Millions of kids on ADHD meds decide their treatment as adults

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Brain training to help with anxiety and ADHD_00014117

Treatment for kids

ADHD is a disorder that deals with the inability to focus, and it comes in three types: inattentive, hyperactive/impulsive and combined. A person with the inattentive type of ADHD — also called attention-deficit disorder, or ADD — has trouble following directions or paying attention to details and is easily distracted.
A person with the hyperactive type of ADHD is restless, has trouble sitting still and is impulsive. A person with the combined type has equal amounts of inattentiveness and hyperactiveness. The CDC says these children are impulsive and restless, whereas children with ADD do not have the hyperactivity characteristic.
Pediatricians and child psychiatrists typically give parents a few treatment options: medication, behavior modification or both. Nearly 43% of children with ADHD in America are treated with medication alone. Some commonly prescribed medications are amphetamine/dextroamphetamine, known as Adderall; methylphenidate, known as Concerta or Ritalin; and lisdexamfetamine, known as Vyvanse.

Safety first

Dr. Angela Hutchins-Howard, a pediatrician and American Academy of Pediatrics fellow in Snellville, Georgia, recommends getting a doctor’s input before practicing self-regulation of medication.
“It’s safe, and I leave a lot of [the decision to self-regulate] up the parents,” Hutchins-Howard said.
Sometimes, people who take ADHD/ADD medication regularly will build a tolerance to the side effects. But if a person practices self-regulation, Hutchins-Howard says, it can be harder to build that tolerance. And according to the Centers for Disease Control and Prevention, young children are more prone to side effects than older kids.
Common side effects of ADHD/ADD medication include decreased appetite, nausea, trouble sleeping and moodiness.
Russell A. Barkley, a clinical professor of psychiatry at the Virginia Treatment Center for Children and the Virginia Commonwealth University Medical Center in Richmond, emphasized the possible problems with self-regulation of ADD/ADHD medication without the supervision of a doctor.
“There can be poor understanding of the side effects profile of the meds, poor dosing, failure to understand any contraindications and dependency from excess usage,” Barkley said.
Barkley recommends working with someone who has a thorough knowledge of the drug, its mechanisms of action and dosing before attempting to self-regulate alone.

Treatment for adults

Studies show that medication eases the symptoms of ADD and ADHD about 80% of the time. But despite its effectiveness, as children age, they tend to want to use the medication less and less and cope with their symptoms by other means.
Barkley has written more than 200 articles about ADHD research, assessment, treatment and development. After studying ADHD-diagnosed children into adulthood, he divides them into three groups based on self-regulation of medication and awareness of the disorder.
Group one, as he defines it, is children who became adults and were able to outgrow the disorder, which happens to 10% to 15%, according to one study Barkley cites in his book “Taking Charge of Adult ADHD.”
The second group is children who don’t outgrow the disorder and are still symptomatic but lose enough characteristics that they can’t be officially diagnosed. Typically, these children are still able to receive medication and make up about 25% of childhood ADHD/ADD diagnoses. They are also the population that is most likely to self-regulate medication.
The third group remains fully diagnosed and makes up about 65% of the population.
For those in the second group, “the majority of them coming off of meds are simply defiant,” Barkley said. “They’re not compliant. They didn’t ask for help. They don’t think they have a problem. But they were dragged into a clinic by Mom and Dad.”
According to the study, once children in the second group hit adulthood and move farther from home, they are less likely to continue taking medication.
“Of all the kids we follow with ADHD to age 21, by 21, only 5% acknowledge that they have a disorder. They don’t think they have it,” Barkley said. “So part of our job with young adults is getting them to buy into it. It may take 10 to 20 years before they hit rock bottom or something severe happens before they realize they have a problem. My brother was in his third marriage, kicked out of the house and was court ordered into treatment for abusing drugs before he realized.”
For some, acknowledging the disorder and taking medication have never been a problem. Edward Hallowell, a graduate of Harvard College and Tulane School of Medicine and a child and adult psychiatrist specializing in managing ADD and ADHD, has a daughter who’s been taking medication for ADHD every day for years.
“My daughter was diagnosed in the third grade. She’s now 28 and … takes it and loves it,” Hallowell said. “So, meds when they’re used properly, are a godsend.”
Barkley agrees that medication, used properly, is the best way to treat ADD/ADHD. “You’re not going to find anything as good as the medication. But there are supplements to your medication that help.”

Behavioral therapy and other options

Behavioral therapy is another option doctors and psychiatrists often recommend or children diagnosed with ADHD, though only about 10% of US children with the diagnosis use behavioral therapy alone. It can come in various forms but ultimately has one goal: implementing tools to change behavior.
March’s mother, Kathy, started using behavioral therapy with her after going to a doctor’s appointment and realizing how her daughter’s brain worked.
“We were at one of her psychiatrist appointments, and they gave her a three-step command,” Kathy said. “They’d tell her ‘Go get me that coloring book, then bring me a pencil, and go get a glass of water.’ [Erin] would only do one of those things.”
Kathy learned that it’s important for caregivers to understand how their child’s brain works in order to properly modify their behavior. She began to build Erin up with small commands and slowly progress to longer commands until she “blossomed beyond anything.”
Hutchins-Howard has worked with many ADD and ADHD patients and recommends a few options for parents before deciding to try medication.
“Parents can try making lists with children, establishing routines, talking with the teacher and changing seating arrangements in the classroom,” Hutchins-Howard said. “I tell people that medication helps, but therapy and making changes is important, too.”
Hutchins-Howard self-diagnosed herself with ADD/ADHD once she was in practice and realized the similarities between her patients and herself. However, she has never has taken medication for the condition. Instead, she practices routines and emphasizes the importance of learning organizational skills.
Hollis Cuffie was diagnosed when he was 19. After three years of trying medications to ease his symptoms, he now uses supplemental ways of managing his ADHD.
Hollis Cuffie spent three years trying different medications to ease his ADHD symptoms.

In addition to medication, he recommends getting enough sleep, eating lots of protein and doing physical exercise. “It’s so important for people with ADHD to be able to release some of the frantic, distracting energy going on upstairs into consistent forms of activity,” he said. “And although it’s not talked about enough, diet plays a huge role in deploying adequate resources for your cognitive function.”
Hiring a coach is another technique. They might help a person with ADD/ADHD manage time and money, keep track of goals and provide structure to their lives. A coach can also create accountability.
According to the book “Getting Ahead of Adult ADHD” by Joel T. Nigg, the commonly used behavioral modification techniques are:
  • Exercise, especially when children are young
  • Eating healthy, including getting enough water, cutting out sugary foods and piling up protein
  • Getting enough sleep
  • Using a planner for events
  • Establishing routines
  • Caffeine to help with focus
  • Meditation
  • Coaching
  • Cognitive behavioral therapy
Although behavior modification is a popular treatment option for people with ADHD/ADD, a recent review of 50 studies conducted from 2009 to 2016 suggests that “there are significant gaps in knowledge regarding the effectiveness of ADHD non-pharmacologic treatments.” This includes behavioral therapy and complementary medicines as well as natural and herbal remedies such as omega fatty acid supplements.

How self-regulation works

As children go into adolescence and then adulthood, they might make ADD/ADHD work for them. For some, this means using the medication only when needed. Amber Timility, who was 8 when she was diagnosed, now self-regulates her medication just like March.
“I don’t take the medicine every day, because it makes me feel like a zombie,” said Timilty, 25. “But when I have to work or go to school, I take it. Or if there’s something that I need to get done.”
Shakiara Gilliam, 25, was in the second grade when she was diagnosed. She began self-regulating when she was in high school and college. Today, she doesn’t take the medication all.
“I will honestly say I hated the way I felt,” Gilliam said. “I would go into this robotic personality, and I only wanted to do work and had zero emotion. I felt like I couldn’t laugh or make jokes. I only wanted to focus.”
Khaliah Shaw doesn't let an ADHD diagnosis stop her from mission trips to help children in the Dominican Republic.

Khaliah Shaw takes her medication relatively regularly. She was diagnosed later in life, at 18. Now 27, she takes her medication during the week but not on the weekends. She also goes to cognitive behavioral therapy. “I knew it was a lifelong disorder that would need medication indefinitely,” Shaw said.
Most regulate their medication by what tasks need more concentration, such as school or work. But for more leisurely activities such as hanging with friends, people go without. Hallowell recommends whatever works for the specific individual and properly managing the diagnosis instead of stopping medication.
“The part that people don’t know is that [ADD/ADHD] is an asset if you manage it right,” Hallowell said. “If you don’t manage it, it’s horrible.” Picking a career path that utilizes ADD/ADHD as a benefit is one way of using it as an asset.

Adulthood

As children become adults, they find professions they like, and some are more conducive to those with ADD/ADHD.
“Medicine is great for people with ADD/ADHD. Sales is great. Trial lawyers. They’re all great,” Hutchins-Howard said. “I tell people all the time that I get paid to have ADD. I get paid to run from room to room and multitask. … Find what works for you, and don’t be discouraged.”
Barkley has seen ADD and ADHD patients do well in the military, performing arts, athletics, law enforcement and firefighting. When proper self-regulation of medication, practice of behavior modification and choosing a career that works with ADD/ADHD come together, he said, the outcomes are beneficial to the patient and everyone around them.
The benefits of ADD/ADHD don’t stop there: Hutchins-Howard sees positive outcomes in herself and her patients in various aspects of life.

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“I’m able to have multiple balls in the air at once. I’m much better at multitasking,” she said. “And with having a family, I can balance a lot more on my plate between being a parent, having a job and being married.”
For recent college grad March, ADHD allows her to be more social. “I am more comfortable speaking in crowds and just going up to people I don’t know,” she said.
“I’m more open than most, more willing to talk to anyone, and I can basically hold a conversation with a brick wall,” Hutchins-Howard said. “So, it’s not all bad. It really depends on how you look at it. God made me this way, and I use [ADHD] to my advantage.”
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The Impact of Smartphones on Concentration and Cognitive Abilities

ISM

Vol. 17 No. 9 5/31/18

PSN eletter vol15 no12 smartphone

Smartphones have become an integral part of most people’s everyday routines. Researchers say that Americans check their phones every 12 minutes on average, totaling 80 times each day.

With smartphones infiltrating every aspect of our lives—how does even the presence of a smartphone impact one’s ability to concentrate and use cognitive abilities?

Researchers from the University of Texas at Austin, the University of California at San Diego, and Carnegie Mellon joined forces to find out. They conducted a study with 548 participants, split into three groups. All were asked to complete computerized tests.

The first group was asked to leave their belongings outside the testing room. The second group left most of their belongings outside the room, but were asked to bring their phones in and place them face down on their desks. The third group brought all of their belongings into the room and were told to keep their phones “wherever they ‘naturally’ would.” Most either kept their phones in their pockets or in their bags.

Once the tests were complete, participants were asked if they believed their phones impacted their performance. The majority, 80%, said they did not think their phones impacted them at all.

However, the results showed something different. Participants who left their phones outside the room drastically outperformed those with their phones on their desks, and slightly outperformed those who had their phones in their pockets or bags. The results suggest that “the mere presence of one’s smartphone may reduce available cognitive capacity and impair cognitive functioning, even when consumers are successful at remaining focused on the task at hand.”

As more students own and use smartphones at younger ages, school leaders wonder what policies they should implement regarding use during the school day. The findings from this research present an extremely interesting viewpoint.

Phones appear to have a significant impact on one’s ability to concentrate and use cognitive abilities—even when they aren’t in use. Review your school’s policies for student smartphone usage. Consider whether you’re doing everything you can to promote learning—and remove distractions—during this vital time in your students’ lives.

Extending the Silence

Edutopia

Giving students several seconds to think after asking a question—and up to two minutes for some questions—improves their learning.

Kids raising hands in an elementary school class.

©Shutterstock.com/Monkey Business Images

How long do you think teachers pause, on average, after asking a question?

Several studies from the 1970s on have looked into the effect that the amount of time teachers pause after asking a question has on learners. In visiting many classrooms in the United States and other parts of the world, I’ve found that, with few exceptions, these studies are still accurate. For example, according to work done by Mary Budd Rowe in 1972 and Robert J. Stahl in 1994, pausing for three or more seconds showed a noticeable positive impact on learning. Yet the average length that teachers pause was found to be 0.9 seconds.

Wow.

I’ve observed this phenomenon in many classrooms, and there is a real need to increase the time granted to students to process what they know and to make sense of what they do not understand.

In differentiating instruction, process and learning preference are the keys. Process is how learners make sense of ideas, compose their thinking, and prepare a thoughtful answer. Learning preference, in the case of questions posed to the whole class, refers to how some students prefer to silently process the content, keeping their own counsel (Internal Thinkers), while others prefer to talk or express their thinking with an audience as a sounding board (External Thinkers).

The External Thinkers, those go-to students who can be counted on to talk within the first three seconds, may be shaping their ideas as they talk—they haven’t had sufficient time to fully process but speak out anyway. Meanwhile, the Internal Thinkers have also had insufficient time to process, but don’t feel comfortable responding.

One solution is for teachers to pause for five to 15 seconds before calling on students. The silence for some may feel unbearably long. Yet consider that the fastest male and female 100-meter sprinters in the world run at or under 10 seconds. The world record is under 10 seconds, which goes by quickly. Why not offer a similar amount of time for students to consider their responses to questions that require deep thinking?

STRATEGIES FOR PROVIDING STUDENTS WITH TIME TO THINK

Provide wait time: Give students five to 15 seconds to formulate a response to a question for which they should know the answer. Not every learner processes thinking at the same speed. Quality should be measured in the content of the answer, not the speediness.

I count in my head to 15. Most times, I get responses by 10 to 12 seconds. If you don’t get responses within 15 seconds, you can call on students, instead of asking for volunteers.

Give think time: Give students 20 seconds to two minutes to make sense of questions that require analysis to synthesize concepts into a different construct or frame. You can aid this by encouraging journaling, silent reflection, or partner discussions. Giving such chunks of time honors the work being asked of students. Quick responses probably mean that the question did not stretch the learners’ understanding. After the allotted time, any student can be called on to share their response.

Teach reflection: Coach students on the value and practice of reflection. Educators and students may appear to be uncomfortable with silence, hence the typical one-second pause time. Silence may be equated with nothing happening.

In reality, when students are provided with structured ways to practice thinking and specific directions about what to accomplish within the silent time, they can become more productive during reflection. Think From the Middle is a collection of approaches for students to hone their thinking processes during reflection and collaborative communication.

Teach students how to manage a conversation: It’s a beautiful thing to witness students running thoughtful conversations around topics that combine curriculum and real-world connections. Establish a culture for students to engage in such conversations, and they’ll soon be doing most of the heavy lifting during the lesson.

One powerful example I’ve witnessed in Michigan and Texas uses a guide for student-led conversation prompts called Talk Moves. This list of conversation stems provides students with communication tools for participating in and sustaining discussions. I’ve witnessed their use in science classes using the Next Generation Science Standards, and they’re equally useful in all subject area courses.

Students choose the starter stem that best supports the topic to be discussed. Teachers use the Talk Moves to coach and guide students to different levels of complex thinking by directing them toward different sections of conversation prompts. The intent is for students to own the conversation, which empowers their ability to process concepts for understanding.

PLACING STUDENTS AT THE CENTER OF LEARNING

We want students to become independent learners who can navigate challenging material and situations. Students learn at different paces, which seems less about intelligence and more about the time barriers put in the path of learning. There may be a place for timed responses and answering questions under the pressure of a clock, yet there are no standards that say that students should master concepts in less than one second.

Most people need adequate time to process their thoughts if they are expected to contribute to a conversation. Life is not a 30-minute game show with rapid-fire questions that require low-level answers, plus commercial breaks. Even if it were, one would need time to develop and master the processing skills to compete.

In Praise of ADHD

Photo

CreditSarah Mazzetti

Ten years ago, when my son Nicolai was 11, his doctor wanted to put him on medication for attention deficit hyperactivity disorder. “It would make him less wild,” I explained to my mother, who was then 85. “It would slow him down a bit.”

My mother grumbled. “Look around you,” she said in Yiddish. “Look how fast the world is changing. He doesn’t need to slow down. You need to speed up.”

It was a surprising recommendation from someone who had never learned to use a microwave. But recent research suggests she had a point: Some people with A.D.H.D. may be naturally suited to our turbocharged world.

Today the word “hyperactive” doesn’t just describe certain individuals; it also is a quality of our society. We are bombarded each day by four times the number of words we encountered daily when my mother was raising me. Even vacations are complicated — people today use, on average, 26 websites to plan one. Attitudes and habits are changing so fast that you can identify “generational” differences in people just a few years apart: Simply by analyzing daily cellphone communication patterns, researchers have been able to guess the age of someone under 60 to within about five years either way with 80 percent accuracy.

To thrive in this frenetic world, certain cognitive tendencies are useful: to embrace novelty, to absorb a wide variety of information, to generate new ideas. The possibility that such characteristics might be associated with A.D.H.D. was first examined in the 1990s. The educational psychologist Bonnie Cramond, for example, tested a group of children in Louisiana who had been determined to have A.D.H.D. and found that an astonishingly high number — 32 percent — did well enough to qualify for an elite creative scholars program in the Louisiana schools.

It is now possible to explain Professor Cramond’s results at the neural level. While there is no single brain structure or system responsible for A.D.H.D. (and some believe the term encompasses more than a single syndrome), one cause seems to be a disruption of the brain’s dopamine system. One consequence of that disruption is a lessening of what is called “cognitive inhibition.” The human brain has a system of filters to sort through all the possible associations, notions and urges that the brain generates, allowing only the most promising ones to pass into conscious awareness. That’s why if you are planning a trip to Europe, you think about flying there, but not swimming.

But odd and unlikely associations can be valuable. When such associations survive filtering, they can result in constructive ideas that wouldn’t otherwise have been thought of. For example, when researchers apply a technique known as transcranial stimulation to interfere with key structures in the filtering system, people become more imaginative and inventive, and more insightful as problem solvers.

Individuals with A.D.H.D. naturally have less stringent filters. This can make them more distractible but also more creative. Such individuals may also adapt well to frequent change and thus make for good explorers. Jews whose ancestors migrated north to Rome and Germany from what is now Israel and the Palestinian territories show a higher proportion of the A.D.H.D. gene variant than those Jews whose ancestors migrated a shorter distance south to Ethiopia and Yemen. In fact, scientists have found that the farther a group’s ancestors migrated, the higher the prevalence of the gene variant in that population.

Or consider the case of the Ariaal, a Kenyan tribe whose members through most of its history were wild-animal herders. A few decades ago, some of its members split off from the main group and became farmers.

Being a wild-animal herder is a good job if you are naturally restless; subsistence farming is a far tamer occupation. Recently, the anthropologist Dan Eisenberg and collaborators studied whether people with A.D.H.D. might thrive in the former lifestyle but suffer in the latter. They found that among the herders, those who possessed a gene that predisposed them to A.D.H.D. were, on average, better nourished. Among the farming Ariaal, the opposite was true: Those who lacked the genetic predisposition for A.D.H.D. were, on average, better nourished. Restlessness seemed to better suit a restless existence.

A.D.H.D. is termed a disorder, and in severe forms it can certainly disrupt a person’s life. But you might view a more moderate degree of A.D.H.D. as an asset in today’s turbulent and fast-changing world. My mother, now 95, long ago realized that speed is the essence of our era. Her intuition about Nicolai proved correct, and she has lived to watch her grandson thrive without taking the A.D.H.D. medication she was dead set against.

Break the Cycle of Stress and Distraction by Using Your Emotional Intelligence

Being able to focus helps us succeed. Whether it’s focusing inward and attuning ourselves to our intuitions and values or outward and navigating the world around us, honing our attention is a valuable asset.

All too often though, our focus and attention get hijacked, leaving us feeling frazzled, forgetful, and unable to concentrate. In my coaching work with executives, these are the kinds of statements I most often hear when they’ve lost their focus (I may have uttered a few of them myself):

  • “I feel completely overwhelmed.”
  • “My workload is insane, and there’s never enough time to get things done when I’m in meetings and dealing with urgent issues all day long.”
  • “I’m mentally exhausted from the pressure and constant distractions in my office. I just can’t seem to focus.”

Constant distractions and a lack of time certainly interrupt our focus, but stress also plays a major role.

Chronic stress floods our nervous system with cortisol and adrenaline that short-circuits important cognitive functions. Researchers have studied the negative effects of stress on focus, memory, and other cognitive functions for decades. The findings are consistent – short-term stress raises cortisol levels (the so-called stress hormone) for short periods and can jump-start our adrenalin and motivate us to perform more efficiently in response to impending deadlines. Long-term stress, however, can lead to prolonged increases in cortisol and can be toxic to the brain. Scientists also suspect that high levels of cortisol over a long period of time are a key contributor to Alzheimer’s and other forms of dementia.

When we can’t focus at work because of distractions, it may lead us to feel stressed about not being productive, which then causes us to focus less, further feeding the cycle. Unfortunately, most of us don’t notice our focus declining until we become completely overwhelmed. When mental and emotional exhaustion sets in, it further drains our ability to focus, concentrate, and recall information.

Fortunately, there are things we can do to break the cycle. I’ve found in my research that one of the reasons why some people get burned out and others don’t is because they use their emotional intelligence (EI) to manage their stress. You can use these same competencies, in particular self-awareness and self-management, to improve your focus. Here’s how.

Start by using your self-awareness to help you notice several things:

Why you feel stressed or anxious. Before you can deal with stress, you need to know what’s causing it. As simple as it may sound, it can be helpful to make a list of the sources of your stress. Write down each thing in your life and at work that’s causing you anxiety. You might categorize items into things you have the ability to change and things you don’t. For the stressors in the latter category, you will need to figure out how to change your attitude toward them.

How you lose your ability to focus. According to clinical psychologist Michael Lipson, you can learn to sharpen your focus, by understanding how exactly your concentration strays in the first place. By paying attention to the patterns that lead to your lack of focus, you can begin to develop your ability to dismiss distractions and stay with your original point of attention.

How you feel when you can’t focus. Does it make you anxious when you can’t recall information when you need it – perhaps during a job interview, a high-stakes presentation, or an important client meeting? Do you feel tense and dazed when you’re racking your brain trying to find just the right words for an important email? These can be clues that you’re more stressed than you may realize, and that your inability to concentrate is causing even more stress.

When you lose your ability to focus. If, for example, you find yourself worrying yourself sick over something while you’re driving 65 mph on the highway with a car full of kids, you’re putting yourself and others in real danger. This can be a wake-up call to bring your attention back to what you’re doing and make a decision to think about your concerns later.

Once you’ve increased your awareness of what’s causing you stress and how and when you lose your focus, you can use the following strategies, which depend on your self-management abilities, to make better choices that keep you focused.

Do a digital detox. In its 2017 Stress in America survey, The American Psychological Association (APA) found that “constant checkers” – people who check their emails, texts, and social media on a constant basis – experience more stress than those who don’t. More than 42% of respondents attribute their stress to political and cultural discussions on social media, compared with 33% of non-constant checkers. While it may feel impossible to take a cold turkey break from technology, the APA says that periodically unplugging or limiting your digital access can be great for your mental health.

Rest your brain. Most of us have experienced sleepless nights caused by ruminating over past events, or fears and anxieties about the future. But when you add a few of these nights together, sleep deprivation can set in, making it more difficult to focus, and more challenging to receive and recall information. Our interpretation of events and our judgment may be affected, too. Lack of sleep can negatively affect our decisions because it impairs our ability to accurately assess a situation, plan accordingly, and behave appropriately. Committing to the recommended 7 to 8 hours of sleep each night may seem impossible when you’re stressed and overworked, but the payoff is worth it.

Practice mindfulness. The research on mindfulness is clear and compelling. Having a mindfulness practice decreases our tendency to jump to conclusions and have knee-jerk reactions we may regret later (and potentially cause more stress). Neuroscientist Richard Davidson says that “Mindfulness boosts the classic attention network in the brain’s fronto-parietal system that works together to allocate attention.” In other words, mindfulness is key to emotional resilience, which is a key contributor in our ability to quickly recover from stress. Don’t worry, you don’t have to be a serious yogi to practice mindfulness. You can find some simple methods for everyday people here.

Shift your focus to others. When we fixate on our own worries and fears, it can take our attention away from those we care about. Studies (mine included) show that shifting our focus to others produces physiological effects that calm us and strengthen our resilience. If you pay more attention to other people’s feelings and needs, and show concern for them, you can not only take your mind off of your stress but also reap the benefits of knowing that you’re doing something meaningful for someone you care about.

Too many people feel like they need to work harder when they struggle to focus. But this strategy is likely to backfire. Instead, pay attention to the causes of your stress and inability to focus and then take actions that promote improvements in the specific brain functions that drive concentration and awareness

How to Be Better at Stress

By Tara Parker-Pope @nytimes

Stress is unavoidable in modern life, but it doesn’t have to get you down. Work, money and family all create daily stress, while bigger issues like politics and terrorism contribute to our underlying stress levels. But approach it the right way, and it won’t rule your life — it can even be good for you. Here are ways to deal with stress, reduce its harm and even use your daily stress to make you stronger.

Take Control

Stress is inevitable; getting sick from it is not.

THE PERCEPTION OF STRESS

While we know that stress is associated with health problems, plenty of people with high-stress lives are thriving. How is that possible? In 2012, researchers from the University of Wisconsin-Madison published a seminal study looking at how 28,000 people perceived stress in their lives. People in the study answered these two questions:

  1. During the past 12 months, would you say that you experienced:
    1. A lot of stress
    2. A moderate amount of stress
    3. Relatively little stress
    4. Almost no stress at all
  2. How much effect has stress had on your health?
    1. A lot
    2. Some
    3. Hardly any
    4. None

The researchers looked at death rates in the study group over nine years. The results are startling. The study found that having a lot of stress in your life was not linked with premature death. But having a lot of stress in your life and believing it was taking a toll on your health increased risk of premature death by 43 percent.

CHANGING YOUR PERCEPTION

With stress, the mind and the body are intrinsically linked. You can view stress as something that is wreaking havoc on your body (and it can) or as something that is giving you the strength and energy to overcome adversity. Here’s a quick way to think about these two very different views of stress. Read the statement, and then think about your own reaction to the biological changes that occur during times of stress.1. When I’m stressed, my body releases adrenaline and cortisol. My heart is beating faster. This means that:

  • Common View: Stress is increasing my risk for cardiovascular disease and heart attack.
  • Alternative View: My heart is working harder and my body is mobilizing its energy to get ready for this challenge.

2. When I’m stressed, my stress response is causing my breathing rate to increase. This means that:

  • Common View: My fast breathing is a sign of anxiety. I worry about how stress is affecting my mental and physical health.
  • Alternative View: I should take a deep breath. My faster breathing means more oxygen is getting to my brain so I can think more clearly.

3. When I’m stressed, my heart and circulatory system respond, causing my blood pressure to rise. This means that:

  • Common View: I can feel my blood pressure rising. This can’t be good for my health.
  • Alternative View: Circulatory changes are allowing more oxygen and nutrients to fuel my muscles. I’m feeling stronger and ready for the challenge ahead.

It’s probably clear to you that the alternative view is the better choice for thinking about stress. It may be hard to believe that such a small shift in thinking could make a difference, but that’s what Harvard researchers found when they paid 50 study subjects $25 each to take part in a lab experiment designed to induce stress. The test involves giving a talk in front of a group of unfriendly evaluators, followed by a tricky word test. (Researchers have consistently found that this formula of public speaking plus testing in front of a hostile crowd is incredibly uncomfortable and stress-inducing for the poor people who agree to take part in the study.)

Before the social stress test, one group was allowed to play video games; another was taught to simply ignore stressful feelings if they experienced them during the test. But a third group was given advice similar to the quiz above. They got a primer about the physical stress response and were told how a higher heart rate, faster breathing and internal jitters were all tools for making you strong during a stressful event. They were told how the body’s stress response evolved to help us succeed, and that the increased arousal symptoms of stress can aid your performance during times of stress. The bottom line of the lesson was this: In a tough situation, stress make you stronger.

The group that learned to rethink the role of stress in their lives did far better on the test. They gave better speeches and were rated as more confident. They smiled more and had more-positive body language. And physiological indicators showed that their bodies were also managing the stress response better than those of test subjects who were taught to ignore stress or given no advice at all.

The Stanford psychologist Kelly McGonigal has been a champion of rethinking stress, noting that the right approach can make you smarter and stronger. Her TED talk on the subject, “How To Make Stress Your Friend,” has been viewed 14 million times.

“What I learned from these studies, surveys and conversations truly changed the way I think about stress,” Dr. McGonigal wrote in her book “The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It.” “The best way to manage stress isn’t to reduce or avoid it, but rather to rethink and even embrace it.”

Practice Stress

Learn skills to better handle stress.

STRESS INOCULATION

The best way to get better at stress is to practice it. Scientists call this “stress inoculation,” and just as exposure to a virus will inoculate you from contracting a virus a second time, regular exposure to small amounts of stress can inoculate you from the most detrimental effects of stress when you suffer a big stressful event in your life.

Stress inoculation has three phases.

1. Education: Learn what to expect. If you need chemotherapy, are experiencing a divorce or have had a setback at work, talk to people who have been through it and learn what to expect going forward so you can be prepared, rather than blindsided, by the stressors ahead of you.

2. Rehearsal: While you can’t rehearse for life’s biggest moments, you can live your life in a way that prepares you for stress. It can be a physical challenge like competing in a triathlon or conquering a mountain. It can be an intellectual stressor like reading your poetry in public or giving a speech. The point is that you need to rehearse stressful situations in order to perform your best under stress.

3. Implementation: When the stressful event hits, you are prepared. You know what to expect, and you’ve experienced stressful situations before. You’ve got this.

STILL SKEPTICAL?

Think about how firefighters train. They educate themselves about fire and how it behaves in different situations. They put themselves through grueling physical training to practice carrying heavy equipment, navigating smoky, dark buildings and stairwells, and braving the heat of a raging fire. They practice running into burning buildings. The training is hard and highly stressful.

Now imagine you are out for a nightly walk and you see that a neighbor’s house is on fire. Your heart races. You panic. You fumble with your phone. You take a step toward the house. You hesitate. What do you do? Fortunately, the firefighters arrive and race into the home without hesitation. Your moment of stress and anxiety is just another day at the office for them. They know what to expect. They trained for it.

You can practice for everyday stress in similar ways, by putting yourself in challenging situations. The good news is that practicing stress can actually be enjoyable, even thrilling. The key is to push yourself out of your comfort zone. Here are some suggestions:

  • Run a marathon
  • Play in a Scrabble competition
  • Read an original poem at a poetry slam
  • Climb a mountain
  • Sing karaoke
  • Tell a story in front of a crowd
  • Take on a tough project at work
  • Kayak the Colorado rapids
  • Train to scuba dive
  • Attend a boot camp

Not only will challenging experiences give you more confidence, but the repeated exposure to stressful situations can also change your body’s biological response to stress. Your stress hormones become less responsive, allowing you to better handle stress when it comes.

Dr. Dennis Charney, a psychiatrist and the dean of the Icahn School of Medicine at Mount Sinai in New York City, notes that programs like Outward Bound and basic military training are all designed to make people uncomfortable and build their skills so that they will be better able to handle stress later on. When his children were young, he took them on adventure trips that included “a degree of anxiety” like exposure to wildlife or kayaking in remote areas as a way to build confidence and prepare them to deal with stressful events. Putting yourself or your children in difficult social situations or speaking in public can help adults and children accumulate social and intellectual skills that help in times of stress.

“Live your life in a way that you get the skills that enable you to handle stress,” says Dr. Charney. “Put yourself out of your comfort zone.”

AN RX FOR RESILIENCE

Another factor in how you handle a stressful situation is resilience. The American Psychological Association defines resilience this way:

Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems or workplace and financial stressors. It means “bouncing back” from difficult experiences.

You can boost your resilience in a number of ways. In the book “Resilience: The Science of Mastering Life’s Greatest Challenges,” the authors, Dr. Steven M. Southwick and Dr. Charney, studied people who experienced great stressors — prisoners of war, men in the special forces, victims of trauma or survivors of catastrophic events. They found that people with the most resilience in the face of extreme challenges shared several behaviors and mind-sets. From that research, the duo identified 10 factors associated with resilience. You don’t need to practice all 10 behaviors to build resilience; just pick the two or three or four that speak to you.

1. Adopt a positive attitude. Optimism is strongly related to resilience.

2. Reframe the situation. Just like the stressed-out study subjects were taught to reappraise stress as their friend, people who are resilient typically reframe a negative situation as an opportunity for growth, learning or change.

3. Focus on core beliefs. People with a deeply held core belief, strong faith or a commitment to altruism often show more resilience.

4. Find a role model. Seeing someone else who has come through adversity can strengthen your own resilience.

5. Face your fears. Confronting a challenge rather than avoiding it will help you cope and build confidence.

6. Fall back on religion or spirituality. For many people, strong faith or spiritual beliefs can fuel resilience.

7. Seek social support. People who reach out to friends, family and support groups fare better during stressful times.

8. Exercise. It improves mood, relieves stress and makes you physically stronger.

9. Inoculate against stress. Challenge yourself regularly in the areas of emotional intelligence, moral integrity and physical endurance.

10. Find meaning and purpose. Having a clear purpose in life can boost your emotional strength during difficult times.

Exercise

Numerous studies have shown us that exercise can improve your mood.

Exercise can channel your stress response into something constructive and distract your mind from the challenges at work or home that make you feel chronically stressed. In many ways exercise appears to be a form of stress inoculation. In studies, mice given access to running wheels and tubes to explore for just two weeks became resistant to stress compared with mice who had not exercised. They measured this by exposing the mice to an aggressive mouse. After the bullying, the exercising-mice bounced back, but the sedentary mice continued to show signs of stress. The bottom line: Exercise doesn’t eliminate stress, but it does give your body the physical conditioning it needs to recover from it.

How Much Exercise Do I Need to Manage Stress?
It doesn’t take much. Even small amounts of exercise can help you manage your stress. The key is consistency. Don’t let the stress of your day push exercise off the schedule.

Does the Type of Exercise Matter?
The exercise that is best for relieving stress is the one you will do consistently. Find something that fits your schedule and that you enjoy. For some, that will be a morning spin class or an evening run. For others, it will be a 30-minute walk at lunch time. A Norwegian study found that people who engaged in any exercise, evan a small amount, reported improve mental health compared with people who never exercised.

What About Weight Training?
One study showed that six weeks of bicycle riding or weight training eased symptoms in women who received a diagnosis of anxiety disorder. The weight training was especially effective at reducing irritability.

Indeed, some research suggests that when it comes to reducing stress, you’ll get more out of exercise if you incorporate some weight training. Studies show that anaerobic or resistance exercises (working with weights) taxes muscles more than aerobic exercise like walking or running. The result is that weight training, done right, may produce more mood-boosting endorphins than cardio exercise. Exercises that stress the large muscles seem to have the biggest effect, like squats, leg presses, incline situps, military presses and bench presses.

Don’t go for a powerlifting record. The best weight training to manage stress consists of three moderate-weight sets of 10 repetitions with one minute of rest. The U.S. Army Research Institute of Environmental Medicine found in a small study that this 3-10-1 moderate weight strategy produced more endorphins than using heavier weights for five reps and a longer rest.

TAKE IT OUTSIDE

Simply taking your exercise outdoors can have a significant effect on your mood.

In a number of recent studies, volunteers who walked outdoors reported enjoying the activity more than those who walked indoors on a treadmill. Subsequent psychological tests showed outdoor exercisers scored significantly higher on measures of vitality, enthusiasm, pleasure and self-esteem and lower on tension, depression and fatigue.

study last year of older adults found that those who exercised outside did so longer and more often than those working out indoors. The outdoor exercisers averaged about 30 minutes more exercise each week than those who walked or otherwise exercised indoors.

few small studies have found that people have lower blood levels of cortisol, a hormone related to stress, after exerting themselves outside as compared with inside. There’s speculation, too, that exposure to direct sunlight, known to affect mood, plays a role.

A study in Austria found that almost all the participants reported that the outdoor effort had felt less strenuous to them than their time on the treadmill. And they enjoyed it more.

A small study from the University of Essex found that exercisers exposed to the color green found it easier to exercise and were in a better mood than exercisers exposed to gray or red. (Think green trees versus a cement-walled gym.)

Mind

Exercise your mind and let it rest to help it better process stress.

GIVING YOUR MIND A REST

For people dealing with high levels of stress, it can be hard to fathom how a few moments of meditation will help. After meditation, the stressors are still there — you’re still getting divorced, caring for an aging parent, struggling with the demands of a high-stress job. How can a few moments of deep thought possibly help your life?

It may help to think about how muscles get stronger. Unrelenting exercise simply tears down a muscle and leads to injury. Smart exercisers know the value of a day of rest — that’s when your muscles regenerate and come back stronger than before.

Now think about your mind as an emotional muscle. Unrelenting stress without a break will not make it stronger. Your emotions, your brain and your body need moments of recovery to get stronger from stress.

“It’s about stress and recovery. Just like you build a physical muscle, just like you build biceps, you have to take the same approach to life stressors,” says Jack Groppel, co-founder of the Johnson & Johnson Human Performance Institute, which offers a course called “The Power of Positive Stress.“

Think of meditation like high-intensity interval training (H.I.I.T.) for the brain. During H.I.I.T., you go as hard as you can, then you give yourself a few minutes of recovery before returning to the exercise. This cycle is repeated multiple times and has been shown to be more effective for building strength than long, slow bouts of exercise.

Now imagine a high-intensity, high-stress workday. But every hour, you take two minutes to let your brain recover. “Stress is the stimulus for growth,” says Dr. Groppel. “Recovery is when growth occurs. If there is no recovery, there is no growth. That’s how we build the resilience muscle.”

CONTROLLED BREATHING

Controlled breathing has been shown to reduce stress, increase alertness and boost your immune system. For centuries yogis have used breath control, or pranayama, to promote concentration and improve vitality. The Buddha advocated breath-meditation as a way to reach enlightenment.

Science is just beginning to provide evidence that the benefits of this ancient practice are real. Studies have found, for example, that breathing practices can help reduce symptoms associated with anxiety, insomnia, post-traumatic stress disorder, depression and attention deficit disorder.

Rock and Roll Breathing

When your mind is racing or you feel keyed up, try Rock and Roll breathing, which has the added benefit of strengthening your core.

MEDITATION

One study recruited 35 unemployed men and women who were seeking work and experiencing considerable stress. All of them participated in stretching exercises, but half of them were also taught formal mindfulness meditation. After three days, everyone said they felt refreshed and better able to withstand the stress of unemployment. Yet follow-up brain scans showed differences in only those who underwent mindfulness meditation. There was more activity, or communication, among the portions of their brains that process stress-related reactions and other areas related to focus and calm. Four months later, those who had practiced mindfulness showed much lower levels in their blood of a marker of unhealthy inflammation than the relaxation group, even though few were still meditating.

To learn more about meditation, try the introductory exercise below.

Basic Mindfulness Meditation

Learn how to pay close attention to the present moment with this meditation exercise.

TRY IT!

WRITE IT DOWN

Another way to cope with stress: writing. It is based on the idea that we all have a personal narrative that shapes our view of the world and ourselves. But sometimes our inner voice doesn’t get it completely right. Some researchers believe that by writing and then editing our own stories, we can change our perceptions of ourselves and identify obstacles that stand in the way of better health. It may sound like self-help nonsense, but research suggests the effects are real.

Timothy D. Wilson, a University of Virginia psychology professor and author of “Redirect: Changing the Stories We Live By,” believes that while writing doesn’t solve every problem, it can definitely help people cope. “Writing forces people to reconstrue whatever is troubling them and find new meaning in it,” he said.

There are a number of methods to tap into the power of expressive writing:

Journal every day. Just writing about your thoughts, feelings and experiences every day can help. Explore your thoughts and feelings about an issue. Don’t just re-live the stress in your life but try to find meaning in it or explore how well you’ve handled certain situations. Be disciplined and write at the same time every day so it becomes a habit. In a University of Texas study, students who wrote about stressful or traumatic events for four days in a row reaped the benefits for months after. For the next six months, the writing students had fewer visits to the campus health center and used fewer pain relievers than the students in the experiment who wrote about trivial matters.

Change your story. Use writing to force yourself to confront the changes you need to make in your life. On the first day, write down your goals, then write down why you haven’t achieved them (“I don’t have the time or the money,” “Too many family responsibilities,” etc.) The next day review your writing. Now ask: What is really standing in the way of your goals? Change the story so you have control. Maybe the answer is: I don’t put myself first. I don’t make exercise a priority. I let other people talk me into spending money rather than saving.

Write a mission statement. People deal with stress better when they have a strong moral compass. This means knowing what you value in life and using that as a guidepost for all decision. By creating a mission statement people can begin to identify the underlying causes of behaviors, as well as what truly motivates them to change. “A mission statement becomes the North Star for people,” says Dr. Groppel. “It becomes how you make decisions, how you lead and how you create boundaries.” To learn more, read our article “Creating a New Mission Statement.”

Food

STRESS AND YOUR APPETITE

Stress can have a huge impact on your eating habits. During acute stress (the hours after a car accident or the shock of a layoff announcement at work), the stress response can shut down appetite. The fight-or-flight response is designed to suppress hunger — you won’t be effective in battle or run that fast if you are thinking about food. But chronic stress has the opposite effect. Repeated doses of cortisol in your body due to high stress can lead to an increase in appetite.

According to the Harvard Health Letter, gender can play a role in how you eat during times of stress. Some research suggests women are more likely overeat due to stress while men turn to alcohol or smoking.

And the reality is that food really can make you feel better during times of stress. So-called comfort food like chocolate cake and ice cream literally blunt the body’s response to chronic stress. The problem with continuing to self-medicate chronic stress with comfort foods is that it will lead to weight gain and poor health.

Just as you need to reframe your view of stress and exercise and meditate to give your body a break from stress, you can also adopt strategies to use food to help you better cope with stress.

MINDFUL EATING

During times of stress, we can be particularly careless about what we eat and resort to mindless snacking, grabbing sweets from the office treat table or eating bags of junk food on the run. During times of stress, it’s particularly important to engage in “mindful eating,” which involves eating slowly and relishing every bite.

“The question isn’t what are the foods to eat, in my mind,” says Dr. Michael Finkelstein, a holistic physician who oversees SunRaven, a holistic-living center in Bedford, N.Y. “Most people have a general sense of what the healthy foods are, but they’re not eating them. What’s on your mind when you’re eating: That’s mindful eating to me.”

Here’s a simple exercise to try next time you are sitting down to a delicious meal:

  1. Place a forkful of food in your mouth. Make it something you love.
  2. Put the fork down and resist the temptation to take a second bite.
  3. Chew slowly. Tune in to the texture of the food, the flavor, the aroma. Focus on the colors on your plate.
  4. Be present in the moment and think only about the food in your mouth. Reflect on the effort that went into growing or producing this food; the effort it took to prepare this meal.
  5. Savor the moment.

To learn more, read “Mindful Eating as Food for Thought.”

Support and Relationships

Your friends and family can be both a cause of stress and a cure for it.

LEAN ON LOVED ONES

The pressure of family responsibilities is one of the most common forms of stress. But during times of stress, our friends and family members are most likely to give us the support we need to get through it.

One of my favorite friendship studies involved a steep hill, a heavy backpack and 34 university students. Students were fitted with a backpack full of free weights equivalent to 20 percent of their body weight. They stood at the base of a hill on the University of Virginia campus with a 26-degree incline. Wearing the heavy backpack, they had to imagine climbing that hill and guess the incline. When a student stood alone, he or she tended to guess that the hill was very steep. But when they stood next to a friend, the hill didn’t look as daunting. Overall, students in pairs consistently gave lower estimates of the hill’s incline compared with students who were alone. And the longer the friends had known each other, the less steep the hill appeared.

The lesson: The world does not look as challenging with a friend by your side.

For people who study stress, the role of friendship, family and support networks can’t be overstated. Time and again research shows that social support is a defining element in our happiness, quality of life and ability to cope with stress.

MAP YOUR SOCIAL NETWORK

During times of high stress we have a tendency to retreat. We cancel social plans and focus on the work, money crisis or trauma that is our source of stress. But friends and social support are among the best forms of therapy to help you escape stress for brief periods of time. Friends can also make you feel better about yourself, and that mountain of stress in your life won’t look so steep.

When Dr. Southwick, Yale Medical School psychiatrist, co-wrote his book on resilience, he interviewed a number of people who had shown resilience against all odds, including former prisoners of war and people who had survived trauma. One thing they had in common was social support.

“The resilient people we interviewed actively reached out for support,” said Dr. Southwick. “They don’t sit around and wait.”

Even POWs held in isolation devised a tapping method of communication with their fellow prisoners. “Most, if not all, said it was life-saving to know they weren’t alone and they were cared for,” said Dr. Southwick.

When Dr. Southwick, a psychiatrist, meets with a new patient, one of the first things he does is construct a diagram of the patient’s social network. Sometimes they just talk about it; some patients want to map it out on paper. “Who is in your life? Who can you count on?” asks Dr. Southwick. Make your own list of your social network and keep it handy when you need to call on someone for support.

DON’T JUST SEEK SUPPORT, GIVE IT

If you lead a highly stressful life, the solution may be to add one more task to your daily to-do list. Give back.

Research consistently shows that helping other people and giving social support is a powerful way to manage the stress in your life and boost your resilience. Volunteer work, mentoring, mowing your elderly neighbor’s lawn, listening to a friend who is struggling — all these can enhance your own ability to manage stress and thrive.“

Time spent helping others, sharing our knowledge and providing social and emotional support gives meaning and purpose to our lives,” said Adam Grant, a Wharton management professor and co-author of the book “Option B: Facing Adversity, Building Resilience and Finding Joy” with Sheryl Sandberg. “Getting out of yourself and helping others may be even more powerful than receiving social support.”

REACH OUT AND TOUCH SOMEONE

The simple act of touching another person — or being touched — can ease your stress. James A. Coan, an assistant professor of psychology and a neuroscientist at the University of Virginia, recruited 16 women who felt they had strong support in their relationships. To simulate stress, he subjected each woman to a mild electric shock under three conditions, all while monitoring her brain. The shocks were administered in no particular order while the woman was 1) alone, 2) holding a stranger’s hand, and 3) holding her husband’s hand.

Notably, both instances of hand-holding reduced the neural activity in areas of the woman’s brain associated with stress. But when the woman was holding her husband’s hand, the effect was even greater, and it was particularly pronounced in women who had the highest marital-happiness scores. Holding a husband’s hand during the electric shock resulted in a calming of the brain regions associated with pain similar to the effect brought about by use of a pain-relieving drug.

Coan says the study simulates how a supportive marriage and partnership gives the brain the opportunity to outsource some of its most difficult neural work. “When someone holds your hand in a study or just shows that they are there for you by giving you a back rub, when you’re in their presence, that becomes a cue that you don’t have to regulate your negative emotion,” he told me. “The other person is essentially regulating your negative emotion but without your prefrontal cortex. It’s much less wear and tear on us if we have someone there to help regulate us.”

ANIMALS CAN HELP

Spending time with your pet can offer a temporary reprieve from stress. Spending time with your dog and taking it for a walk is a twofer — you get the stress reduction of a pet plus the stress-busting benefits of a walk outdoors.

The evidence that pets are a source of comfort and stress relief is compelling. At Veterans Affairs hospitals, therapy animals including dogs and parrots have helped patients undergoing treatment for post-traumatic stress reduce their anxiety.

Studies have shown that after just 20 minutes with a therapy dog, patients’ levels of stress hormones drop and levels of pain-reducing endorphins rise.

In a controlled study of therapy dog visits among patients with heart disease, researchers at the University of California, Los Angeles, found a significant reduction in anxiety levels and blood pressure in the heart and lungs in those who spent 12 minutes with a visiting animal, but no such effect occurred among comparable patients not visited by a dog.

Health

Excessive stress can take a physical toll if it’s not managed correctly.

While some stress is essential for human function, chronic stress creates a cascade of physical changes throughout your body.

Heart: During a stressful event, your heart rate increases and your body releases the stress hormones — cortisol, adrenaline and noradrenaline. In some parts of the body (skin, digestive system, brain) blood vessels constrict, allowing blood flow to increase to larger systems (heart, large muscles). The body is redirecting oxygen and nutrients to the areas where they are needed most to give you the strength to fight or flee. But blood flowing to a smaller area causes blood pressure to rise. Normally the effects are temporary, but some research suggests that in people with chronic stress, the effects on the heart are unrelenting, raising the risk for high blood pressure, heart attack and stroke.

Immune System: Chronic stress can depress the immune system and make you more vulnerable to colds or more serious illnesses.

Diabetes Risk: During stress, the liver increases glucose production for a boost of energy to propel you during an emergency. Chronic stress can lead to extra blood sugar, increasing risk for diabetes, especially among those already at high risk, such as the overweight or those with a family history of the disease. According to the American Psychological Association, learning to manage your stress can be nearly as effective at controlling blood sugar as medication.

Stomach and Digestion: Stress can affect how fast food moves through your body, stomach acid and the absorption of nutrients. Chronic stress can also lead to overeating or alcohol use. All of these factors can contribute to a number of gastrointestinal issues including acid reflux, heartburn pain, nausea, stomach pain, ulcers and diarrhea.

Sex and Reproduction: In men, chronic stress can affect testosterone levels and sperm count, and contribute to erectile dysfunction. In women, stress can create irregular menstrual cycles and painful periods and exacerbate premenstrual syndrome. Stress can also worsen the symptoms of menopause, including more frequent and more severe hot flashes. In both men and women, chronic stress can dampen sexual desire.

About the Author

Tara Parker-Pope is the founding editor of Well, an award-winning consumer health site with news and features to help readers live well every day.

Twitter: @nytimes

Illustrations by Sam Kalda

Quick Classroom Exercises to Combat Stress

Edutopia

These brain breaks and focused-attention practices can help students cope with stress and trauma and focus on their learning.

The trauma and adversity that students are carrying into classrooms are changing how educators need to address learning and academic performance. Fifty-one percent of children in public schools live in low-income households, and when poverty levels exceed 50 percent, there’s a significant drop in academic performance across all grade levels. At the same time, 25 percent of all adolescents—including 30 percent of adolescent girls—are experiencing anxiety disorders.

Adversity and trauma reside in our biology, not our psychology and cognition, so we educators need to prime students’ brains for learning. This calls for a deeper understanding of how our brains develop and how they respond to adversity and trauma, and how building relationships and providing strategies that promote emotional regulation can positively affect students’ emotional, physiological, and cognitive health.

Brain Breaks

Brain breaks stimulate many areas in the brain that pay attention to novelty and curiosity, sparking the motor and sensory systems while initiating emotional regulation in the more reactive and primitive areas of the brain. Here are a few brain breaks you can try in class.

Funny talk: Have students loosely touch the roof of their mouth with their tongue and begin to speak. Create a class chant to say altogether, or the teacher can address the class, modeling what he or she would like students to say.

Tongue stretch: Have students use clean hands or a Kleenex to stretch their tongue as far as it can go. This relaxes the throat, palate, upper neck, and brain stem. What could you add to this to make it funny?

Hum: There are many ways you can incorporate humming as a break or to begin class. Lead students in Simon Says or Name That Tune, or have them move their arms and legs to someone’s humming. This activity releases stress and blockages in the brain stem.

Bilateral scribbles: Have students hold a different color marker in each hand and draw or scribble to the beat of some music for 30 seconds. When they’re finished, see if the drawings turned into anything familiar or strange. Have them share with a classmate and then give their art a name.

Name scribbles: Have students write their favorite word four times with their dominant hand and then again with their other hand. Discuss how it felt, which they found more difficult and why, and what happened in their brains when they used their non-dominant hand.

Focused-Attention Practices

Focused-attention practices calm the brain’s stress response and stimulate sustained attention and emotional regulation. A regulated and calm brain is a brain that is ready to deeply learn.

When we consciously use sensations, breath, movement, and our body’s awareness, we activate those areas in the brain that pay attention to what is happening in this moment, while supporting areas we need for learning, attention, and engagement. I’ll share four focused-attention practices here.

Ice cube: Give each student an ice cube and a paper towel or napkin to hold. As they hold the ice cube, ask them to focus on what it feels like in their hands and what the sensation reminds them of. Can they sit still and wait for the ice cube to melt?

Deep breathing: Have students scrunch their toes and cross their legs at the ankles. Then they should cross the left arm over the right arm, clasp their hands together, and—keeping their hands clasped—bring them toward their chest. Have them hold that pose for 30 seconds as they take five deep breaths, and then have them take another 30 seconds to uncurl their toes, uncross their legs, extend and unclasp their hands, and uncross their arms while taking another five deep breaths. How did that feel?

So what? As students close their eyes and sit up nice and tall in their chairs, they should visualize a golden thread that connects their hearts to their stomachs. As they breathe in, have them picture a pulse in the thread moving from their stomachs to their hearts; with each exhale, the pulse travels from the heart back down to the stomach. As the students breathe, have them say, “So what?” to themselves if a negative thought occurs.

Feeling phrases: To begin the day, have students share through a picture or description how their bodies feel. Some example phrases: cold/warm/hot; twitchy/butterflies/soft/stuck; sharp/dull/itchy; shaky/trembly/tingly; jittery/weak; empty/full; relaxed/calm/peaceful; flowing/spreading; strong/tight/tense; dizzy/fuzzy/blurry; numb/prickly/jumpy/tearful/goosebumpy.

Sensations are different than emotions in that they describe the way the body feels physically. Children who struggle with speaking can point to places on their body that hold a sensation. Sensory awareness promotes cognitive growth and self-awareness. When students can begin to identify their sensations, they begin to tap into where the negative feelings and images are. This focused-attention practice can be implemented several times a day after different experiences. Questions to ask as part of this practice:

  • What are you sensing? As the teacher, begin by sharing and modeling your own sensations.
  • Where is this in your body?
  • What might be the reason for these butterflies?
  • Can you draw what fuzzy, tingly, tight, etc. looks like?