Juuling: An Alarming Trend Reversing Decades of Health Gains

NAIS

Cigarette smoking has been on a steady decline among teens for the past decade. That’s good news … but, a new craze called “Juuling” is threatening to reverse that. A Juul is a brand of e-cigarette that has become popular among middle and high schoolers, at least in part because of youth-friendly flavors and a discrete, concealable design. If Juuling is not yet on your radar, it should be, as it is quickly moving from a trend among a small percentage of teens to a major health crisis, with many implications still unknown.

Our Country’s Long Relationship with Tobacco

The history of smoking in the United States is as old as the country itself, with tobacco at the center of many early Native American spiritual ceremonies. European settlers fueled the economic growth of America through the tobacco trade, with many linking the country’s dependence on this cash crop to the birth of the slave trade. Tobacco use spiked after World War I, when soldiers returned home addicted to tobacco.

During the decades that followed, smoking took on a “cool” vibe, with ad campaigns like the Marlboro Man driving cigarette sales despite emerging research on the associated health risks. By the late 1950s, research confirmed those links between smoking and a variety of life-threatening diseases, pushing cigarette packs to carry a warning label by the ‘60s. Smoking bans in public places followed but did not really take root until the early ‘90s. By then, smoking had reached its peak in the U.S. population, with slightly more than 50 percent of eighth-, 10th-, and 12th-graders combined reporting cigarette usage, according to the University of Michigan’s Monitoring the Future (MTF)report.

By 2017, the number of teens smoking cigarettes had dropped to 17 percent, thanks to a growing awareness of the harmful effects. According to the MTF study, “it takes quite some time for the public to comprehend adverse consequences of a particular drug, thus when a new one comes on the scene, it has a considerable honeymoon period before usage declines as awareness peaks.” The United States had reached the point of steady decline in cigarette smoking among teens, with usage dropping by nearly two-thirds since 2000. Now, we may reverse those gains due to the popularity of vaping and Juuling. As defined by MTF, “vaping involves the use of a battery-powered device to heat a liquid or plant material that releases chemicals in an inhalable vapor or aerosol, or mist. Examples of vaping devices include e-cigarettes, ‘mods,’ and e-pens. The vapor may contain nicotine, the active ingredients of marijuana, flavored propylene glycol, and/or flavored vegetable glycerin. The liquid that is vaporized comes in hundreds of flavors, many of which (e.g., bubble gum and milk chocolate cream) likely are attractive to teens.”

The New Honeymoon with Vaping and Juuling

The MTF survey began tracking vaping usage in 2015, with more than one-third of 12th-graders reporting usage at that time. In 2017, MTF began tracking the substances used in the devices, with 25 percent of 12th-graders reporting nicotine usage and 12 percent reporting marijuana vaping. MTF researchers believe these numbers are likely to grow.

Although originally touted to help an adult population curb cigarette smoking, vaping may be introducing a whole new generation to nicotine and potentially other dangers not yet fully understood. Many researchers are now tracking evidence that vaping predicts cigarette experimentation. According to JAMA Pediatrics, as reported in the Wall Street Journal, “teens and young adults who try e-cigarettes are about three times more likely to try cigarettes later.” In addition, according to a recent article in USA Today, “Nicotine, contained in varying amounts in e-cigarettes, can rival the addictiveness of heroin and cocaine. For young people, whose brains are not fully developed, it can be particularly dangerous, leading to reduced impulse control, deficits in attention and cognition, and mood disorders.”

And, by all measures, vaping appears to still be in its honeymoon stage. The trend that appears to be accelerating this is Juuling. A Juul is a vaping device that resembles a flash drive and can be used for smoking all types of substances. In an interview with CNN, Pamela Ling, a professor at the University of California-San Francisco School of Medicine, said, “Because it’s referred to as Juuling, not smoking or vaping, some students may think what they’re doing is harmless. They may not even know it contains nicotine.” She goes on to point out that “one Juul ‘pod,’ the nicotine cartridge inserted into the smoking device and heated, delivers about 200 puffs, about as much nicotine as a pack of cigarettes, according to the product’s website.”

The maker of Juul has now taken measures to restrict teen access to the product, but many students report that the product is relatively easy to come by. After months of complaints by parents, teachers, and others, the Food and Drug Administration (FDA) is finally stepping in. It announced in April that it had begun “a large-scale, undercover nationwide blitz” on the illegal sale of e-cigarettes to minors, online and in stores. The FDA has discovered numerous violations and has sent warning letters to more than 40 retailers. Next steps include:

  • Working with eBay to prevent sales of Juuls through re-sellers.
  • Working directly with the manufacturers of Juuls to hold them accountable for taking action to prevent teen access.
  • Investigating companies that are using misleading advertising to lure teens into using vaping products.
  • Engaging in research-based campaigns to alert students to the dangers of all tobacco products.

Actions Schools Should Take Now

So what can schools do to protect students? Experts suggest a few essential steps:

  • Revise school policies to specifically call out vaping and related devices.
  • Develop programs to educate students on the dangers of vapes and Juuls.
  • Train faculty and administrators to recognize the use of vapes and Juuls at school.
  • Inform parents about the dangers of vaping and what they can do at home to protect their children.
  • Share this American Academy of Pediatrics fact sheet with parents and teachers.

Some schools have taken even more proactive steps, such as placing sensors in bathrooms to detect vaping. Others have banned the use of flash drives that so closely resemble these devices. Clearly, every school needs to take this threat seriously and to take proactive steps that fit with the age of the students they serve.

Unfortunately, the long-term health effects of vaping and Juuling on both the development of the teen brain and overall physical health are just beginning to be discovered. There is time to end the honeymoon period for these devices if we act now as a community. Please share what actions your school is taking to deal with this crisis so that together we can end this epidemic.

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Today’s Exhausted Superkids

The New York Times

There are several passages in the new book “Overloaded and Underprepared” that fill me with sadness for American high school students, the most driven of whom are forever in search of a competitive edge. Some use stimulants like Adderall. Some cheat.

But the part of the book that somehow got to me most was about sleep.

It’s a prerequisite for healthy growth. It’s a linchpin of sanity. Before adulthood, a baseline amount is fundamental and non-negotiable, or should be.

But many teenagers today are so hyped up and stressed out that they’re getting only a fraction of the rest they need. The book mentions a high school in Silicon Valley that brought in outside sleep experts, created a kind of sleep curriculum and trained students as “sleep ambassadors,” all to promote shut-eye.

The school even held a contest that asked students for sleep slogans. The winner: “Life is lousy when you’re drowsy.”

Sleep ambassadors? Sleep rhymes? Back when I was in high school in the 1980s, in a setting considered intense in its day, the most common sleep problem among my peers was getting too much of it and not waking up in time for class.

Now the concern isn’t how to rouse teens but how to lull them. And that says everything about the way childhood has been transformed — at least among an ambitious, privileged subset of Americans — into an insanely programmed, status-obsessed and sometimes spirit-sapping race.

Take one more Advanced Placement class. Add another extracurricular. Apply to all eight Ivies.

Lose a few winks but never a few steps.

“Overloaded and Underprepared,” published on Tuesday, was written by Denise Pope, Maureen Brown and Sarah Miles, all affiliated with a Stanford University-based group called Challenge Success, which urges more balanced learning environments. The book looks at homework loads, school-day structures and much more.

And it joins an urgently needed body of literature that pushes back at helicopter parenting, exorbitant private tutoring, exhaustive preparation for standardized tests and the rest of it. This genre goes back at least a decade and includes, notably, Madeline Levine’s “The Price of Privilege” and Paul Tough’s “How Children Succeed.”

But it has expanded with particular velocity of late. “How to Raise an Adult,” by Julie Lythcott-Haims, came out last month. “The Gift of Failure,” by Jessica Lahey, will be released in two weeks.

There’s a unifying theme: Enough is enough.

“At some point, you have to say, ‘Whoa! This is too crazy,’ ” Pope, a senior lecturer at Stanford, told me.

Sleep deprivation is just a part of the craziness, but it’s a perfect shorthand for childhoods bereft of spontaneity, stripped of real play and haunted by the “pressure of perfection,” to quote the headline on a story by Julie Scelfo in The Times this week.

Scelfo wrote about six suicides in a 13-month period at the University of Pennsylvania; about the prevalence of anxiety and depression on college campuses; about many star students’ inability to cope with even minor setbacks, which are foreign and impermissible.

Those students almost certainly need more sleep. In a study in the medical journal Pediatrics this year, about 55 percent of American teenagers from the ages of 14 to 17 reported that they were getting less than seven hours a night, though the National Sleep Foundation counsels 8 to 10.

“I’ve got kids on a regular basis telling me that they’re getting five hours,” Pope said. That endangers their mental and physical health.

Smartphones and tablets aggravate the problem, keeping kids connected and distracted long after lights out. But in communities where academic expectations run highest, the real culprit is panic: about acing the exam, burnishing the transcript, keeping up with high-achieving peers.

I’ve talked with many parents in these places. They say that they’d love to pull their children off such a fast track, but won’t the other children wind up ahead?

They might — if “ahead” is measured only by a spot in U-Penn’s freshman class and if securing that is all that matters.

But what about giving a kid the wiggle room to find genuine passions, the freedom to discover true independence, the space to screw up and bounce back? Shouldn’t that matter as much?

“No one is arguing for a generation of mediocre or underachieving kids — but plenty of people have begun arguing for a redefinition of what it means to achieve at all,” wrote Jeffrey Kluger in Time magazine last week. He noted, rightly, that “somewhere between the self-esteem building of going for the gold and the self-esteem crushing of the Ivy-or-die ethos, there has to be a place where kids can breathe.”

And where they can tumble gently into sleep, which is a gateway, not an impediment, to dreams.

Spreading First Aid for Teens’ Mental Health by Training Adults to Help

MindShift

iStock/Anna_Isaeva

During the vulnerable transition from childhood to young adulthood, many kids grapple with low self-esteem, anxiety and depression. According to the National Alliance on Mental Illness, 20 percent of adolescents between the ages of 13-18 live with a mental health condition. In fact, a recent study found that nearly 25 percent of teenage girls and almost 10 percent of teen boys suffer from depression by the age of fourteen.

When kids struggle, their emotional problems often unfold in the classroom, affecting their ability to concentrate and straining interactions with teachers and peers. Left untreated, mental health concerns can contribute to high school dropout rates. A 2001 survey conducted by the Department of Education found almost 50 percent of students age 14 and older with mental illness withdraw from school, and a recent study, published in the journal BMC Public Health discovered males with psychological disorders are five times more likely to quit attending school.

While educators often want to assist these students, many feel unsure of what to say, especially during a mental health crisis. But a community-wide intervention called Mental Health First Aid seeks to equip teachers, parents and caregivers with the information and skills they need to intervene during a mental health emergency.

MHFA training, referred to as “CPR for the mind,” teaches educators and caretakers how to recognize, understand and respond to signs of psychological distress. Educators across the country can receive “Youth” First Aid training, a unique version of MHFA teaching individuals how to recognize the psychological challenges that adolescents face.

“The course taught me how to get students the help they need, especially in an emergency,” says Tori Wardrip, an art teacher at Lewis and Clark Middle School in Billings, Montana.

Wardrip completed the training in June. The full-day course taught her several First Aid skills, including how to recognize the signs of a panic attack, psychosis and PTSD. She also learned how to assess for suicide risk by asking questions like, “Are you having thoughts of hurting yourself?” and “Are you in danger?”

Spreading the Word

Since 2013, more than 200,000 educators have been trained in Youth Mental Health First Aid, according to Betsy Schwartz, vice president of public education at the National Council for Behavioral Health; hundreds of middle schools, high schools and 27 state departments of education have implemented it. Schwartz says the results have been positive, resulting in $30 million in grant funding from the Substance Abuse and Mental Health Service Administration’s (SAMHSA) Now is the Time Project AWARE grant initiative.

The initiative also has garnered support from pop star Lady Gaga, who wants to help break silence around mental health. In 2012, the singer and her mother, Cynthia Germanotta started the “Born This Way Foundation,” a nonprofit organization committed to raising awareness about mental wellness, especially for young people. Recently, the foundation partnered with the National Council for Behavioral Health to sponsor Mental Health First Aid training across the nation.

The program trains people how to support and de-escalate an emergency crisis by using a five-step action plan, called ALGEE, according to Schwartz. “ALGEE stands for assessing for suicide risk/self-harm, listening nonjudgmentally, giving reassurance and information, encouraging professional help, and encouraging self-help and additional support strategies,” says Schwartz.

She adds that educators and caregivers who participate in the daylong YMHFA training learn how to recognize risk factors and warning signs of youth mental health challenges. Individuals are also informed about the prevalence of mental illness among adolescents, learning how protective factors, like available mental health resources, can contribute to psychological resilience.

During training, YMHFA participants practice these skills by role-playing with each other. Similar to medical First Aid training, role-play mimics realistic emergencies, allowing people to rehearse what they might “say” and “do” in an actual mental health crisis.

While the training focuses on mental wellness, instructors also discuss topics, like bullying and attention difficulties, teaching educators how these behaviors contribute to mental health concerns, like depression, suicidality and eating disorders.

At Lewis and Clark, Wardrip has put her new knowledge to good use. Since completing the training, she has become the “go to” person for the faculty’s behavioral health questions, serving as a bridge between educators and counselors.

She’s also using her new knowledge to teach students how to look out for each other.

“This year, using my First Aid training, I plan to teach my kids how to recognize the signs of a mental health emergency. If a peer is in danger, I want them to know how to get help,” she says.

Additional Resources

recent report, released by the “Born This Way Foundation,” found that even though adolescents value their psychological well-being, less than half are talking about their mental health. However, research shows teaching kids how to find psychological resources can make a world of difference, helping to break the shame and stigma that surrounds mental illness.

Schwartz says, educators and caregivers who participate in the daylong YMHFA training will learn five First Aid skills, including:

  1. Recognizing risk factors and warning signs of youth mental health challenges
  2. Understanding the prevalence of mental health conditions among young people
  3. Understanding protective factors that contribute to psychological resilience
  4. Learning the ALGEE five-step action plan
  5. Identifying community resources that can help support adolescents and their families

With support from the Born This Way Foundation, the National Council for Behavioral Health hopes to train 150,000 additional educators, parents and caregivers before the end of 2017.

Educators who are interested in setting up a YMHFA training can find courses here. See Lady Gaga and Prince William chat on FaceTime about mental health from earlier this year:

Juli Fraga is a psychologist and writer in San Francisco. You can find her @dr_fraga on Twitter.  

Get Happy: Four Well-Being Workouts

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CreditCharlie Riedel/Associated Press

Relieving stress and anxiety might help you feel better — for a bit. Martin E.P. Seligman, a professor of psychology at the University of Pennsylvania and a pioneer in the field of positive psychology, does not see alleviating negative emotions as a path to happiness.

“Psychology is generally focused on how to relieve depression, anger and worry,” he said. “Freud and Schopenhauer said the most you can ever hope for in life is not to suffer, not to be miserable, and I think that view is empirically false, morally insidious, and a political and educational dead-end.”

“What makes life worth living,” he said, “is much more than the absence of the negative.”

To Dr. Seligman, the most effective long-term strategy for happiness is to actively cultivate well-being.

In his 2012 book, “Flourish: A Visionary New Understanding of Happiness and Well-Being,” he explored how well-being consists not merely of feeling happy (an emotion that can be fleeting) but of experiencing a sense of contentment in the knowledge that your life is flourishing and has meaning beyond your own pleasure.

To cultivate the components of well-being, which include engagement, good relationships, accomplishment and purpose, Dr. Seligman suggests these four exercises based on research at the Penn Positive Psychology Center, which he directs, and at other universities.

Identify Signature Strengths

Write down a story about a time when you were at your best. It doesn’t need to be a life-changing event but should have a clear beginning, middle and end. Reread it every day for a week, and each time ask yourself: “What personal strengths did I display when I was at my best?” Did you show a lot of creativity? Good judgment? Were you kind to other people? Loyal? Brave? Passionate? Forgiving? Honest?

Writing down your answers “puts you in touch with what you’re good at,” Dr. Seligman explained. The next step is to contemplate how to use these strengths to your advantage, intentionally organizing and structuring your life around them.

In a study by Dr. Seligman and colleagues published in American Psychologist, participants looked for an opportunity to deploy one of their signature strengths “in a new and different way” every day for one week.

“A week later, a month later, six months later, people had on average lower rates of depression and higher life satisfaction,” Dr. Seligman said. “Possible mechanisms could be more positive emotions. People like you more, relationships go better, life goes better.”

Find the Good

Set aside 10 minutes before you go to bed each night to write down three things that went really well that day. Next to each event answer the question, “Why did this good thing happen?”

Instead of focusing on life’s lows, which can increase the likelihood of depression, the exercise “turns your attention to the good things in life, so it changes what you attend to,” Dr. Seligman said. “Consciousness is like your tongue: It swirls around in the mouth looking for a cavity, and when it finds it, you focus on it. Imagine if your tongue went looking for a beautiful, healthy tooth.” Polish it.

Make a Gratitude Visit

Think of someone who has been especially kind to you but you have not properly thanked. Write a letter describing what he or she did and how it affected your life, and how you often remember the effort. Then arrange a meeting and read the letter aloud, in person.

“It’s common that when people do the gratitude visit both people weep out of joy,” Dr. Seligman said. Why is the experience so powerful? “It puts you in better touch with other people, with your place in the world.”

Respond Constructively

This exercise was inspired by the work of Shelly Gable, a social psychologist at the University of California, Santa Barbara, who has extensively studied marriages and other close relationships. The next time someone you care about shares good news, give what Dr. Gable calls an “active constructive response.”

That is, instead of saying something passive like, “Oh, that’s nice” or being dismissive, express genuine excitement. Prolong the discussion by, say, encouraging them to tell others or suggest a celebratory activity.

“Love goes better, commitment increases, and from the literature, even sex gets better after that.”

Stressed-Out High Schoolers Advised To Try A Nap Pod

NPR

Listen·3:193:19

Hannah Vanderkooy demonstrates the napping pod she uses at Las Cruces High School in Las Cruces, N.M.  Joe Suarez for NPR

 

When 18-year-old Hannah Vanderkooy feels extremely tired or anxious, she heads to a spacelike capsule for a nap — during school. Like many teens struggling to get good grades and maybe even a college scholarship, Vanderkooy doesn’t get enough sleep.

And she’s not alone. Various studies indicate that chronically sleepy and stressed-out teenagers might be the new normal among U.S. adolescents who are competing for grades, colleges and, eventually, jobs.

Studies have shown teenagers actually need between nine and 10 hours of sleep a night. But the vast majority (69 percent) aren’t getting it.

Enter “napping pods.” They’re essentially egg-shaped lounge chairs that recline, with a circular lid that can be pulled over the chest to shield against light.

“It just sort of envelops you in a really nice darkness, with soft lighting behind you,” says Vanderkooy, a frequent user of the pods. She says she typically gets only four to five hours of sleep a night.

There’s soft music playing in the pod and “you just feel extremely relaxed,” she says. The 20-minute experience is a wonderful “oasis” amid all the worry and stress of school, she says.

Las Cruces High School has one napping pod, which students use for 20 minutes when they are tired, stressed or angry.

Joe Suarez for NPR

“Being a senior, I have to apply for scholarships, do all my homework,” she says — noting that she’s taking three advanced placement courses. “So my sleep cycle has just sort of become this night-owl life, and it’s just kind of the new normal.”

A nap can’t substitute for a good night’s sleep, but it certainly can help, says Dr. Nitun Verma, a sleep specialist and spokesperson for the American Academy of Sleep Medicine.

A short nap for a teenager “can give a boost to memory and attention during the day, and it can increase school performance,” he says, adding that in a perfect world, schools would roll back their start times.

As it is now, the average school starts at 7:30 in the morning while the start time recommended by researchers at the Centers for Disease Control and Prevention is 8:30 a.m. or later. On top of that, teens’ circadian rhythms work against them — coaxing them to stay up late and then sleep late. So they are already sleep-deprived and “waking up much earlier than normal,” Verma says.

Several public schools in New Mexico are trying to tackle the problem by providing napping pods for their students.

“We know lack of sleep changes mood and makes you more anxious,” says family nurse practitioner Linda Summers, who is an associate professor at New Mexico State University’s school of nursing in Las Cruces.

Summers also works with the nearby Las Cruces High School health center, and has seen firsthand the effects of sleep deprivation on students there. So she decided to apply for a federal health grant to buy the pods, which, at the time, cost $14,000 each. They were installed in four high schools.

Vanderkooy is a senior at Las Cruces High School. She says she typically gets only four to five hours of sleep a night. Joe Suarez for NPR

 

And while the Las Cruces school napping pods were bought to remedy sleep deprivation, Summers says, “it also turns out to be good for anger and stress.”

Even if kids don’t fall asleep, but simply “zone out,” she says, they emerge saying they feel “refreshed and calm.” This led Summers to embark on a study looking at the emotional impact of pods.

She recruited students who reported feeling “agitated or upset about something,” and had them describe their feelings before and after spending 20 minutes in the pod.

“They all felt more rested, happier and more in control of their emotions,” she says, “after just 20 minutes.” Summers now writes prescriptions for the nap pod for students who are anxious, angry or just plain sleepy.

The findings haven’t been published yet, but they have been accepted for publication by a peer-reviewed journal. Summers says the teachers and school nurses she works with already see the pods as a big success. Each capsule is sort of a “therapeutic study hall,” she says, that helps students focus better when they’re in the classroom.

Vanderkooy recalls falling asleep in one of her classes and being told by her teacher that she “really, really” needed to go take a nap.

“I came back and I was awake and attentive,” she says, able to take out her notes and proceed — “just like a normal class.”

Breathe. Exhale. Repeat: The Benefits of Controlled Breathing

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CreditAndrew Rae

Take a deep breath, expanding your belly. Pause. Exhale slowly to the count of five. Repeat four times.

Congratulations. You’ve just calmed your nervous system.

Controlled breathing, like what you just practiced, 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. 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.

“Breathing is massively practical,” says Belisa Vranich, a psychologist and author of the book “Breathe,” to be published in December. “It’s meditation for people who can’t meditate.”

How controlled breathing may promote healing remains a source of scientific study. One theory is that controlled breathing can change the response of the body’s autonomic nervous system, which controls unconscious processes such as heart rate and digestion as well as the body’s stress response, says Dr. Richard Brown, an associate clinical professor of psychiatry at Columbia University and co-author of “The Healing Power of the Breath.”

Consciously changing the way you breathe appears to send a signal to the brain to adjust the parasympathetic branch of the nervous system, which can slow heart rate and digestion and promote feelings of calm as well as the sympathetic system, which controls the release of stress hormones like cortisol.

Many maladies, such as anxiety and depression, are aggravated or triggered by stress. “I have seen patients transformed by adopting regular breathing practices,” says Dr. Brown, who has a private practice in Manhattan and teaches breathing workshops around the world.

When you take slow, steady breaths, your brain gets the message that all is well and activates the parasympathetic response, said Dr. Brown. When you take shallow rapid breaths or hold your breath, the sympathetic response is activated. “If you breathe correctly, your mind will calm down,” said Dr. Patricia Gerbarg, assistant clinical professor of psychiatry at New York Medical College and Dr. Brown’s co-author

Dr. Chris Streeter, an associate professor of psychiatry and neurology at Boston University, recently completed a small study in which she measured the effect of daily yoga and breathing on people with diagnoses of major depressive disorder.

After 12 weeks of daily yoga and coherent breathing, the subjects’ depressive symptoms significantly decreased and their levels of gamma-aminobutyric acid, a brain chemical that has calming and anti-anxiety effects, had increased. The research was presented in May at the International Congress on Integrative Medicine and Health in Las Vegas. While the study was small and lacked a control group, Dr. Streeter and her colleagues are planning a randomized controlled trial to further test the intervention.

“The findings were exciting,” she said. “They show that a behavioral intervention can have effects of similar magnitude as an antidepressant.”

Controlled breathing may also affect the immune system. Researchers at the Medical University of South Carolina divided a group of 20 healthy adults into two groups. One group was instructed to do two sets of 10-minute breathing exercises, while the other group was told to read a text of their choice for 20 minutes. The subjects’ saliva was tested at various intervals during the exercise. The researchers found that the breathing exercise group’s saliva had significantly lower levels of three cytokines that are associated with inflammation and stress. The findings were published in the journal BMC Complementary and Alternative Medicine in August.

Here are three basic breathing exercises to try on your own.

Coherent Breathing

If you have the time to learn only one technique, this is the one to try. In coherent breathing, the goal is to breathe at a rate of five breaths per minute, which generally translates into inhaling and exhaling to the count of six. If you have never practiced breathing exercises before, you may have to work up to this practice slowly, starting with inhaling and exhaling to the count of three and working your way up to six.

Photo

CreditAndrew Rae

1. Sitting upright or lying down, place your hands on your belly.

2. Slowly breathe in, expanding your belly, to the count of five.

3. Pause.

4. Slowly breathe out to the count of six.

5. Work your way up to practicing this pattern for 10 to 20 minutes a day.

Stress Relief

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

Photo

CreditAndrew Rae

1. Sit up straight on the floor or the edge of a chair.

2. Place your hands on your belly.

3. As you inhale, lean forward and expand your belly.

4. As you exhale, squeeze the breath out and curl forward while leaning backward; exhale until you’re completely empty of breath.

5. Repeat 20 times.

Energizing HA Breath

When the midafternoon slump hits, stand up and do some quick breathwork to wake up your mind and body.

Photo

CreditAndrew Rae

1. Stand up tall, elbows bent, palms facing up.

2. As you inhale, draw your elbows back behind you, palms continuing to face up.

3. Then exhale quickly, thrusting your palms forward and turning them downward, while saying “Ha” out loud.

4. Repeat quickly 10 to 15 times.

How to Become a ‘Superager’

Think about the people in your life who are 65 or older. Some of them are experiencing the usual mental difficulties of old age, like forgetfulness or a dwindling attention span. Yet others somehow manage to remain mentally sharp. My father-in-law, a retired doctor, is 83 and he still edits books and runs several medical websites.

Why do some older people remain mentally nimble while others decline? “Superagers” (a term coined by the neurologist Marsel Mesulam) are those whose memory and attention isn’t merely above average for their age, but is actually on par with healthy, active 25-year-olds. My colleagues and I at Massachusetts General Hospital recently studied superagers to understand what made them tick.

Our lab used functional magnetic resonance imaging to scan and compare the brains of 17 superagers with those of other people of similar age. We succeeded in identifying a set of brain regions that distinguished the two groups. These regions were thinner for regular agers, a result of age-related atrophy, but in superagers they were indistinguishable from those of young adults, seemingly untouched by the ravages of time.

What are these crucial brain regions? If you asked most scientists to guess, they might nominate regions that are thought of as “cognitive” or dedicated to thinking, such as the lateral prefrontal cortex. However, that’s not what we found. Nearly all the action was in “emotional” regions, such as the midcingulate cortex and the anterior insula.

My lab was not surprised by this discovery, because we’ve seen modern neuroscience debunk the notion that there is a distinction between “cognitive” and “emotional” brain regions.

This distinction emerged in the 1940s, when a doctor named Paul MacLean devised a model of the human brain with three layers. An ancient inner layer, inherited from reptiles, was presumed to contain circuits for basic survival. The middle layer, the “limbic system,” supposedly contained emotion circuitry inherited from mammals. And the outermost layer was said to house rational thinking that is uniquely human. Dr. MacLean called this model “the triune brain.”

The triune brain became (and remains) popular in the media, the business world and certain scientific circles. But experts in brain evolution discredited it decades ago. The human brain didn’t evolve like a piece of sedimentary rock, with layers of increasing cognitive sophistication slowly accruing over time. Rather (in the words of the neuroscientist Georg Striedter), brains evolve like companies do: they reorganize as they expand. Brain areas that Dr. MacLean considered emotional, such as the regions of the “limbic system,” are now known to be major hubs for general communication throughout the brain. They’re important for many functions besides emotion, such as language, stress, regulation of internal organs, and even the coordination of the five senses into a cohesive experience.

And now, our research demonstrates that these major hub regions play a meaningful role in superaging. The thicker these regions of cortex are, the better a person’s performance on tests of memory and attention, such as memorizing a list of nouns and recalling it 20 minutes later.

Of course, the big question is: How do you become a superager? Which activities, if any, will increase your chances of remaining mentally sharp into old age? We’re still studying this question, but our best answer at the moment is: work hard at something. Many labs have observed that these critical brain regions increase in activity when people perform difficult tasks, whether the effort is physical or mental. You can therefore help keep these regions thick and healthy through vigorous exercise and bouts of strenuous mental effort. My father-in-law, for example, swims every day and plays tournament bridge.

The road to superaging is difficult, though, because these brain regions have another intriguing property: When they increase in activity, you tend to feel pretty bad — tired, stymied, frustrated. Think about the last time you grappled with a math problem or pushed yourself to your physical limits. Hard work makes you feel bad in the moment. The Marine Corps has a motto that embodies this principle: “Pain is weakness leaving the body.” That is, the discomfort of exertion means you’re building muscle and discipline. Superagers are like Marines: They excel at pushing past the temporary unpleasantness of intense effort. Studies suggest that the result is a more youthful brain that helps maintain a sharper memory and a greater ability to pay attention.

This means that pleasant puzzles like Sudoku are not enough to provide the benefits of superaging. Neither are the popular diversions of various “brain game” websites. You must expend enough effort that you feel some “yuck.” Do it till it hurts, and then a bit more.

In the United States, we are obsessed with happiness. But as people get older, research shows, they cultivate happiness by avoiding unpleasant situations. This is sometimes a good idea, as when you avoid a rude neighbor. But if people consistently sidestep the discomfort of mental effort or physical exertion, this restraint can be detrimental to the brain. All brain tissue gets thinner from disuse. If you don’t use it, you lose it.

So, make a New Year’s resolution to take up a challenging activity. Learn a foreign language. Take an online college course. Master a musical instrument. Work that brain. Make it a year to remember.