young people were experiencing high rates of clinical-level anxiety. About 11.6% of kids had anxiety in 2012, up 20% from 2007. But during the pandemic, those numbers nearly doubled, such that 20.5% of youth worldwide now struggle with anxiety symptoms, according to a meta-analysis of 29 studies reported in JAMA Pediatrics (Vol. 175, No. 11, 2021). Besides Covid-related stressors like social isolation, missed milestones, and increased family tension, background stressors such as school shootings, political unrest, and the war in Ukraine have likely fueled these increases.

These soaring numbers are clashing with a major crisis in mental health provision, and most children and teens with anxiety disorders are not getting the help they need. Factors exacerbating this problem include long waiting lists to see a psychologist, a dearth of trained providers, and a disproportionate lack of access to quality care for low-income individuals and people of color, according to those who study and treat these disorders.

But for children and parents who find the right care, there is great news: "There are effective treatments for anxiety disorders, and those treatments are pretty darn good," said Temple University's Philip Kendall, PhD, who directs the Child and Adolescent Anxiety Disorders Clinic there. In a major randomized controlled study by John T. Walkup, MD, Kendall, and colleagues, 60% of young people who received a full dose of tailored cognitive behavioral therapy (CBT)-a program called "Coping Cat"-improved significantly, and those numbers rose to 80% when they also took sertraline (Zoloft), an anti-anxiety medication (New England Journal of Medicine, Vol. 359, No. 26, 2008).

Another positive development is that the medical community is seeing the value of homing in on anxiety disorders: In April, a group of experts making up the independent U.S. Preventive Services Task Force recommended that all young people ages 8 to 18 receive regular screening for anxiety. And thanks to increased public awareness about mental health issues, stigma surrounding anxiety is down, and psychologists say more parents are open to seeking anxiety treatment for their children.

When kids get appropriate treatment for anxiety, it can make an enormous difference in the trajectory of their lives, said Kathryn D. Boger, PhD, ABPP, co-founder of the McLean Anxiety Mastery Program at McLean Hospital and co-founder and chief clinical officer of InStride Health, a new virtual company that broadly disseminates evidence-based anxiety and OCD treatment to young people.

The right treatment provides struggling youth with "a powerful way to start to understand the world and to face new and hard challenges," Boger said. "And they will take the skills they learn with them for the rest of their lives."

Main anxiety disorder types

The current iteration of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), the DSM-5-TR (text revision), lists 11 anxiety disorders in total. That is a change from the DSM-4, which included obsessive-compulsive disorders and trauma-based symptoms within the anxiety disorders category. Those conditions are now listed separately, though they often overlap with anxiety disorders.

The most common anxiety disorders in children and teens are:

Generalized anxiety disorder: This is pervasive worry or anxious feelings across all domains of life. These kids "are worried across the board-about their performance, their friend group, their health, their pet's health, their parents' health," said Ellen Flannery-Schroeder, PhD, who heads the Child Anxiety Program at the University of Rhode Island and specializes in treating anxiety disorders. These youth may experience physiological anxiety reactions such as upset stomach, muscle tension, difficulty relaxing, difficulty falling asleep, difficulty concentrating, and feeling fatigued or on edge.

Separation anxiety disorder: Particularly common in younger children, this intense fear of being separated from a primary caregiver goes beyond the developmental norm. Children may be reluctant or refuse to go out or sleep away from home without the caregiver and may experience nightmares about separation. They fear that something bad might happen to that person and the person will never return, leaving them alone and unprotected, explained Rachel Merson, PsyD, clinical director of the Child and Adolescent Fear and Anxiety Treatment Program at Boston University's Center for Anxiety and Related Disorders.

Social anxiety disorder: This condition is especially likely to affect teens, though it occurs in younger children as well. These young people are intensely afraid of social situations where they might feel embarrassed or judged and will avoid the situation or endure it only with great anxiety, according to the DSM-5. Other common symptoms include having difficulty making friends, avoiding social situations, worrying for days before a social event, and feeling shaky, sweaty, or nauseous in feared social settings.

Panic disorder: More common in teens than in younger children, this condition is marked by recurrent, unexpected panic attacks and persistent concern and worry about having another attack. According to the DSM-5, panic attacks are "abrupt surges of intense fear or extreme discomfort that reach a peak within minutes, accompanied by physical and cognitive symptoms such as palpitations, sweating, shortness of breath, fear of going crazy, or fear of dying." These reactions can occur unexpectedly with no obvious trigger, or they may be expected, for example, in response to a feared object or situation.

Specific phobias: This condition involves strong fears of specific situations or objects. For children, these often include needles and injections, dogs and other animals, and vomiting. While most people have an immediate negative reaction to at least some of these triggers, children with these phobias can become fixated on their fears, which can cascade into other problems such as fear of leaving home and greater social anxiety.

Selective mutism: This anxiety disorder typically begins in early childhood but can persist into adulthood if untreated. Children with selective mutism have no trouble talking in situations where they are comfortable-at home or with others they feel close to-"but with new people and in new places, there is almost a freeze response, where their anxiety prevents them from being able to use their voices," explained Merson, who specializes in treating the condition. Children with selective mutism who act normally at home often show behavioral inhibition at school and in community settings, communicating only through gestures, head nods, and pointing, she added.

All of these disorders can appear anywhere on a continuum, Merson added. "So, there can be very severe cases, but also more moderate ones that respond quickly to effective treatment," she noted.

Commonalities and differences

Regardless of the type of disorder or the child's age, however, the basic psychophysiology of anxiety disorders is the same, Flannery-Schroeder said.

"I think of anxiety as a false alarm of the sympathetic nervous system-it's a fight or flight response to something that is perceived as alarming when it doesn't need to be," she said. That can show up as worried thinking, avoidant behavior, and physiological stress reactions. "If you think of it that way, it looks the same across all ages," she said. While the causes of anxiety disorders are not entirely clear, both genetics and the environment, including parenting styles, traumatic events, and even one's birth cohort, play roles, she and others noted.

While the underlying mechanisms are the same, however, anxiety disorders look somewhat different in children and adolescents depending on their developmental stage, Flannery-Schroeder added. One big difference is that young children think in concrete terms and hence lack insight into how unreasonable their anxiety may be. Teens and adults, though, can see that their level of anxiety does not necessarily make sense, but cannot stop feeling anxious anyway.

Teens' ability to think abstractly can add an extra layer to their anxiety because they can observe their own anxiety and get down on themselves for it, Kendall noted. And because these youngsters tend to be shy and inhibited, they're often afraid to share these thoughts and feelings with friends, who could potentially help to normalize their thoughts. Developmentally, teens also tend toward self-focus and egocentrism, and that, too, can make anxiety worse, he noted.

A winning treatment

The anxiety disorder treatment with the strongest evidence base for success is CBT tailored to the specific anxiety disorder, usually lasting for 12 to 20 sessions and sometimes more. While the application differs depending on the youth's condition, the basic methodology is the same: addressing unrealistic or exaggerated anxious thoughts and exposing youth to the things they fear until they experience and learn that the anticipated catastrophe does not occur. As a result, they become less triggered when they enter similar situations.

Treatment begins with a holistic assessment of the child, said Clark Goldstein, PhD, who specializes in treating youth anxiety disorders and is founder of Growth Psychology, P.C., a private practice in Garden City, New York. He uses an evidence-based assessment tool, the Anxiety Disorders Interview Schedule, or ADIS, asking questions of the parents and child separately to gain an understanding of the child's symptoms. He also asks questions of both to learn about mood issues, family dynamics, and family history. And he screens for other conditions such as attention-deficit/hyperactivity disorder, autism spectrum disorders, and eating disorders.

With children and teens, Goldstein begins treatment by showing them a diagram depicting thoughts, feelings, and behaviors connected via bidirectional arrows. He explains that positive thoughts can lead to positive behaviors, and negative behaviors can lead to negative feelings, for example.

"The aim is to help kids start to understand the difference between thoughts, feelings, and behaviors, and that can be challenging sometimes, even for teenagers," he said.

The next few sessions focus on the cognitive aspects of treatment, working with youth to recognize common cognitive distortions such as probability overestimation (believing the chances that something bad will happen are higher than they actually are) and emotional reasoning (the propensity to think, "I feel like it's true; therefore, it's true."). He also teaches young people to notice and label their thoughts, which helps them separate the negative thought from the distorted take on reality that often emerges from unrealistic anxiety. For example, "'I notice that I'm having the thought that the dog is going to bite me' is very different from, 'The dog's going to bite me,'" he said.

Such strategies help set the stage for what experts agree is the most powerful part of treatment: the behavioral work. It starts with developing a "fear and avoidance hierarchy"-a list of situations the child or teen is asked to rate based on how strong their fear is, sometimes with the help of parents. Then, in a gradated fashion, the therapist helps them enter the feared situations, known as exposures or behavioral experiments. For example, if a teen's big fear is asking someone on a date, exposures might include practicing various scenarios with a therapist in which they are rejected, accepted, or treated neutrally. If a child has an intense fear of dogs, exposures might include helping them look at cute dogs on the internet, pet a stuffed dog, or feed a gentle, old dog.

Goldstein also has kids rate their progress along the way, including toward the end of treatment. Seeing their fear levels drop from 10 to 2, for example, "is a nice confidence boost, and it helps kids see the fruits of their labor," he said.

Parents take part in treatment in different capacities depending on the situation, Merson added. With very young children, she may see parents and children together for all or most of the sessions, or just work with the parents alone. For older kids and teens, she often sees the child separately for most of a given session and then brings in the parents for the last 10 minutes to do a recap and go over homework. She may also see parents of older children alone for a few sessions to ensure that they can effectively coach their children in using new anxiety-management skills.

No matter the structure of treatment, however, parental involvement is key, Merson emphasized. Often, parents unwittingly foster a child's anxiety by providing too much reassurance or protection. While that is a natural response, "it can actually perpetuate anxiety in the long term because the child isn't learning how to handle difficult situations themself," she said. Other parents may invalidate or ignore children's anxious reactions, which can leave kids feeling unsettled and strain the parent-child relationship.

Merson helps parents develop the winning communication strategy of acknowledging and empathizing with their child's feelings while at the same time promoting their autonomy and not giving too much credence to their anxiety. She also works with parents to facilitate behavioral experiments at home to help kids practice facing anxiety-provoking situations.

Who's at greatest risk?

While anxiety disorders affect many young people, some are at greater risk than others. These include sexual- and gender-minority youth, who are much more likely than youth in general to meet criteria for anxiety disorders. In the 2022 National Survey on LGBTQ Youth Mental Health, conducted by the Trevor Project, for example, 73% of LGBTQ+ youth reported experiencing current symptoms of anxiety, and 45% said they had seriously considered attempting suicide in the past year.

To help these young people cope with anxiety and suicidal ideation that may emerge from that anxiety and then go on to develop fulfilling lives, Lily Brown, PhD, director of the University of Pennsylvania's Center for the Treatment and Study of Anxiety, and José A. Bauermeister, PhD, MPH, a professor at Penn Nursing, launched an intervention this fall that will address known mental health risk factors for these teens, including social isolation, negative emotions like shame and guilt, and lack of safe spaces to connect with like-minded others.

Using peer chats via smartphone, the intervention will incorporate two aspects. One is CBT-based life skills training, which helps teens transition from relying on adults to gaining greater independence by providing supports that enhance their emotional knowledge and help them find safe spaces to connect with others. The other is safety planning, an evidence-based practice for reducing the risk of future suicide attempts.

The aim is to give these young people practical tools to anticipate and weather suicidal thoughts that may arise, "but for the rest of the time, to help them build lives worth living through opportunities to get connected," Brown said.

Another at-risk group is children of color, due to social determinants such as poor access to quality mental health care, psychological factors related to racism, and greater stigma about seeking mental health care, said Kent State University professor Angela Neal-Barnett, PhD.

For more than 30 years, Neal-Barnett has been heading the Program for Research on Anxiety Disorders among African Americans, which develops research-based anxiety interventions for Black Americans. One project within that program is a weekly meeting called Sisters United Now (SUN), aimed at helping middle-school Black girls lower their anxiety, create connections, and build psychological resiliency. SUN uses psychoeducation along with an app to teach the girls about causes of stress and anxiety and employs culturally competent cognitive behavioral interventions to help build their confidence.

For example, girls create their own theme songs by taking parts of their favorite songs and rewriting them with self-empowering endings. Their songs are loaded into an app, "and they are there for them in times of stress and anxiety," Neal-Barnett said. Neal-Barnett is also studying cultural factors that may make Black youth more vulnerable to anxiety than others.

Additionally, researchers are finding that certain temperamental styles are closely linked to the development of anxiety disorders. A recent study indicates that anxious children who exhibited a temperamental style called behavioral inhibition at a very early age had a much more difficult time managing their anxiety symptoms during the pandemic than did others. The study, conducted by Selin Zeytinoglu, PhD, of the University of Maryland, and colleagues, analyzed longitudinal data on 291 young adults tracked at ages 2, 3, 7, 15, and 18, looking at measures of behavioral inhibition characterized by fearful responses to novel stimuli.

Teens with high levels of behavioral inhibition starting as toddlers were much more likely to suffer increased anxiety during the pandemic than those who did not show this behavior early on. The findings suggest the importance of pinpointing and treating behavioral inhibition as early as possible, the authors noted (Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 60, No. 10, 2021).

Improving on good treatment

The effectiveness of CBT in treating anxiety disorders in young people has been well established, with recent studies showing that cognitive restructuring and exposure tasks both lead to major improvements in youth anxiety, and that the quantity of exposures is linked to better outcomes. Now, researchers are looking into what can make treatment even more successful.

One trait they are examining is called "intolerance of uncertainty," or IU-the tendency to hold negative beliefs toward and reactions against uncertain situations and events. Studies suggest that kids with anxiety disorders who score higher in this tendency and whose parents are overly accommodating have poorer treatment outcomes. To this end, several researchers have created adaptations of CBT for anxiety that target one or both dimensions. In a summary of this area of research in Current Psychiatry Reports (Vol. 22, No. 49, 2020), Kendall and colleagues noted that the work shows promising results, adding that it could lead to an important next step in CBT treatment for anxiety: tailoring interventions to particular subsets of kids.

Researchers at Boston University's Psychotherapy and Emotion Research Lab are examining additional ways to enhance treatment. One study is adding a mindfulness-based intervention called Positive Affect Training to CBT treatment, while another will compare the effectiveness of yoga, CBT, and stress education in treating generalized anxiety disorder. Members of the lab are also looking at structural and functional brain biomarkers that may differentiate teens with anxiety and depression from healthy teens (visit Psychotherapy and Emotion Research Laboratory for a list of these projects).

Others are looking into how to better disseminate proven treatments for pediatric and adolescent anxiety to broader populations. For example, Boger is eager to make evidence-based treatments available to many more kids via her new company.

"Too many kids and teens are struggling to find treatment, particularly evidence-based care," she said. "So, our plan is to be a 50-state solution focused on providing access to evidence-based care for anxiety and obsessive-compulsive disorder." Her startup works with insurance companies, operating in a value-based framework in which payments for care delivery are bundled and tied to the quality of that care, Boger noted. Treatment encompasses comprehensive, evidence-based care that includes intensive intervention, a step-down phase, and ongoing maintenance.

Providers who treat anxiety should make sure they are fully trained in CBT and up to date on new research, Goldstein added. "I've had people come to me who have seen providers who say they do CBT, but who didn't really push the child to do exposures in a way that was productive," he said. He recommends consulting with or gaining supervision from a known expert and reading key books by leaders in the field such as David H. Barlow, PhD, Michelle G. Craske, PhD, and Ronald M. Rapee, PhD (see Further reading).

It's important to get it right, Boger added, because untreated anxiety can spiral into worse issues like depression, substance use disorders, and even suicidality. But when kids get quality treatment, she said, it can be life changing.

"I've seen kids who were completely stuck and avoiding pretty much every facet of their lives-from school to social interactions, to extracurriculars, to friends-who were able to reclaim their lives," she said. "Now they're off to college or grad school and living their full lives. It's really inspiring and remarkable."

Further reading

A developmental pathway from early behavioral inhibition to young adults' anxiety during the Covid-19 pandemic
Zeytinoglu, S., et al., Journal of the American Academy of Child and Adolescent Psychiatry, 2021

Helping your anxious child: A step-by-step guide for parents (2nd ed.)
Rapee, R. M., et al., New Harbinger, 2008

Intolerance of uncertainty and parental accommodation: Promising targets for personalized intervention for youth anxiety
Kendall, P. C., et al., Current Psychiatry Reports, 2020

Mastery of your anxiety and panic: Workbook (5th ed.)
Barlow, D. H., & Craske, M. G., Oxford University Press, 2022

Results from the Child/Adolescent Anxiety Extended Long-term Study (CAMELS): Functional outcomes
Swan, A. J., et al., Journal of Consulting and Clinical Psychology, 2018

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Anxiety among kids is on the rise. Wider access to CBT may provide needed solutions

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Opinion_ Teens are more anxious than ever_ Is social media to blame

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Major Depression Explained (Background Video)

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Depression Explained (Major Depressive Disorder)

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Depression and anxiety: Exercise eases symptoms

Depression and anxiety symptoms often improve with exercise. Here are some realistic tips to help you get started and stay motivated.
By Mayo Clinic Staff
When you have depression or anxiety, exercise often seems like the last thing you want to do. But once you get motivated, exercise can make a big difference.

Exercise helps prevent and improve a number of health problems, including high blood pressure, diabetes and arthritis. Research on depression, anxiety and exercise shows that the psychological and physical benefits of exercise can also help improve mood and reduce anxiety.

The links between depression, anxiety and exercise aren't entirely clear - but working out and other forms of physical activity can definitely ease symptoms of depression or anxiety and make you feel better. Exercise may also help keep depression and anxiety from coming back once you're feeling better.

How does exercise help depression and anxiety?

Regular exercise may help ease depression and anxiety by:

Releasing feel-good endorphins, natural cannabis-like brain chemicals (endogenous cannabinoids) and other natural brain chemicals that can enhance your sense of well-being

Taking your mind off worries so you can get away from the cycle of negative thoughts that feed depression and anxiety

Regular exercise has many psychological and emotional benefits, too. It can help you:

Gain confidence. Meeting exercise goals or challenges, even small ones, can boost your self-confidence. Getting in shape can also make you feel better about your appearance.

Get more social interaction. Exercise and physical activity may give you the chance to meet or socialize with others. Just exchanging a friendly smile or greeting as you walk around your neighborhood can help your mood.

Cope in a healthy way. Doing something positive to manage depression or anxiety is a healthy coping strategy. Trying to feel better by drinking alcohol, dwelling on how you feel, or hoping depression or anxiety will go away on its own can lead to worsening symptoms.

Is a structured exercise program the only option?

Some research shows that physical activity such as regular walking - not just formal exercise programs - may help improve mood. Physical activity and exercise are not the same thing, but both are beneficial to your health.

Physical activity is any activity that works your muscles and requires energy and can include work or household or leisure activities.

Exercise is a planned, structured and repetitive body movement done to improve or maintain physical fitness.

The word "exercise" may make you think of running laps around the gym. But exercise includes a wide range of activities that boost your activity level to help you feel better.

Certainly running, lifting weights, playing basketball and other fitness activities that get your heart pumping can help. But so can physical activity such as gardening, washing your car, walking around the block or engaging in other less intense activities. Any physical activity that gets you off the couch and moving can help improve your mood.

You don't have to do all your exercise or other physical activity at once. Broaden how you think of exercise and find ways to add small amounts of physical activity throughout your day. For example, take the stairs instead of the elevator. Park a little farther away from work to fit in a short walk. Or, if you live close to your job, consider biking to work.

How much is enough?

Doing 30 minutes or more of exercise a day for three to five days a week may significantly improve depression or anxiety symptoms. But smaller amounts of physical activity - as little as 10 to 15 minutes at a time - may make a difference. It may take less time exercising to improve your mood when you do more-vigorous activities, such as running or bicycling.

The mental health benefits of exercise and physical activity may last only if you stick with it over the long term - another good reason to focus on finding activities that you enjoy.

How do I get started - and stay motivated?

Starting and sticking with an exercise routine or regular physical activity can be a challenge. These steps can help:

Identify what you enjoy doing. Figure out what type of physical activities you're most likely to do, and think about when and how you'd be most likely to follow through. For instance, would you be more likely to do some gardening in the evening, start your day with a jog, or go for a bike ride or play basketball with your children after school? Do what you enjoy to help you stick with it.

Get your mental health professional's support. Talk to your doctor or mental health professional for guidance and support. Discuss an exercise program or physical activity routine and how it fits into your overall treatment plan.

Set reasonable goals. Your mission doesn't have to be walking for an hour five days a week. Think realistically about what you may be able to do and begin gradually. Tailor your plan to your own needs and abilities rather than setting unrealistic guidelines that you're unlikely to meet.

Don't think of exercise or physical activity as a chore. If exercise is just another "should" in your life that you don't think you're living up to, you'll associate it with failure. Rather, look at your exercise or physical activity schedule the same way you look at your therapy sessions or medication - as one of the tools to help you get better.

Analyze your barriers. Figure out what's stopping you from being physically active or exercising. If you feel self-conscious, for instance, you may want to exercise at home. If you stick to goals better with a partner, find a friend to work out with or who enjoys the same physical activities that you do. If you don't have money to spend on exercise gear, do something that's cost-free, such as regular walking. If you think about what's stopping you from being physically active or exercising, you can probably find an alternative solution.

Prepare for setbacks and obstacles. Give yourself credit for every step in the right direction, no matter how small. If you skip exercise one day, that doesn't mean you can't maintain an exercise routine and might as well quit. Just try again the next day. Stick with it.

Do I need to see my doctor?

Check with your doctor before starting a new exercise program to make sure it's safe for you. Talk to your doctor to find out which activities, how much exercise and what intensity level is OK for you. Your doctor will consider any medications you take and your health conditions. He or she may also have helpful advice about getting started and staying motivated.

If you exercise regularly but depression or anxiety symptoms still interfere with your daily living, see your doctor or mental health professional. Exercise and physical activity are great ways to ease symptoms of depression or anxiety, but they aren't a substitute for talk therapy (psychotherapy) or medications.

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Show references

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2. Peterson DM. The benefits and risks of exercise. https://www.uptodate.com/contents/search. Accessed Sept. 15, 2017.

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4. Schuch FB, et al. Exercise as treatment for depression: A meta-analysis adjusting for publication bias. Journal of Psychiatric Research. 2016;77:42.

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7. Exercise for mental health: 8 keys to get and stay moving. National Alliance on Mental Illness. https://www.nami.org/Blogs/NAMI-Blog/May-2016/Exercise-for-Mental-Health-8-Keys-to-Get-and-Stay. Accessed Sept. 7, 2017.

8. Exercise for stress and anxiety. Anxiety and Depression Association of America. https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety. Accessed Sept. 7, 2017.

9. Zschucke E, et al. Exercise and physical activity in mental disorders: Clinical and experimental evidence. Journal of Preventive Medicine and Public Health. 2013;46:512.

10. Anderson E, et al. Effects of exercise and physical activity on anxiety. Frontiers in Psychiatry. 2013;4:1.

11. Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 19, 2017.

See more In-depth

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Depression and anxiety: Exercise eases symptoms

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Research on depression and anxiety shows that exercise and other physical activity can help improve mood, reduce anxiety and improve other health problems.

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Onset of depression more complex than a brain chemical imbalance

It's often said that depression results from a chemical imbalance, but that figure of speech doesn't capture how complex the disease is. Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, and stressful life events. It's believed that several of these forces interact to bring on depression.

To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life.

With this level of complexity, you can see how two people might have similar symptoms of depression, but the problem on the inside, and therefore what treatments will work best, may be entirely different.

Scientists have learned much about the biology of depression, but their understanding of the biology of depression is far from complete. Major advances in the biology of depression include finding links between specific parts of the brain and depression effects, discovering how chemicals called neurotransmitters make communication between brains cells possible, and learning the impact of genetics and lifestyle events on risk and symptoms of depression.

This article will address the how different parts of the brain affect mood.

Brain regions and mood

Popular lore has it that emotions reside in the heart. Science, though, tracks the seat of your emotions to the brain. Certain areas of the brain help regulate mood. Researchers believe that - more important than levels of specific brain chemicals - nerve cell connections, nerve cell growth, and the functioning of nerve circuits have a major impact on depression.

Increasingly sophisticated forms of brain imaging - such as positron emission tomography (PET), single-photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI) - permit a much closer look at the working brain than was possible in the past. An fMRI scan, for example, can track changes that take place when a region of the brain responds during various tasks. A PET or SPECT scan can map the brain by measuring the distribution and density of neurotransmitter receptors in certain areas.

Use of this technology has led to a better understanding of which brain regions regulate mood and how other functions, such as memory, may be affected by depression. Areas that play a significant role in depression are the amygdala, the thalamus, and the hippocampus (see Figure 1).

Research shows that the hippocampus is smaller in some depressed people. For example, in one fMRI study published in The Journal of Neuroscience, investigators studied 24 women who had a history of depression. On average, the hippocampus was 9% to 13% smaller in depressed women compared with those who were not depressed. The more bouts of depression a woman had, the smaller the hippocampus. Stress, which plays a role in depression, may be a key factor here, since experts believe stress can suppress the production of new neurons (nerve cells) in the hippocampus.

Researchers are exploring possible links between sluggish production of new neurons in the hippocampus and low moods. An interesting fact about antidepressants supports this theory. These medications immediately boost the concentration of chemical messengers in the brain (neurotransmitters). Yet people typically don't begin to feel better for several weeks or longer. Experts have long wondered why, if depression were primarily the result of low levels of neurotransmitters, people don't feel better as soon as levels of neurotransmitters increase.

The answer may be that mood only improves as nerves grow and form new connections, a process that takes weeks. In fact, animal studies have shown that antidepressants do spur the growth and enhanced branching of nerve cells in the hippocampus. So, the theory holds, the real value of these medications may be in generating new neurons (a process called neurogenesis), strengthening nerve cell connections, and improving the exchange of information between nerve circuits. If that's the case, depression medications could be developed that specifically promote neurogenesis, with the hope that patients would see quicker results than with current treatments.

Figure 1: Areas of the brain involved with depression

The regions shown here are mirrored in both hemispheres of the brain. Also, these structures are interlocking; the illustration suggests relative position but not precise location.

Amygdala: The amygdala is part of a group of structures deep in the brain that's associated with emotions such as anger, pleasure, sorrow, fear, and sexual arousal. Recalling an emotionally charged memory, such as a frightening situation, activates the amygdala. Activity in the amygdala is higher when a person is sad or clinically depressed, and this continues even after recovery from depression. This increase in activity may actually cause the amygdala to enlarge.

Basal ganglia (not pictured): The basal ganglia are a related group of structures deep in the brain. They are connected to and interact with structures that are closer to the brain's surface. They may help facilitate movement and may be involved in memorizing, thinking, and emotional processing. Some studies have found shrinkage and other structural changes in the basal ganglia in people with depression.

Hippocampus: The hippocampus plays a key role in processing long-term memory. Interplay between the hippocampus and the amygdala might account for the adage "once bitten, twice shy." It is this part of the brain that registers fear when you are confronted by a barking, aggressive dog, and the memory of such an experience may make you wary of dogs you come across later in life. The hippocampus is smaller in some depressed people, and research suggests that ongoing exposure to stress hormones impairs the growth of neurons in this part of the brain.

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What causes depression? - Harvard Health

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Depression has many possible causes, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems. It's believed that several of these forces interact to bring on depression.

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Childhood Trauma and the Brain | UK Trauma Council

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Use the Timestamps as a table of contents. You won't have time to listen to the whole thing. The goal is to find a few standout quotes and type them up word for word.

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Andrew Huberman:

Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. This podcast is separate from my teaching and research roles at Stanford. It is however part of my desire and effort to bring zero-cost-to-consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Today's episode is going to be all about the science of emotions. The first month of the podcast, we talked about sleep and wakefulness.

Andrew Huberman:

Last month, we were talking about neuroplasticity, the brain's ability to change in response to experience. In this month, we're going to talk about these things that we call emotions. We're going to decipher what they are, how they work, how we can control them, when we might not want to control them. There are going to be four episodes on emotions, and today, we're going to talk in particular about something that most often is called stress.

Andrew Huberman:

Now you might be thinking, wait, stress isn't an emotion, but stress really lies at the heart of whether or not our internal experience is matched well or not to our external experience, or the events that are happening to us and around us. And as you'll soon see, those converge or combine to create what we call emotions. Now, I want to be very clear that we're going to talk about the biology of emotions. We're going to talk a little bit about some psychological concepts related to emotion, and we are definitely going to talk about tools to control what we call stress, or commonly think of as stress.

Andrew Huberman:

We're also going to clean up some common myths about stress. For instance, that stress impairs your immune system - that's true in certain contexts. And in other contexts, stress actually enhances your immune system and makes it function better. There is going to be a lot of discussion about whether or not our internal state, whether or not we are alert or calm, is good or bad, depending on the circumstances.

Andrew Huberman:

So where we're headed here is, I'd like you to come away from today's episode with what I call an organizational logic, a framework for thinking about these things that typically we just call happy or sad or depressed or anxious. And I'm going to make sure that you have tools that are grounded in physiology and neuroscience that will allow you to navigate this otherwise complex space that we call emotions, that will allow you to ground yourself better when you're feeling like life is weighing on you, or you're kind of being pulled by the currents of life. As well as to support other people, whether or not that's in a psychological practice if you're a practitioner, or you have clients, or children, or spouses, really to be able to support other people in your environment better.

Andrew Huberman:

And the tools that I'm going to focus on today range from behavioral tools; we will talk about some of the more valuable supplementation tools that are out there; and we're going to talk a little bit about things like depression, PTSD, but we will be devoting entire episodes to things like depression, PTSD, and even attention deficit and obsessive compulsive disorder, which believe it or not, although this might not surprise many of you, have a very strong emotional component. It's not just about compulsive behaviors and intrusive thoughts, it's also about the emotional load of being in that state.

Andrew Huberman:

So I promise that today we're going to clean up a lot of misunderstanding. We're going to give you a lot of tools, and you're going to learn a lot about the biology of how your body and brain work together. Because if ever there was a topic that brought together the brain and body, or mind-body relationship, it's stress and emotions. It's also the positive emotions. When we feel something, whether or not we're super happy or just feeling kind of pleasant, or we are feeling stressed, anxious, and overwhelmed, it isn't just in our head, it's also in our body.

Andrew Huberman:

And as you may recall, the nervous system, which includes the brain and the eyes and the spinal cord, but also all the connections with the organs of the body, includes the brain and body. And those organs of the body, your gut and your liver and your spleen - they're also communicating with the brain. So I look forward to a day, in fact, when we no longer think about neuroscience as just the brain, and many neuroscientists now also think about the body of course, and the brain controls the body, but the body is also having a very profound and concrete influence on the brain.

Andrew Huberman:

I think up until recently, people would hear about, kind of, brain-body and always think about mindfulness. We're actually not going to talk that much about mindfulness at all today. Mindfulness is kind of a vague concept, in fact. When you think about mindfulness, it's good to take the opposite. What's the opposite of mindfulness would be mindlessness. Well, all of a sudden we're into territory that isn't really easy for one person to describe their experience or to help others with their experience. Today, we're going to talk about objective tools that match the brain-body experience, or separate the brain-body experience in ways that leverage your ability to lean into life better, to feel better, literally to just feel better about what you're experiencing, and believe it or not, to be able to control your emotions when that's appropriate.

Andrew Huberman:

This isn't about becoming robotic, this isn't about trying not to feel human. This is actually about being able to lean into life better, as a consequence of being able to control some of your inner real estate, this nervous system that includes the brain and body, and how that nervous system is interacting with the outside world. So it's to place you in a greater position of power. And so let's get started in deciphering what is stress, what are emotions, and why did I batch stress and emotions into one discussion today?

Andrew Huberman:

Okay, so what is stress? We hear all the time that stress is bad. We hear people saying they're really stressed out. What is stress? You've all presumably heard the arguments or the framework that stress is this horrible ancient carryover from times in which humans were pursued by animals or other human predators. And that whenever we feel what we call stress or feel stressed out, that it's just this unfortunate invasion of something that we no longer need in modern life, that this was designed for when we were being attacked by bears, or tigers, or lions or whatever it is. And gosh, what an unfortunate thing. And we have so many creature comforts nowadays, but we have not eliminated this stress. Almost as if it was like an organ or a system in our body that was bad for us that we're stuck with just because of the species that we are.

Andrew Huberman:

But first of all, all species experience stress. And I think that it's fair to say, even though I wasn't there, that yes, in fact throughout our evolutionary history, we were vulnerable to animal attack and other human attacks on a regular basis, up until points where we started developing weapons, and structures, and fire and other things that allow us to protect ourselves better from those animals and invaders of various kinds. But it is entirely naive for us to think that in ancient times, ancient times being a kind of loose term for previous time, medieval times, 100 years ago, 1,000 years ago, 10,000 years ago, of course there were infidelities, right? Partners cheated, people died.

Andrew Huberman:

In fact, before the advent of phones, which we're going to talk about today, you can imagine that someone might head off on a hunt or to go visit a relative and never come back, and you would never know why. That would be very stressful. So there was psychosocial stress, there was the stress of losing loved ones. There was the stress of cold, of famine, there was the stress probably also of just worry. This idea that ancient versions of humans 1,000 years ago, 100 years ago didn't worry, I think that is entirely inconsistent with everything we know about the structure of the human brain 100 years, 1,000 years ago.

Andrew Huberman:

All the problems that we're struggling with existed forever. It's just that stress, at its core, is a generalized system; it wasn't designed for tigers attacking us or people attacking us. It's a system to mobilize other systems in the brain and body. That's what stress really is, it's designed to be generic. And that's the most important thing that I'd like you to understand today, is that the system that governs what we call stress is generic.

Andrew Huberman:

It wasn't designed for one thing, and that gives it a certain advantage in taking over the state of our brain and body. But it also gives you, all of us, an advantage in controlling it because it's based on hardwired biological mechanisms. And there are hardwired biological mechanisms, meaning cells, and chemicals and pathways and tissues that exist in you right now that require no neuroplasticity, that allow you to put a brake on stress. And so we're going to talk about those.

Andrew Huberman:

So you have a system for stress, and you have a system for de-stress that are baked into you. They were genetically encoded, and you were born with them, and you still have them now. So if you're alive and listening, you have the capacity to control your stress. And today, I'm going to talk about ways that you can control your stress, not just by doing some offline practice of meditation, or breathwork, or something like that, but real-time tools. Tools that allow you to push back on stress when stress hits in real time.

Andrew Huberman:

This is something that my lab works actively on, in developing and testing these tools, and evolving these tools. And there are other laboratories that do this as well. So let's talk about the stress response, and by doing that, you'll understand exactly why the tools I'm going to give you work. For those of you that are saying, wait, I just want the tools, just give me a summary. Trust me, if you understand mechanism, you are going to be in a far better position to incorporate these tools, to teach these tools to others, and to modify them as your life circumstances change.

Andrew Huberman:

If you'd like the cheat sheet, or you just want the one-page PDF, eventually we'll get that stuff out to people, but it's really important to understand the underlying mechanism. Okay, so what is stress? Well, let's just distinguish between stressors, which are the things that stress us out, and stress, which is the psychological and physiological response to stressors.

Andrew Huberman:

I'm mainly going to talk about stress, which is your response to things. Let's be clear about what we already know, which is that stressors can be psychological or they can be physical, okay? If I put you outside on a cold day without a jacket for a very long time, that is stressful. If I have you prepare for too many exams at once, and you can't balance it all with your sleep schedule and your other needs for comfort and wellbeing like food, rest, sleep and social connection, that is stressful. So stress, and as I mentioned before, is generic. It doesn't distinguish between physical and emotional stress.

Andrew Huberman:

What happens when the stress response hits? Let's talk about the immediate, or what we call the acute stress response. We could also think of this as short-term stress. So you have a collection of neurons, they have a name. It's called the sympathetic chain ganglia, and it has nothing to do with sympathy, sympa means together. And there's a group of neurons that start right about at your neck and run down to about your naval, a little bit lower. And those are called the sympathetic chain ganglia. You don't need to memorize that name, there will not be a quiz. But it's important to know that in the middle of your body, you have a chain of neurons that when something stresses us out, either in our mind or because something enters our environment, and we see something that stresses us out. That we don't like heights if you're afraid of heights, somebody you dislike walks into the room, et cetera, that chain of neurons becomes activated like a bunch of dominoes falling [sound of falling] all at once. It's very fast.

Andrew Huberman:

When that happens, those neurons release a neuromodulator, a neurochemical that I've talked about before on this podcast called acetylcholine. They release that at various sites within the body. Now this is important, because normally acetylcholine would be used to move muscles. Actually, every time we move a muscle, pick up a cup of coffee, write with a pen, walk down the street, it's spinal neurons connecting to muscle and releasing acetylcholine. So in the brain, it's involved in focus, and in muscles, it's involved in making muscles twitch.

Andrew Huberman:

But if we were stressed, we wouldn't want all our muscles to contract at once because we would just be kind of paralyzed like this, in what tonic activation, as it's called. We wouldn't want that, something called tetanus, believe it or not. Because the tetanus talks, and will cause that kind of rigor of the entire body, you do not want that. When those neurons are activated, acetylcholine is released, but there're some other neurons, for the aficionados out there, they're called the postganglionic neurons. Those ones respond to that acetylcholine, and then they release epinephrine, which is the equivalent to adrenaline.

Andrew Huberman:

So we have this system where it's very fast whenever we're stressed. The core of our body, these neurons down the middle of our body, release these chemicals, and then there's adrenaline, or epinephrine, released at particular organs, and [it] acts in particular ways. We're going down into the weeds here, so just stay with me because it's going to make a lot of sense and you will appreciate having this knowledge in hand. That epinephrine acts in two different ways. Some things like the muscles of your legs and your heart and other things that need to be active when you're stressed, they have a certain kind of receptor, which is called the beta receptor. And that beta receptor responds to epinephrine, and blood vessels dilate' they get bigger and blood rushes into our legs.

Andrew Huberman:

The heart rate speeds up - lots of things happen that get activated. And at the same time, that epinephrine activates other receptors on certain tissues that we don't need. The ones involved in digestion, reproduction and things of that sort that are luxuries for when things are going well, not things to pay attention to when we're stressed. And that binds to other receptors that contract the blood vessels. So basically the stress response, this is the key phrase here: the stress response, A, is generic - I said that before. And B, it basically pushes certain systems to be activated and other systems to not be activated.

Andrew Huberman:

So the stress response is two-pronged. It's a yes for certain things, and it's a no, you may not right now, for other things. So that's the key thing to understand about the stress response. That's why your heart speeds up. That's why you feel blood in certain organs and tissues of your body, but not in others. That's why your throat goes dry, because it turns out that when you get stressed, the salivary glands are shut down. There's a lot less blood flow to the neurons that control salivation, and so you're going to start swallowing, you feel like your throat is getting dry. There are a lot of different effects; I'm not going to list them all off, but basically you are activated in ways that support you moving. So that's the third thing. It's first of all, it's generic. Second of all, the stress response activates certain things and shuts down other features of our body. And then it's a sense of agitation that makes you want to move.

Andrew Huberman:

And that's because fundamentally the stress response is just this generic thing that says, "Do something." And movement in this case can either be the bias to move in terms of action or it can be the bias to say something. When we are stressed, we are more likely to say something that probably we shouldn't say. We are more likely to move. And if you're trying to suppress movement, you'll feel that as a tremor. You're going to feel agitated, and that's because it was designed to move you.

Andrew Huberman:

This is important because if you want to control stress, you need to learn how to work with that agitation. I'd like to give you a tool at this point because I think if we go any further with a lot more science, people are going to begin to wonder if this is just going to be a kind of standard university lecture about the stress response. I'm going to give you more science about the stress response, but I want to take what we now already know about the stress response, and use that as a framework for thinking about how one might reduce, or even eliminate the stress response quickly in real time, should it arise when we don't want it.

Andrew Huberman:

So we're taking the podium, or we're sitting down at a Zoom call, and all of a sudden we're feeling flushed. We're feeling like our heart is racing, we're feeling a little too alert, we're feeling a little worked up, and we want to calm down. As far as I am aware of, the best tools to reduce stress quickly, so-called real-time tools, are going to be tools that have a direct line to the so-called autonomic nervous system. The autonomic nervous system is a name given to the kind of general features of alertness or calmness in the body. Typically, it means automatic, although we do have some control over it at certain so-called levers or entry points.

Andrew Huberman:

Here's what doesn't work to control stress: telling yourself to calm down. In fact, that tends to just exacerbate stress. Telling someone else to calm down also tends to exacerbate their stress. If you want to reduce the magnitude of the stress response, the best thing you can do is activate the other system in the body, which is designed for calming and relaxation. And that system is called the parasympathetic nervous system. Because as I mentioned before, the neurons that control stress run from about your neck to your naval. The parasympathetic neurons, para just means near, exist in... they're some of the cranial nerves. So it's kind of neck and lower brain stem, kind of back of the brain and in the neck, and in the pelvic area.

Andrew Huberman:

And the parasympathetic nervous system is really interesting. Because especially the cranial nerves, the ones that are up in the brain stem and in the neck area, those have a direct line to various features of your face, in particular the eyes. They control things like eye movements, pupil dilation, things of that sort, as well as the tongue, the facial muscles, et cetera. The parasympathetic nervous system, many people don't realize this, is the system by which we control the face and the eyes, and to some extent our airway, the trachea. And it's these neurons that reside within the pelvic area.

Andrew Huberman:

Now, the neurons within the pelvic area are involved in control of the genitals, the bladder, and the rectum - and those don't have a direct line. You don't have a direct way to control those; it actually has to go from brain to spinal cord and then out to those organs. Whereas, the parasympathetic nervous system has certain entry points, or what I'll call levers, that will allow you to push back on the stress response in real time and diminish it and feel more relaxed really quickly. So I'm going to teach you the first tool now, so I don't overwhelm you with all this academic knowledge without giving you something useful.

Andrew Huberman:

And the tool that at least to my knowledge, is the fastest and most thoroughly grounded in physiology and neuroscience for calming down in a self-directed way is what's called the physiological sigh, S-I-G-H. Now, some of you might have heard me talk about this on previous podcasts, but I'm going to explain this in the context of how respiration, in general, is used to calm us down. And it turns out you're all doing this all the time, but you are doing it involuntarily. And when you stress, you tend to forget that you can also activate these systems voluntarily. This is an extremely powerful set of techniques that we know from scientific studies that are being done in my lab, Jack Feldman's lab at UCLA, and others now, that are very, very useful for reducing your stress response in real time. And here's how they work.

Andrew Huberman:

These days, there seems to be a lot of interest in breathwork. Breathwork typically is when you go and you sit down, or you lie down, and you deliberately breathe in a particular way for a series of minutes in order to shift your physiology, access some states, and it does have some utility that we're going to talk about. That is not what I'm talking about now. What I'm talking about when I refer to physiological sighs is the very real medical school textbook relationship between the brain, the body, and the body as it relates to the breathing apparati, meaning the diaphragm and lungs, and the heart.

Andrew Huberman:

Let's take the hallmark of the stress response. The heart starts beating faster. Blood is shuttled to the big muscles of the body to move you away from whatever it is the stressor is or just make you feel like you need to move or talk. Your face goes flushed, et cetera. Heart rate, many of us feel is involuntary, just kind of functions whether or not we're moving fast or moving slow. If you think about it, it's not really purely autonomic because you can speed up your heart rate by running, or you can slow it down by slowing down your run; you can move to a walk or lie down, but that's indirect control.

Andrew Huberman:

There is however a way in which you can breathe that directly controls your heart rate through the interactions between the sympathetic and the parasympathetic nervous system. Here's how it works. When you inhale, so whether or not it's through the nose or through the mouth, this skeletal muscle that's inside your body called the diaphragm, it moves down. And that's because the lungs expand, the diaphragm moves down. Your heart actually gets a little bit bigger in that expanded space - there's more space for the heart.

Andrew Huberman:

So I'm not talking about your emotional heart getting bigger, I'm talking about your actual physical heart getting a little bit bigger, the volume grows. And as a consequence, whatever blood is in there is now at a lower volume, or moving a little bit more slowly in that larger volume than it was before you inhaled. So more space, heart gets bigger, blood moves more slowly, and there's a little group of neurons called the sinoatrial node in the heart that registers... Believe it or not, those neurons pay attention to the rate of blood flow through the heart and send a signal up to the brain that blood is moving more slowly through the heart.

Andrew Huberman:

The brain then sends a signal back to the heart to speed the heart up. So what this means is if you want your heart to beat faster, inhale longer, inhale more vigorously than your exhales. Now, there are a variety of ways that one could do that, but it doesn't matter if it's through the nose or through the mouth. If your inhales are longer than your exhales, you're speeding up your heart. If your inhales are more vigorous, so even if your inhales are shorter than your exhales, you are speeding up your heart rate. Now, the opposite is also true, if you want to slow your heart rate down. So stress response hits, you want to slow your heart rate down. What you want to do is, again, capitalize on this relationship between the body-, meaning the diaphragm and the heart, and the brain. Here's how it works. When you exhale, the diaphragm moves up, which makes the heart a little bit smaller; it actually gets a little more compact. Blood flows more quickly through that compact space, sort of like just a pipe getting smaller. The sinoatrial node registers that blood is going more quickly, sends a signal up to the brain, and the parasympathetic nervous system, some neurons in your brain stem, send a signal back to the heart to slow the heart down.

Andrew Huberman:

So if you want to calm down quickly, you need to make your exhales longer and or more vigorous than your inhales. Now, the reason this is so attractive as a tool for controlling stress is that it works in real time. This doesn't involve a practice that you have to go and sit there and do anything separate from life. And we are going to get to emotion; emotions and stress happen in real time. And so while it's wonderful to have a breathwork practice, or to have the opportunity to get a massage, or sit in a sauna or do whatever it is that you do in order to set your stress controls in the right direction. Having tools that you can reach to in real time that require no learning. I mean, I had to teach it to you, you had to learn that, but it doesn't require any plasticity to activate these pathways.

Andrew Huberman:

So if you're feeling stressed, you still need to inhale of course, but you need to lengthen your exhales. Now, there's a tool that capitalizes on this in a kind of unique way, a kind of a twist, which is the physiological sigh. The physiological sigh was discovered in the '30s. It's now been explored at the neurobiological level and mechanistically in far more detail by Jack Feldman's lab at UCLA. Also, Mark Krasnow's lab at Stanford.

Andrew Huberman:

And the physiological sigh is something that humans and animals do anytime they're about to fall asleep. You also do it throughout sleep from time to time when carbon dioxide, which we'll talk about in a moment, builds up too much in your system. And the physiological sigh is something that people naturally start doing when they've been crying and they're trying to recover some air or calm down, when they've been sobbing very hard, or when they are in claustrophobic environments. However, the amazing thing about this thing that we call the diaphragm, the skeletal muscle, is that it's an internal organ that you can control voluntarily, unlike your spleen or your heart or your pancreas. Where you can't just say, oh, I want to make my pancreas turn out a little more insulin right now. I'm just going to do that with my mind directly.

Andrew Huberman:

You can't do that. You can do that by smelling a really good donut or something, but you can't just do it directly. You can move your diaphragm intentionally, right? You can do it anytime you want, and it'll run in the background if you're not thinking about it. So this incredible pathway that goes from brain to diaphragm, through what's called the phrenic nerve, P-H-R-E-N-I-C, phrenic, the phrenic nerve innovates the diaphragm. You can control anytime you want. You can double up your inhales, or triple up your inhales. You can exhale more than your inhales, whatever you want to do - such an incredible organ. And the physiological sigh is something that we do spontaneously, but when you're feeling stressed, you can do a double inhale, long exhale.

Andrew Huberman:

Now, I just told you a minute ago that if you inhale more than you exhale, you're going to speed the heart rate up, which would promote more stress and activation. Now I'm telling you to do a double inhale/exhale in order to calm down. And the reason is the double inhale/exhale, which is the physiological sigh, takes advantage of the fact that when we do a double inhale, even if the second inhale is sneaking in just a tiny bit more air - because it's kind of hard to get two deep inhales back to back - you do a big deep inhale and then another little one sneaking it in. The little sacks in your lungs, the alveoli of the lungs. Your lungs aren't just two big bags, but you've got millions of little sacks throughout the lungs that actually make the surface area of your lungs as big as a tennis court.

Andrew Huberman:

It's amazing, if we were to just spread that out. Those tend to collapse as we get stressed, and carbon dioxide builds up in our bloodstream, and that's one of the reasons we feel agitated as well. And it makes us very jittery. I mean, there's some other effects of carbon dioxide that I don't want to get into, but when you do the double inhale/exhale, the double inhale reinflates those little sacks of the lungs. And then when you do the long exhale, that long exhale is now much more effective at ridding your body and bloodstream of carbon dioxide, which relaxes you very quickly.

Andrew Huberman:

My lab in collaboration with David Spiegel's lab - David's the associate chair of psychiatry at Stanford - are doing a study right now exploring how physiological sighs and other patterns of breathing done deliberately can modulate the stress response and other things related to emotionality. Those work are ongoing, I want to be clear those studies aren't done. But it's very clear from work in our labs, from work in Jack Feldman's lab and others, that the physiological sigh is the fastest hardwired way for us to eliminate this stressful response in our body quickly in real time.

Andrew Huberman:

And so I'm excited to give you this tool because I think most people have heard that mindfulness and meditation is good, exercise is good for us, we all need to be getting enough sleep, et cetera, but life happens. And when you find yourself in a position where you are more alert and activated than you would like to be, regardless of whether or not the stressor is relationship-based or it's financial or it's physical, or anything like that, you can look to the physiological side because it bypasses a very important feature of how we function, which is that it's very hard to control the mind with the mind, especially when we are in heightened states of activation.

Andrew Huberman:

When we are very alert or very sleepy, it is very hard to use these so-called top-down mechanisms of intention and gratitude and all these things that are really powerful tools when we are not super activated and stressed, or not super tired. But when we are anywhere in the range of very alert and stressed to very sleepy, physiological sighs are a powerful way of bringing our level of so-called autonomic activation, which just means our level of alertness, down. And so whether or not it's in a line at the bank or whether or not you're wearing a mask nowadays or you're not, whatever the conditions may be where you're at and your needs. When you're feeling stressed, the physiological sigh done just one to three times. So it would be double inhale/exhale, double inhale/exhale, maybe just two times, will bring down your level of stress very, very fast. And as far as I know, it's the fastest way to accomplish that.

Andrew Huberman:

An important note about the physiological sigh, or exhale-emphasized breathing, for lowering the stress response. Many people worry that their heart rate does not come down fast enough. I want to tell you, you do not want your heart rate to reduce very fast. There's actually something called the vasovagal response where people will stand up or they'll get up in the middle of the night to use the bathroom and then all of a sudden they'll collapse, they'll faint. That's because the heart rate was reduced too much. Some people will see blood, or they'll see something really troubling and stressful, and they'll pass out; that's an overactivation, or an acceleration of the calming response.

Andrew Huberman:

They're not so stressed that they kind of fall off the cliff of stress. They get so stressed that the rebound mechanism for calming themselves down goes too high, too fast. They calm down too fast, and they collapse and faint. And so be aware that if you're going to use the physiological sigh, or exhale-emphasized breathing, to calm down, that your heart rate will take about 20 to 30 seconds to come down to baseline. And you may need to repeat the physiological sigh a few times. So that's an important note about the use of breathing to control levels of stress.

Andrew Huberman:

The other thing is that when you decide to look to the body to control the mind, it does something else that's very powerful. When you are stressed in your mind and body - so you're feeling really agitated, activated and worried - and you use a tool like the physiological sigh or exhale-emphasized breathing, you will notice that then your brain and your mind becomes more available for controlling the stress response and reacting to it, which is great. Because the sweet spot in life, provided you're not trying to sleep, is to be alert and calm. And so that's the idea, to be alert and calm, and to bring you back into that sort of plane of alertness.

Andrew Huberman:

For those of you that have trouble sleeping or just relaxing through the day, the physiological sigh can be repeated for 10, 15 cycles if you like. Some people find that it actually puts them to sleep. So if they lie down and they're reading, and they do too many of these, that actually can put them to sleep. And what you'll find is that most breathwork protocols, the kind of stuff that's done away from real life, that you set aside time and decide to do, quote-unquote "breathwork" - most of that works such that if you're doing inhales that are longer and more vigorous than exhales, it tends to be activating and alert[s] you. If you're doing exhales that are longer and more vigorous than the inhales, it tends to put you to sleep.

Andrew Huberman:

And many of the protocols that are out there from laboratories and that populate the internet and wellness sites, and whatnot, if it's exhale-emphasized breathing, oftentimes it's been used as a tool for trying to teach people to fall asleep. Physiological sigh is a little different - it's designed to be used in real time. Just think of it as, kind of, in your kit of things that you can do as life happens and as you need to react to life. A note about nasal versus mouth breathing: there is a plethora of information out there now because of James Nestor's book "Breath: The New Science of a Lost Art," which came out this last year, excellent book. As well as "Jaws," which is from Sandra Kahn [and] Paul Ehrlich with a foreword by Jared Diamond and Robert Sapolsky, so a collection of people from Stanford. Jared Diamond's not at Stanford, but the rest are. And some heavy hitters on that book, which is about the benefits of nasal breathing.

Andrew Huberman:

And in many cases, nasal breathing is more advantageous than mouth breathing, for all sorts of things. Cosmetic features of the face, especially in kids, warding off infection, et cetera. With the physiological sigh, the best way to do it would be double inhale through the nose, exhale through the mouth. But if you can't, and you can only do that through your mouth, just do it through your mouth. If you want to do it all through your nose, do it through your nose. This anchors back to some underlying neurology or neuroscience. So for those of you that want to know, you have two breathing centers. One that's involved in rhythmic breathing for inhales, followed by exhales, followed by inhales, followed by exhales - the so called pre-Bötzinger nucleus, named after a bottle of wine and discovered by Jack Feldman at UCLA. And a nearby nucleus called the parafacial nucleus, also discovered by Jack Feldman at UCLA.

Andrew Huberman:

And the parafacial nucleus is involved in anytime you double up the inhales or double up the exhales; it was designed so that you could breathe while you're speaking. Because you can't always go inhale/exhale, inhale/exhale when you're speaking. So I tell you this, not to overwhelm you with knowledge, but just know that when you double up your inhales or you double up your exhales, you are activating this parafacial nucleus, and it has other cool effects. Because it's located near the neurons that control the face, it also has a tendency to relax the jaw. There's some interplay between the neurons that control the speaking stuff and the stuff for your tongue. So all of a sudden when we do this physiological sigh, we tap into neural circuitry that allows us to speak more clearly, to control the muscles of the face and jaw. Maybe that means not saying certain things when we're stressed and just generally to relax.

Andrew Huberman:

And so this brings us back to the neuroscience of this parasympathetic nervous system, this calming system that's been genetically encoded into us, that we all have, regardless of who our parents are. Which is that the neurons that control all of this stuff, the face, the eyes, et cetera, are all working together. And that's why when we get stressed, it's hard for us to speak, or we tend to jitter and these kinds of things, just like all the neurons that cause stress in the center of the spinal cord are working together to get our body activated. Okay, a lot of science today. You've now got the physiological sigh as a tool. You know that exhale-emphasized breathing will slow your heart down, and inhale-emphasized breathing will speed your heart up.

Andrew Huberman:

Let's think about something now; let's think about stress from not whether or not it's acute or chronic, whether or not it's good for us or bad for us, but on three different time scales. Because then we can arrive at what this is all about as it relates to emotions. Because trust me, this has everything to do with emotions and whether or not you're functioning well emotionally or you're not functioning well emotionally. Whether or not you're coping or not coping. So those are typically psychological terms and psychological discussions. We are entering this through the portal of physiology, the stuff of medical textbooks, and we will arrive at the psychology soon.

Andrew Huberman:

But I really want you to understand the difference between the three kinds of stress on three different time scales: short term, medium term, and long term, and what it's good for and what it's bad for. I think we've all heard that stress is bad for us. We've seen these pictures intended to frighten us, and indeed they are frightening. You see the nice, really plump brain on the left, it says healthy or control. And then you see the brain that says stressed above it on the right, and it's like withered. Or we see that the hippocampus, an area involved in memory is smaller in people that are stressed.

Andrew Huberman:

We see that the Alzheimer's brain is made worse by stress, that people who have a predisposition of schizophrenia when they get stressed, higher incidence of schizophrenic episodes. You hear that addicts will relapse when they're stressed. I mean, okay, we get it, and it's very important. But I think we've all heard now so many times that stress is bad. But in that conversation, unfortunately, it's eclipsed some of the really positive things that stress does for us in the short term. So stress can be short term, medium term, or long term.

Andrew Huberman:

Long-term stress is indeed bad, for all the reasons I just mentioned and many others. But what's never actually been discussed is what stress is so terrific for, positive for, in the short term. And I think we tend to overlook the important question, which is what is short term and what is long term? No one ever bothers to tell us what is chronic, what is acute, right? Is it five minutes? Is it five days? Is it for the duration of final exams, or is it for the duration of a senior thesis in college? No one actually draws boundaries around this stuff or even general guidelines. And so it's become a bit of a mess, frankly, to try and decipher this whole space around stress. I'm going to try and clean some of this up for you based on what we know from the scientific data.

Andrew Huberman:

First of all, acute stress. When the stress response hits, that is good for your immune system. I know that might be a tough pill to swallow, but it's absolutely true. In fact, stress often comes in the form of bacterial or viral infection, and the stress response is in part organized to combat bacterial and viral infection. There are pathways from the same brain centers that activate these neurons in your spinal cord to make you feel like you want to move. There are other neurons in your brain that activate things like your spleen, which will deploy killer cells to go out and scavenge for incoming bacteria and viruses, and try and eat them up and kill them.

Andrew Huberman:

So short-term stress, and the release of adrenaline in particular, or epinephrine - same thing, adrenaline epinephrine - is good for combating infection. And this, to me, is just not discussed enough, so that's why I'm discussing it here. And it relates to a particular tool that many of you ask about, but I don't often get the opportunity to talk about in such an appropriate context. It's not that it's ever inappropriate to talk about, but what I'm about to talk about now is the use of, again, respiration - breathing - to somewhat artificially activate the stress response, and that will accomplish two things.

Andrew Huberman:

I'll return to medium- and long-term stress. But I want to say short-term stress is good because the dilation of the pupils, the changes in the optics of the eyes, the quickening of the heart rate, the sharpening of your cognition, and in fact that short-term stress brings certain elements of the brain online that allow you to focus. Now it narrows your focus; you're not good at seeing the so-called big picture, but it narrows your focus. It allows you to do these, what I call, duration path outcome types of analysis. It allows you to evaluate your environment, evaluate what you need to do. It primes your whole system for better cognition. It primes your immune system to combat infection.

Andrew Huberman:

And that all makes sense when you think about the fact that famine, thirst, bacterial infections, viral infections, invaders, all of this stuff liberates a response in the body that's designed to get you to fight back against whatever stressor that happens to be. Psychological, physical, bacterial, viral. Again, the stress response is generic. The tool takes advantage of the fact that when adrenaline is released in the body from the adrenals, it has the effect of also liberating a lot of these killer cells from the immune organs, in particular from the spleen, but from elsewhere as well, and interactions with the lymphatic system, that combat infection.

Andrew Huberman:

The way this works in the real world is best captured by a study that can be mapped back to so-called Wim Hof breathing. Now, Wim Hof breathing is so named after the so-called Iceman, Wim Hof. Wim, of course, being this Dutch, I think he is self-titled, daredevil. And indeed he has many, many "Guinness Book of World Records" for things like swimming under icebergs, and going up Kilimanjaro in his shorts, and crossing the desert without water, et cetera. Things that are quite dangerous if you don't know what you're doing.

Andrew Huberman:

And Wim, obviously, survived, or I'm telling you he survived. But there are two components to a sort of breathing protocol that he developed that was based also on what's called tummo breathing, T-U-M-M-O. So before Wim, there was tummo breathing. And many people call this now super oxygenation breathing. Although the breathwork aficionados will probably say, well, it's not super oxygenation because you're also blowing an awful lot of carbon dioxide. What I'm talking about here, regardless of whether or not it's called Wim Hof, tummo or super oxygenation, is rapid, deliberate breathing. So it's deliberate hyperventilation. Why would somebody want to do this? Well, deliberate hyperventilation done for maybe 25 cycles. So inhale/exhale, inhale/exhale, inhale/exhale. Typically, it's done in through the nose, out through the mouth, although sometimes it's just through the mouth. If you do that for 15 breaths, 20 breaths, 25 breaths, you will feel very alert. People who have anxiety will feel anxious; they might even have an anxiety attack.

Andrew Huberman:

However, we need to ask why that kind of breathing feels that way. And it's because that pattern of breathing, rapid movements of the diaphragm, will liberate adrenaline from the adrenals. So it's the release of adrenaline. I mentioned that Wim is also called the Iceman. Well, that's because he actually discovered this pattern of breathing, somewhat - and again, it maps back to tummo breathing - by going into cold water. When you go into cold water, that too is a stressor, and you liberate adrenaline in response to cold water. So if you get into an ice bath or a cold shower, you will immediately release adrenaline from your adrenals.

Andrew Huberman:

Now, there are all sorts of things related to this about psychological control and stress thresholds that we'll talk about. But I really want people to understand that when adrenaline is released in the body, you are in a better position to combat infections. And so, whether or not you breathe very quickly in these cycles of 25 breaths, and regardless of what you call it, it doesn't matter, adrenaline is released. If you take a cold shower, adrenaline is released. If you go into an ice bath deliberately, and even if you do it nondeliberately, adrenaline is released; you are mimicking the stress response. And that adrenaline serves to suppress, or combat, incoming infections.

Andrew Huberman:

And this was beautifully shown in a study that was published in a very fine journal, the Proceedings of the National Academy of Sciences of the U.S. - it's literally called Proceedings of the National Academy of U.S.A. to distinguish it from other proceedings of other national academies in other countries. The way the experiment went is that, people were injected with endotoxin, or, in some cases, they were injected with a bacterial wall that mimics infection. It gives you a fever; it makes you feel nauseous; it makes you feel sick. It is not pleasant.

Andrew Huberman:

Half of the people did a particular pattern of breathing that looked very much like the pattern of breathing I described a moment ago. Of doing 25 deep inhales and exhales followed by an exhale, holding their breath, then repeating 25 inhales/exhales, holding their breath. So this would look something like this. Or if you're listening, it sounds like: [sound of breathing in and out] 25, 30 times, you'll start feeling heated up. You'll start feeling the adrenaline response; you're liberating adrenaline in your body. Then exhale, hold your breath for 15 seconds, and then repeat. And then typically after doing three or four rounds of that, they would inhale very deeply and hold their breath.

Andrew Huberman:

Now I want to emphasize, never ever, ever do this anywhere near water. People have passed out, so-called shallow-water blackout, people have died. Don't do it in the bathtub, don't do it in the hot tub. Don't do it before swimming. Please don't do it anywhere near water. Please don't do it at all unless you get clearance to do it from your doctor, because there are some pulmonary effects and whatnot. And the breath holds should definitely not be done by anyone that has glaucoma or pressure concerns for the eyes. But these repeated cycles of breathing that liberate adrenaline allowed the group that did that protocol to essentially experience zero symptoms from the injection of this E. coli, which is remarkable.

Andrew Huberman:

They had much reduced or no symptoms. They didn't feel feverish; they didn't feel sick; they weren't vomiting, no diarrhea. Which is remarkable but makes total sense when you think about the fact that the short-term stress response, what's typically called the acute stress response, is designed to combat all stressors. In fact, were you to cut yourself very deeply while out on a hike in the woods, the other thing that would happen is that there would be a rapid inflammation response. And we always hear, "Inflammation is bad. Inflammation gives us Alzheimer's. Inflammation is the worst thing." But the swelling is associated, the inflammation is associated with the recruitment of things like macrophages, or microglia if it's a neural tissue. Cells in our brain and body whose job is to act like little ambulances and rush to that site and clean it up, and indeed the inflammation response looks horrible. It sounds horrible, but it's a great thing in the short term. You want to have that tissue marked as in trouble, and you want the body and brain to react to it.

Andrew Huberman:

So if you're getting peaks and stress from time to time throughout your day or throughout your week, you are in a better position to combat infection. You are in a better position to heal your wounds, physical wounds; many great things happen in the stress response. Now of course, the stress response isn't always super intense; sometimes it's milder. Sometimes it allows us to just focus on something because we have a deadline; that can feel stressful, but that's one of the reasons... You procrastinators out there. People are always asking me, what can be done for procrastination? What can be done for procrastination is-

Andrew Huberman:

What can be done for procrastination?

Andrew Huberman:

What can be done for procrastination is you can understand what's happening, which is that you are self-imposing stress because stress acts like a drug. It is a powerful nootropic. I get asked about nootropics. The most powerful nootropic, or smart drug, is stress.

Andrew Huberman:

It's the concern of failure. It's the desire to do well. It's the impending deadline. It's the "Oh my gosh, I have to do this thing now or I'm going to fail." That is the best nootropic you will ever find. That, combined with a good night's sleep - which we'll talk about, but we spend a whole month on sleep, so I don't want to backtrack too much. Okay? So, short-term stress, great. The key is to be able to turn the stress response off when you're done, when you don't want that.

Andrew Huberman:

In fact, let's just really tamp down the relationship between the short-term, or acute stress response, and infection.

Andrew Huberman:

Many of us are familiar with the experience of work, work, work, work, work or taking care of a loved one or stress, stress, stress, stress, stress. Then we finally relax. Maybe, we even go on vacation, like "Oh, now I'm finally going to get the break," and then we get sick. And, that's because the adrenaline response crashed and your immune system crashed with it. So, please understand this.

Andrew Huberman:

Now, many of you might say, "Well, how long? Is it two hours? Is it three hours?" A lot of you out there that really like specificity, it will vary for everybody. I would just use a rule of thumb, when you are no longer able to achieve good sleep - what good sleep means to you, and please see the episodes on sleep if you want more about tools to sleep.

Andrew Huberman:

When you are no longer able to achieve good sleep, you are now moving from acute stress to chronic stress. You need to be able to turn the stress response off.

Andrew Huberman:

If I have one wish, well I have many wishes for this lifetime, but if I have one wish today that I hope will permeate and spread out there, is this idea that we need from a young age, but even as adults and forever, we need to learn how to turn off our stress response. Physiological sighs is one.

Andrew Huberman:

If we're going to activate our stress response intentionally by ice baths, cold showers, cyclic hyperoxygenated breathing, aka tummo breathing or Wim Hof breathing, we also need to learn how to press the brake.

Andrew Huberman:

Okay, so let's think about the stress system. It knows how to activate itself. Now we're talking about a way of deliberately activating your stress system in order to combat infection. I do this from time to time. I might feel a tickle in my throat or I'm getting kind of run down; I will do this kind of breathing. I do.

Andrew Huberman:

I will take 25 or 30 breaths, exhale, hold my breath. 25, 30 breaths again, exhale, hold my breath for about 15 seconds. 25, 30 breaths again, exhale, hold my breath for 25 or 30 seconds. Then, a big inhale and I hold my breath until I feel the impulse to breathe, Again, I feel it safe for me. I've run it by my doctor. So, it's fine. You should not do this unless it's right for you. But I do this.

Andrew Huberman:

Some people like the ice bath. I rarely do the ice bath. Some people like cold showers. I like hot showers. So, I take hot showers, but I do this kind of breathing. Again, they are all having more or less the same effect of increasing adrenaline which allows you to combat the infection, because you're activating the immune response.

Andrew Huberman:

Okay, so now let's talk about medium-term stress.

Andrew Huberman:

Medium-term stress is going to be stress that lasts anywhere from several days to several weeks, okay? We might think of that as long-term stress.

Andrew Huberman:

There are times in life when we are just dealing with a lot, okay? This particular quarter, I happened to be directing a course, I'm doing the lab, I'm doing this. I enjoy all these things immensely, but I'm kind of near my threshold. I'm near the point where any additional thing, like I couldn't log onto a website the other day, and it felt like the most intense thing in the world at that moment. And I laughed at myself. Fortunately, I caught it, but that typically wouldn't be my response under conditions where I wasn't pushed to threshold.

Andrew Huberman:

What is this medium-term stress? What is stress threshold?

Andrew Huberman:

Well, stress threshold is actually our ability to cognitively regulate what's going on in our body.

Andrew Huberman:

So, we all hear so much about "we need to unify our mind and body. We need to be at one with our mind and body." Now, I realize I'm kind of poking fun at some of the new age language, but the reason I poke fun is not because I don't think it has value, but it has no specificity. What does that mean? I mean, I think I'm always in my body.

Andrew Huberman:

I've never, fortunately, looked across the room and seen my arm over there or my leg over there. I'm connected to my body. There actually is a syndrome where people feel disconnected from their limbs. This is a real clinical condition. These people actually will seek out amputation. They will try and convince doctors to amputate certain portions of their body. It's a really terrible thing for people to have and it relates to a change in central maps in the brain, believe it or not.

Andrew Huberman:

Most of us want to keep our limbs, whichever ones we happen to have, and most of us feel one in mind and body. So much so that when stress hits, we feel it in our mind and body. A lot of stress inoculation, a lot of managing medium-term stress on the timescale of weeks, or maybe even a couple months - so we're not talking about years of stress - a lot of that has to do with raising our stress threshold. It's about capacity and there are very simple tools, excellent tools, that will allow us to modulate our capacity for stress, and they look a lot like the tools I just described.

Andrew Huberman:

They involve placing oneself, deliberately, into a situation where our adrenaline is increased, somewhat, not to the extreme. And then, when we feel flooded with adrenaline, and normally we would panic, it's about cognitively, mentally, emotionally calming ourselves and being comfortable with that response in our body.

Andrew Huberman:

So, unlike trying to unify the mind and body and make it all calm or make it all alert, this is about dissociating mind and body in a healthy way.

Andrew Huberman:

And, what would this look like?

Andrew Huberman:

Well, this is something I actually do as a practice because, I mentioned before, you can use physiological sighs in real time. You can use the cyclic hyperoxygenation breathing to combat infection, if you're feeling kind of run down, and there's also a way in which you can use things like cold showers or if you exercise and you bring your heart rate up very high. You go into that high intensity realm, where your heart is beating a little bit harder than you're comfortable with.

Andrew Huberman:

Some people think it's lactic acid. No one can agree on this, what the burn is, whether it's lactic acid or it's a buildup of hydrogen, or whatever. I don't want to get into that, but we're all familiar with the intense feeling of your muscles burning because you're working very hard physically.

Andrew Huberman:

The key, in those moments, is to learn to relax the mind while the body is very activated.

Andrew Huberman:

And, what that tends to do, there's a limited amount of research on this, but what that tends to do is it tends to create a situation where, what once felt like a lot feels manageable. Okay? You've raised your stress threshold or your stress capacity.

Andrew Huberman:

One way that you can do this, and this is kind of fun, if it's approved by your physician and you're able to do this, you can bring your heart rate up.

Andrew Huberman:

You could do this through an ice bath, if that's your thing, or a cold shower or cyclic oxygenation breathing, or you could sprint or you could go hard on the bike. Whatever it is that brings your heart rate up. And then, what you want to do is you want to actually try and calm the mind while your body is in this heightened state of activation. And, the best way that I'm aware to do that, again, goes back to physiology, not psychology.

Andrew Huberman:

When we are stressed, our pupils dilate. The effect of that pupil dilation is to create tunnel vision. It literally narrows our view of the visual world. We no longer see in panorama. There'[re] some other effects as well, but that's because the visual system, through this cranial nerve system that I described before, is tethered and is part of this autonomic nervous system.

Andrew Huberman:

By deliberately dilating your gaze, meaning not moving your head and eyes around, but by deliberately going from tunnel vision to broader panoramic vision, literally seeing more of your environment all at once. You don't have to do what I'm doing, which is not blinking; you're welcome to blink. But, it means deliberately dilating your gaze so that you can see yourself in the environment you're in. It creates a calming effect on the mind because it releases a particular circuit in the brain stem that's associated with alertness, aka stress. Now, this is very powerful.

Andrew Huberman:

If you're running, for instance, and you're at max capacity or close to it, or you're kind of hitting like 80, 90% of maximum on the bike, and you dilate your gaze, what you'll find is the mind can relax while the body is in full output. And, this relates to work in various communities. People are working with this in the sports community, military communities, et cetera. But, it's a form, not really of stress inoculation, it's more about raising stress threshold so that the body is going to continue to be in a high alertness, high reactivity mode - high output, but the mind is calm.

Andrew Huberman:

And so, this isn't about unifying mind and body. This is actually about using body to bring up your level of activation then dissociating.

Andrew Huberman:

Not the clinical dissociation, disorders, but dissociating the mental or emotional response from what's going on in your body. And over time, so if you do this a couple times, you don't have to do this every workout, but if you do this maybe once a week or so, you start being comfortable at these higher activation states. What once felt overwhelming and a lot of work now is manageable. It feels tolerable.

Andrew Huberman:

So, that's for navigating medium-term stress.

Andrew Huberman:

Now, there are other tools as well, but we don't want to go over 90 minutes, because 90 minutes is one ultradian cycle. I always try and keep these podcasts at one ultradian cycle, in case you haven't noticed. So, you can drive maximum benefit from them based on ultradian cycle principles of learning. So, I don't want to go into every little bit of this and I want to make sure we get to emotions.

Andrew Huberman:

But, I want to emphasize that these medium-term stressors of "oh, [it] has been a hard month " or "hard week" or, Stanford's on the quarter system so 10 weeks or semester - that becomes more manageable when we train ourselves to be calm of mind when our body is activated.

Andrew Huberman:

And, if you haven't noticed, most of the tools I'm describing today are nothing like the, sort of "okay, sit and do meditation." I'm actively avoiding saying the words NSDR, non-sleep, deep rest. I talked a lot about those tools during the months on sleep and neuroplasticity. And, of course, they're wonderful for replenishing your ability to lean into effort, to learn, to focus. Please do try and check out NSDR protocols, see if they're right for you. The margins for safety, I think, are enormous. You're basically just listening to a script. We have links to them in previous captions. I've talked on them on various podcasts before; we can provide them again.

Andrew Huberman:

But today I'm really talking about tools so that you can learn to dance with stress. To in the short term, reduce that stress response a little bit if it feels too uncomfortable. In the medium term, to be comfortable at these heightened levels of activation because life is going to continue to come at you. We can't pick the stressors, but we need to be able to function at a higher capacity often.

Andrew Huberman:

And then there's long-term stress.

Andrew Huberman:

Now, long-term stress is bad. You do not want adrenaline up in your system for a very long time.

Andrew Huberman:

In fact, ideally you would have your stress go up various times throughout the day, but it would never stay elevated, and it would never prevent you from getting a good night's sleep.

Andrew Huberman:

Now, that isn't realistic, okay? I would say, for me, three, four nights out of the month, no matter what I do, I take on too much or something happens and life is life and I don't get the best night's sleep that I would like to get. For many of you, it's 30 nights per month. For some of you, it's zero nights per month and congratulations to you zero-nights-per-month people. If you are managing your sleep really well every night, that is fantastic.

Andrew Huberman:

You really want to be able to fall asleep at night, stay asleep for most of the night, and if you get up, go back to sleep for as long as you need to in order to feel rested. That's what I define as a healthy relationship to sleep.

Andrew Huberman:

Check out the episodes on sleep. If you want tools to be able to accomplish that, we can all accomplish that. It can be done and there are tools to do it. Zero-cost tools.

Andrew Huberman:

Okay, so let's talk about long-term stress.

Andrew Huberman:

Earlier, I talked about how breathing can modulate heart rate through this loop that includes the brain and the parasympathetic nervous system. I don't think I mentioned this, and I want to make sure that I mention that breathing, controlling heart rate through the sympathetic and parasympathetic nervous system, is the basis of what's called HRV, heart rate variability. And, we know that heart rate variability is good.

Andrew Huberman:

You don't want your heart rate chronically elevated or chronically low. A lot of people think, "Oh, I want a really nice low heart rate." And indeed, if you're in shape, the stroke volume of your heart will be greater and you can have a nice slow heart rate. Years ago when I was running regularly, I think my heart rate was down to like 50 or 60 or something like that.

Andrew Huberman:

That's great. And, now it's higher than that because I'm running a little bit less, but everyone needs to determine what's right for them. But, you don't really want your heart rate to be chronically low or chronically high. Both are bad.

Andrew Huberman:

We know that chronic stress, elevated stress, and especially in the so-called type A personalities, creates heart disease. The leading killer for in most every country, but in particular in the U.S.

Andrew Huberman:

Because of the way that adrenaline impacts those blood vessels, of constricting some and dilating others. It's just that hypertension, chronic hypertension is just bad. And so, chronic stress truly is bad. I want to really make that clear because I emphasized a lot of some of the positive effects of stress, but you want to be able to tamp down your stress in real time. You, also want to be able to modulate your stress and your emotional relationship to stress in the body in the medium term. But, by no means do you want to be stressed out all the time, chronically for months and months and months and years on end.

Andrew Huberman:

The best tools, the best mechanisms that we know to modulate long-term stress might surprise you a little bit.

Andrew Huberman:

First of all, there are going to be the things that don't surprise you, which is everyone knows getting regular exercise, getting good sleep, using real-time tools to try and tamp down the stress response, et cetera. That's all going to be really useful.

Andrew Huberman:

The data really point to the fact that social connection, and certain types of social connection, in particular, are what are going to mitigate or reduce long-term stress. And, this is a particularly important issue nowadays where we have all these proxies or surrogates for social connection.

Andrew Huberman:

We're online and texting with people a lot so we can feel connected. The plane's about to take off and everyone's texting each other whether or not they have fear of flying or not. They're like, "Okay, see you, love you, hate you." Whatever it is that they're trying to communicate to people. Then, plane lands, phone's out - "See you, love you, hate you." Let's hope it's fewer hate yous. But, everyone has this need to stay connected to one another. Humans are incredibly social creatures.

Andrew Huberman:

Now, there is a way to look at this whole business of social connection, not from just the wishy-washy new agey perspective.

Andrew Huberman:

And I want to point out that sometimes I'll say wishy-washy new agey. I have nothing against that. My goal here is always to put scientific data and some neurochemistry on things so that, for those of you that are into wishy-washy, new agey stuff, you also can arm yourself with some arguments for the members of your family and your life that maybe aren't so tuned into the typical language around those practices, like "Oh, connection is really key, we all get oxytocin."

Andrew Huberman:

Actually, did you know that connection between individuals rarely causes the release of oxytocin? Oxytocin is released in very particular circumstances like postorgasm, baby and mother, milk let down. It's associated with really intense kinds of pair-bonding things of mother and child, also father and child, but especially mother and child because its relationship to the lactation system. Couples post sex, these kinds of things that reflect deep layers of our biology. Oxytocin is not just released when we walk in and pat the dog on the head or we see somebody and we give them a hug and, "Hey, great to see you," fist bump. That's not a situation for oxytocin.

Andrew Huberman:

The way to think about social connection and how it can mitigate some of the long-term effects of stress is really through the systems of neuromodulation, like serotonin, and through blocking certain things that are really bad for us when we feel socially isolated. Things like tachykinins.

Andrew Huberman:

So, let me explain what these are.

Andrew Huberman:

Serotonin, again, is a neuromodulator. Neuromodulators are a little bit like playlists in the brain. They tend to amplify or bias the likelihood that certain brain circuits and body circuits are going to be activated and that others will not. Serotonin, generally, and I realize I'm speaking very generally here, but it, generally, gives us feelings of wellbeing. At very high levels, it makes us feel bliss and it tends to make us feel like we have enough in our immediate environment.

Andrew Huberman:

This is why some of the side effects of antidepressants that elevate serotonin and actually can help a lot of people with depressive symptoms, but the side effects associated with drugs that increase serotonin tend to be reduced affect. They tend to kind of blunt affect or make people feel like their libido is lower. Desire goes down because the body has so much serotonin and the brain has so much serotonin that one feels like they have enough.

Andrew Huberman:

But, serotonin pharmacology aside or taking antidepressants aside, a topic for another time, serotonin tends to make us feel good. When we see somebody that we recognize and trust, serotonin is released in the brain, and that has certain positive effects on the immune system and on other systems of neural repair and synapses and things that really reinforce connections in the brain and prevent that long-term withering of connections.

Andrew Huberman:

So, serotonin is tied to social connection.

Andrew Huberman:

Now, social connection can take many forms. As many of you know, I am very attached to my dog. I hope he's attached to me. He's asleep most of the time. So, I don't know. And even if he was awake, I don't really know what I would ask him, but he seems more or less to be attached to me, as well. And, there's no scientific evidence that it has to be human attachment. I do have attachments to humans as well, but you can have attachments to other people. Some of those can be romantic attachments, those could be familial attachments that are nonromantic, friendship, pets, even attachments to things that just delight us.

Andrew Huberman:

One of the things that really can mitigate against the long-term negative effects of chronic, long-term stress isn't just having fun. We hear all this stuff, you need to play and have fun. That can be a little bit of a tough concept, especially for the hard driving people or people that are stressed. But, having a sense of delight, a sense of really enjoying something that you see and engage, in witness or participate in, that is associated with the serotonin system. And, certainly play is one of those things. Social connection of various forms, those are things to invest in. Some people might say, "Well, nobody wants to be my friend or nobody wants to engage socially anymore."

Andrew Huberman:

I'll be the first to admit, social connection and friendship and relationships of all kinds to animals or humans or inanimate objects takes work. It takes investment. It takes time in not needing everything to be exactly the way you want it to be.

Andrew Huberman:

I have a friend who struggles with this, and oftentimes the conversations just circle back to the fact that when you want social connection, you often have to be more flexible. You have to eat on other people's schedules. Sometimes you have to eat things you don't necessarily want to eat the most in that moment, or stay up a little later or wake up a little earlier.

Andrew Huberman:

Social connection is something that we work for, but it is incredibly powerful.

Andrew Huberman:

I want to, of course, tip my hat to, it's only appropriate to call him the great Robert Sapolsky - my colleague, who I'm fortunate enough to know at Stanford, of course, has talked about this quite a lot. So, I want to acknowledge Robert's incredible work and discussions around this. You can look up those materials online and his wonderful books.

Andrew Huberman:

But, primates, and we are primates, we are social species. And, as Robert has said many times before, never before in any primate history, but in particular in human history, have we interacted with so many strangers at a distance when we are not really connected to them. So, finding just a few people, even one, or an animal or something that you delight in, believe it or not, has very positive effects on mitigating this long-term stress, on improving various aspects of our life as it relates to stress and emotionality.

Andrew Huberman:

So, that's the social connection part.

Andrew Huberman:

The other thing is that social isolation that goes too long is associated in everything from flies, believe it or not, to mice and humans with this molecule, tachykinin.

Andrew Huberman:

Tachykinin is a molecule that makes us more feel fearful, paranoid and impairs our immune system. And so, tachykinin is like this punish, internal punishment signal. It's like our body and our brain telling us you're not spending enough time with people that you really trust. You're not spending time doing things that you really enjoy.

Andrew Huberman:

And, I often think about tachykinin for myself because I'm pretty hard driving. I have a lot of pursuits. I also have a lot of wonderful people and an incredibly wonderful bulldog in my life. But there are times when I can be so goal-directed and so in motion, and trying to accomplish everything, that I sometimes forget that about tachykinin. And, I like to remind myself, so much so that I actually have a little post-it above my desk; it says tachykinin to remind me that tachykinin is this very sinister molecule that starts being secreted when we are not socially connected enough.

Andrew Huberman:

And, this is why long meals with friends or family, and we'll talk about phones in a moment, but where there'[re] no intrusions, or even if there are, just feeling like we are connected, suppresses tachykinin. And, tachykinin is something you really want to avoid because chronic isolation, chronically high tachykinin that's associated with long-term stress, really depletes so many good functions of our brain and body and promote so many bad ones, including irritability, paranoia, fear, et cetera. That is really something to avoid.

Andrew Huberman:

And, so I want to highlight tachykinin as something to avoid. I don't want to completely disregard oxytocin, it's just that oxytocin has been built up a lot in the media, and really serotonin works on much faster time scales.

Andrew Huberman:

Now, how do you know if you're making serotonin? You don't know in the moment, but you can learn if you pay attention to recognize these feelings of comfort, trust, bliss, delight. And, those are not weak terms; those are not associated just with psychological terms. They are every bit as physiological as the movement of your muscles or the secretion of adrenaline.

Andrew Huberman:

Many people focus now on gratitude. Gratitude is a little bit subjective, and here we're moving from some objective to subjective things, but recognizing and, in particular, writing down things that you're thankful for, however small they may, does seem to have a positive effect on the serotonin system.

Andrew Huberman:

Now, there are a plethora of things that will also impact wellbeing and allow you to modulate your long-term stress, reduce the likelihood that you'll engage in long-term stress. And, we don't have time to go into all these, but of course finding the diet and nutrition that's right for you, the exercise schedule that's right for you, the sleep schedule, all that. But do not underemphasize the social connection part, please. As well, there are some compounds that are not antidepressants, although if you need antidepressants and a clinician prescribes them to you, please follow their advice, if that's what's right for you. There are compounds that are not prescription compounds that can modulate the stress system, and sometimes, because of the way that life is, we just don't have the opportunity to control life and to control our response to stress. At least for myself, I can only talk about my own experience. I've found it useful in times of chronic stress to start modulating some of the neurochemistry related to the stress response in order to help.

Andrew Huberman:

Now, if a doctor prescribes you prednisone or prescribes you some other hormone or something, that's important, but what I'm talking about now are nonprescription things. You should check out examine.com, this free website, which will allow you to put in any supplement and evaluate that supplement with, they provide links in the so-called human effect matrix to PubMed. It tells you the exact subjects they were done in. Was it postmenopausal women? Was it kids? Was it normal adults? Was it people with autism? Et cetera. Check out that site for any and all supplements you're considering or taking. I highly recommend it. I have no relationship to them. I just think it's a wonderful site that's curated all this important information.

Andrew Huberman:

But some of these compounds are effective enough, they can kind of take the edge off, and I'll use them periodically myself. And so I just thought I'd mention them since there are a number of you that are interested in them. The three I want to focus on, and one that I think you need to be cautious about, that I've mentioned before, include Ashwagandha, funny name, but that's what it's called. L-Theanine or theanine, it's often called, and melatonin.

Andrew Huberman:

Let's talk about melatonin first. Melatonin I talked about during the month on sleep. Melatonin is a hormone secreted from the pineal in direct relationship to how much darkness you are in. Not emotional darkness, but light suppresses melatonin. Melatonin helps you fall asleep. It doesn't help you stay asleep. I personally do not recommend supplementing melatonin because it's supplemented typically at very high levels, one to three milligrams or even more. That is an outrageously high dose. It's super, super physiological compared to what you normally would make. It also has a number of potentially negative effects on the reproductive access and hormones there. Some people can take it without problems. If you like it and that's your thing, fine. I just want to cue you to the fact that there can be issues. You should check on examine.com. Talk to your doctor, especially in kids because melatonin suppresses the puberty response in a number of species.

Andrew Huberman:

Enough about the negative things of melatonin, except that people who take too much melatonin chronically, oftentimes when they're taking it to sleep or for whatever reason, yes, it can reduce anxiety and stress, but it also can reduce the output of the adrenals to the point where it can become problematic.

Andrew Huberman:

Now, a note about adrenal burnout. There is actually no such thing as adrenal burnout under normal conditions. The adrenals have enough adrenaline to support 200 years of stress, for better or for worse. The concept of adrenal burnout has origins in the work of Nobel Prize winner, Hans Selye, who actually discovered what he called the general adaptation syndrome. He discovered a lot of things about stress. He did some phenomenal work that turned out to be true, that we have stressors. There's something called distress. He talked about eustress, which is positive stress. Eustress has never really caught on in the kind of more general discussion. But he had this theory that if stress went on long enough, that you would eventually reach a phase called exhaustion. And that turned out to be wrong. Although many of you may feel exhausted after chronic stress, there isn't really a physiological exhaustion that happens. And that eventually got picked up and ran with the general public. And they talk about adrenal burnout, too much coffee, adrenal burnout. You hear all this stuff. There is no such thing as adrenal burnout. The adrenals don't burn out.

Andrew Huberman:

There is something, however, called adrenal insufficiency syndrome, which is a real physiological problem, where some people have very impaired adrenals and they can't produce adrenaline, and melatonin taken at very high levels for periods of time that are too long can cause suppression of the cortisol and epinephrine release from the adrenals and can create a kind of pseudo-adrenal insufficiency syndrome. So, beware melatonin for that reason. Please, I'm trying, I alone can't get rid of the phrase adrenal burnout. I'm not trying to give a hard time to anyone who feels burnt out or exhausted, but it is for other reasons. It is not because the adrenals are burnt out unless you happen to have adrenal insufficiency syndrome. So, I'm not a fan of melatonin for a lot of reasons. Now, I've mentioned several.

Andrew Huberman:

The other is L-Theanine, I've talked about L-Theanine, which provided it's safe for you, can be taken 100 milligrams or 200 milligrams, about a 30 minutes or 60 minutes before sleep. It can enhance the transition to sleep and depth of sleep for many people. It increases GABA, this inhibitory neurotransmitter in the brain. It tends to turn off our forebrain a little bit or reduce the activity of our kind of thinking systems and ruminating systems to help people fall asleep. That's for sleep.

Andrew Huberman:

But theanine has also been shown for people that are chronically anxious or chronically stressed to, if you look at the studies or I have a large collection of studies in front of me right now, if you want to see those links, I know if you want those, go to examine.com, put in theanine. They link, for instance, it is known to significantly increase relaxation. There are four studies listed there with PubMed links. It is known to have a minor effect on anxiety, but eight studies have shown that, which I think is a fairly large set of studies, some of them in great journals. It also can reduce task completion anxiety, so anxiety related to task completion. Not good for the procrastinators perhaps, but for those of you that are chronically stressed. It can increase attention a little bit. It can reduce blood pressure a little bit, improve sleep quality, et cetera. It definitely has a notable effect on stress. Two studies in particular, that it can notably reduce the effects of stress. So, there's a lot there. It also has effects on insomnia, on some blood lipid profiles. And so go to examine.com and check it out.

Andrew Huberman:

But this is one reason why I supplement theanine for sleep. But if I'm feeling like I've been under a lot of stress and I'm not managing my stress very well with the short-term and medium-term tools that I talked about earlier, I might start taking a little bit of theanine, especially in the late afternoon, which is when I tend to start to feel like I haven't gotten enough done and the day is kind of carrying on. And so you can blunt the response to stress a little bit, which is why a lot of companies are now putting theanine into energy drinks. I am not a big fan of most energy drinks. Most of them have taurine, which I know some of you wrote to me and said, "Oh, taurine's great for all these reasons." Taurine also has effects on the microvasculature that, at least for me, were not good. It caused bursting of microvasculature in my sclera, in my eyes, which is why I'm not a fan of any energy drink that has taurine, or taurine generally, but that's just me. You have to decide for you. I'm sure the comment section, there'll be a couple taurinistas out there that will say, "But I love taurine." Great. Keep the taurine companies in business, but it's not for me. And I'd like people to know that it may or may not be for them.

Andrew Huberman:

The other supplement that can be very useful is Ashwagandha. Ashwagandha is known to lower anxiety and cortisol. There are six studies that collectively show reductions in cortisol, which is, cortisol is typically associated with waking up in the morning, which is good. That's a healthy, brief cortisol bump that goes away, provided you're getting your light at correct times of day, like morning and evening. But you don't want cortisol chronically elevated. That's associated with all the bad stuff about stress.

Andrew Huberman:

There's a very strong effect of Ashwagandha. You can find dosages at examine.com. They report in across six studies, 14.5 to 27.9 reduction in cortisol in otherwise healthy but stressed individuals. Now, I don't know about kids. You have to look at what it says on various supplements. Most things here are being done in adults, so please check carefully. But this is great. I mean, the opportunity for me anyway, to be able to take something that can help me reduce my cortisol so that I don't get some of the long-term effects of stress, and I'm not going to take Ashwagandha year round. I would only do this if I was feeling like I wasn't managing my short- and medium-term stress well. So, I don't take it on a regular basis. I do take it when I'm in these times when things are particularly stressful. There are five other studies that show reduced stress. So, that's not cortisol measurements, but things like fatigue, cognitive impairment, et cetera.

Andrew Huberman:

It does lower total cholesterol, which may or may not be good or bad for you, up to 10%. Some people don't want their cholesterol lowered. Some people might. Cholesterol, we'll talk about this in a month on hormones, but cholesterol is the molecule from which testosterone and estrogen and cortisol, for that matter, are synthesized. So, you don't want to get your cholesterol so low, then there are all sorts of negative effects, but you don't want it too high either. Mild effects in good clinical studies on reducing depression, probably associated with the effects on stress and some other things as well. So, Ashwagandha is something I use from time to time. It's kind of interesting.

Andrew Huberman:

L-Theanine, I rarely will use those during the daytime except under conditions where I'm feeling chronically stressed. Check out the human effect matrix on examine.com. Again, a phenomenal website. I've sent them a few emails before. That's the only exchanges I've ever had with them. But I just think it's wonderful that they put together this resource, otherwise we'd be stuck mining PubMed. They've collated the papers from PubMed with links to PubMed. So, terrific resource.

Andrew Huberman:

So, social connection and some supplementation, of course, diet, exercise, sleep for long-term stress. And now, we are finally in a position to talk about what we have set out to do from the beginning, which is spend the month on emotions. It was very important that we discuss stress and we discuss it in the context of short-, medium-, and long-term stress that we discussed tools for short-term, medium-term, and long-term control. I don't really want to say mitigation of stress. Stress is going to happen, but our ability to modulate and control stress in real time, offline, using tools such as respiration, using tools such as dilation of gaze, using tools like social connection, maybe some supplements. Certainly, take care of your sleep and nutrition and exercise. Again, tons of resources and information in the sleep episodes. So, you can look there. We will do a month on hormones, on exercise, et cetera.

Andrew Huberman:

But let's talk about emotions because in subsequent episodes we're going to talk about OCD, we're going to talk about depression, we're going to talk about mania, we're going to be talking about dopamine and all sorts of things. But at the core of emotions is this question, what is an emotion? Well, it's complex. There isn't a single brain area for any one of these things that we call emotions. My framework, and I think the modern science, both psychology and neuroscience, is pretty well-aligned with what Lisa Feldman Barrett has talked about. Now, Lisa's at Northeastern University. She runs a big lab there. She's a world expert in emotions. She's written two books that are really wonderful. One is "How Emotions Are Made," which was her first book. The second one is "Seven and a Half Facts About the Brain." It's a wonderful book as well. It came out more recently. I hosted Lisa on an Instagram Live once. Maybe we'll get her here on the podcast if we're lucky.

Andrew Huberman:

We don't agree on everything about the neuroscience of emotions, but I subscribe to most everything that I've heard Lisa say, in particular, the fact that emotions are context dependent. There's a cultural dependence, etcetera. I look at things mainly through the lens of physiology and neuroscience at kind of low-level circuitry.

Andrew Huberman:

One way to think about emotions that I think is consistent, and I think Lisa would generally approve, I can't speak for her, but I would hope she would generally approve of this description, is that when our internal state of stress or calm matches the demands on us, or is mismatched from the demands on us, we tend to interpret those as good or bad.

Andrew Huberman:

Let me give you an example. If I am feeling very anxious, very stressed inside, and I have a lot to do, that doesn't feel good, but it's really no different than if I'm very tired and I have a lot to do, because there's this mismatch. I'm not in the right internal state. My internal state isn't correct, rather, to meet the demands that are being placed upon me. In both cases, when I'm too tired or I'm too stressed to do what I need to do, the valence, meaning the value that I assign to that is, I don't feel good. It's not a good situation and I don't feel good. Now, I might call it stressed, I might call it anxious, I might call it worried, might call it a number of things, but it's not good. However, when I'm tired and I want to fall asleep, well, then I feel good because that's what the demand is. I need to go to sleep and I'm tired. If I'm wide awake and I need to fall asleep, then that's not good. And then the brain tends to go down the direction of interpreting the situation as a bad one.

Andrew Huberman:

While the discussion around emotions is far more nuanced and more elaborate than this, one way to think about your relationship to emotions is whether or not your internal state is matching the demands that are upon you. So, in that way, we don't really place so much value on whether or not we're feeling alert or sleepy. We only place value on whether or not that alertness, whether or not it's full-blown stress or not, or our sleepiness, whether or not we're falling asleep or just a little bit drowsy, whether or not that matches the conditions that we face. It's a useful framework to have, and it's the reason in part why I spent this last hour and a half or so talking about stress and how to control stress.

Andrew Huberman:

One reason we did that is because I think it's a valuable opportunity to learn some tools and understand stress and really learn how to take control of stress, which I think we could all benefit from doing, regardless of age.

Andrew Huberman:

The other reason is that when you start to understand that you have this kind of seesaw system in your body, this autonomic nervous system that takes you from alert and calm to stressed, to full-blown panic. It has that capacity. Or from sleepy and drowsy to passing out tired to, God forbid, let's hope never, but a coma. That you're basically on this seesaw all the time. Where you are on that seesaw of alertness or calmness positions you to be in better reaction to the demands that you face. Whether or not the thing that you face is a need to fall asleep or to listen quietly and not react. You now know, for instance, that if your job is to take feedback, or maybe you're going in for a job evaluation, or you're in a relationship where there was a call for a discussion and somebody needs to talk to you about something and we need to talk about something, you're going into that like, "Goodness, this is going to be rough," learning to reduce that stress response a little bit so that you are in a position to hear the information better.

Andrew Huberman:

Remember, from a previous episode, if you close your eyes, you'll be able to actually focus on the information better. There's your permission to not look someone directly in the eye where they talk to you, if you really want to hear what they have to say. You will be able to modulate that stress response and lean into life better. You'll be able to react to things in a more effective way and to not be reactive.

Andrew Huberman:

This is really one of the important things, to me anyway, is that so much of the language around psychology, which I think is a wonderful field, but pop psychology in particular, is be responsive, not reactive. Well, great, but then how does one do that? Well, one does that by modulating their short-term stress response in real time, not by saying, "Hold on, I need to meditate. Hold on, I need a massage. And then I can have this conversation." By modulating the reactivity in real time. How does one, for instance, be mindful, which is a beautiful concept, but how are you mindful? Well, I don't know. When I'm moving through my day, a lot of times I'm just trying to get things done. As soon as I start monitoring and seeing what I'm doing and kind of third person-ing what I'm doing, it actually takes me out of the effectiveness and experience of what I'm doing. So, for me, sometimes that mindfulness, that observer, as they call it, is something that doesn't help me. It actually hinders me.

Andrew Huberman:

What's important to me is to be able to work and focus and then to be able to disengage, to be able to do an non-sleep deep rest, or to be able to still fall asleep, even though I've been working hard until 9:30, to put my head down at 10:00 and be out cold sleeping by 10:02. That's possible if you can learn to control this stress response.

Andrew Huberman:

To do that, we can't use the mind to control the mind. We need tools. And so a lot of the people being grumpy or anxious or depressed, a lot of that, provided it's not for some underlying neurochemical reason that's chronic, a lot of that comes from being poorly rested, from overworked, from feeling like the world is bearing down on us.

Andrew Huberman:

And so rather than take a subjective view of this, I take the view of objective physiology. What can we do that's anchored to these neuronal systems in our body, in our brain, in our eyes, in our diaphragm, et cetera, and look to those as tools, levers that we can pull on and push and maneuver through life in a way where we start to feel like we have some agency. We actually have some real control because we're controlling the internal landscape.

Andrew Huberman:

So, I think that ought to set the stage for where we're headed next, which is to talk about all the things that you normally think of when you think of emotions, like happiness, like awe, like joy. We will get into some of that. But all of that rests firmly on the foundation of this thing we call the autonomic nervous system. This stress modulation, this calming modulation system. Again, whether or not you're activated or you're calm is not good or bad. It depends on the situation. Certainly, when you want to fall asleep, being activated isn't good. When you have work to do, being activated is great. So, I hope today you are able to take a slightly different view of this thing that we call stress, not just see it as evil, but see it as powerful and useful in certain contexts. Great for us in certain contexts and problematic in other contexts.

Andrew Huberman:

And, as well, to think about the various tools that I've presented that can allow you to adjust and modulate your internal levels of alertness or calmness so that you can lean more effectively into life, which includes sleep and social connection and the work you have to do. And of course, acknowledges that the events in the world are beyond our control. What's in our control is how we react to them. Something that's commonly said in the wellness and self-help and psychology world, but for which there often aren't as many concrete tools that we can really look to and trust in real time. Of course, there are other tools out there. As always, I'll say it, I strive to be accurate, but I'll never be exhaustive. I might have exhausted you. I might have cured your insomnia with this discussion today. But in all seriousness, my goal is to bring you tools and information so that you can manage better through life.

Andrew Huberman:

So, thanks so much. I very much want to thank all of you for your support for the podcast. It's really been wonderful. If you've subscribed to the podcast on YouTube, Apple or Spotify, or maybe even all three, terrific. If you haven't, please do subscribe on YouTube, Apple or Spotify, or maybe even all three, which would be wonderful. On Apple, you can leave a five star review if you think we deserve that, as well as a comment reviewing us. If you have suggestions, if you have questions regarding the content of the podcast or things that you'd like us to cover in the future, please put those in the comment section on YouTube. As well, if you could recommend the podcast to friends, family members, coworkers that you think would benefit from the information, maybe even send them the links if you like. That's tremendously helpful. In addition, if you want to follow us on Twitter, we're there @HubermanLab or on Instagram, @HubermanLab. I also do some content on Huberman lab, little neuroscience posts. Some are reposts of clips from the podcast, others are unique content that you won't find on the podcast, so you can follow us at @HubermanLab.

Andrew Huberman:

As always, really appreciate your time and attention today. I hope you practice some of the tools if they're right for you. I hope you think hard about stress and how you can control your stress. And above all, as always, thank you for your interest in science.

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In this episode, Dr. Huberman explains what stress is, and how it recruits our brain and body to react in specific ways.