Dallas is currently in the midst of another triple digit heatwave that, despite the no-doubt immanent arrival of pumpkin-spice season, shows no signs of letting up soon. While there are regular reminders in the news to guard against heat stroke and the physical effects of heat, it is also important to know that extreme heat can negatively impact our mental health as well.
 
A recent meta-analysis published in The Lancet found positive associations between temperature and suicide rates, hospital admissions for mental illness, and community mental health outcomes. Aggression, domestic violence, and substance use can also increase during periods of extreme heat.
 
Certain groups are more vulnerable to the mental health impacts of extreme heat. People with pre-existing mental health conditions, dementia, or those taking certain medications (more on that below) might be at higher risk. Socioeconomic factors, such as poverty and substance use disorders, also substantially contribute to vulnerability.

​Certain classes of medication used to manage physical health conditions can make it harder for your body to handle extreme heat. These include medications to treat heart conditions, blood pressure, diuretics, anticholinergics (such as those prescribed for Parkinson’s and overactive bladder), antihistamines, and decongestants.
 
Similarly, some medications used to manage mental health conditions can impact the body's ability to stay hydrated, regulate temperature, and respond to heat. These include central nervous system stimulants prescribed for ADD/ADHD, medications to treat depression and anxiety (SSRIs, SNRIs, and tricyclic antidepressants), as well as some medications prescribed for schizophrenia and bipolar disorders. These medications can be life-saving and have profound benefits for quality of life, so it is important for healthcare providers and patients to work together to manage medications effectively, especially during heatwaves or other extreme weather events.
 
As we collectively navigate the extreme heat of the next several weeks, you can prioritize your physical and mental health by staying well-hydrated, taking precautions against becoming overheated, and checking on vulnerable family members, friends, and neighbors.
 
If you'd like to learn more about the Lancet study, Dr. Robert Bright, a psychiatrist with the Mayo Clinic, talks more about that research and the effects of heat on mental health here.

Research has shown physical movement to be a powerful tool in alleviating symptoms of depression and anxiety, as well as enhancing our overall sense of well-being. As we enter the sunshine and blue skies of Hot Texan Summer (TM), it is helpful to remember the beneficial effects of movement on our mental health and the importance of incorporating physical activity into our daily lives.

Over the years, a growing body of research has shed light on the positive impact of physical activity on individuals experiencing depression and anxiety. These studies highlight several key findings:
 
Release of Mood-Boosting Chemicals. Engaging in regular physical activity triggers the release of endorphins, neurotransmitters that act as natural painkillers and mood elevators. Endorphins induce feelings of happiness and well-being, counteracting negative emotions. This chemical boost can significantly improve mood and reduce symptoms of anxiety.
 
Neurogenesis and Neuroplasticity. Movement has been shown to promote neurogenesis (the formation of new neurons) and enhance neuroplasticity (the brain's ability to reorganize and adapt). These processes play a vital role in improving cognitive function, memory, and learning abilities. By stimulating the growth and connectivity of brain cells, physical activity helps create a healthier neural network that supports mental well-being. Studies indicate that regular exercise may even significantly reduce the risk of developing dementia.
 
Stress Reduction and Anxiety Management. Movement acts as a natural stress reliever by reducing the levels of stress hormones such as cortisol and promoting relaxation. Regular activity can also help manage anxiety symptoms, which often coexist with depression. Engaging in activities like walking, jogging, yoga, or swimming can provide a much-needed respite from daily stressors, promote a sense of calm and mental clarity, and improve sleep.
 
Social Interaction and Support. Participating in group activities or team sports provides an opportunity for social interaction and support. Engaging in activity with others can foster a sense of belonging and community, creating a supportive environment that combats loneliness and enhances our sense of well-being.
 
Physical activity can be a powerful a complementary tool alongside professional treatment for depression and anxiety. A recent meta-analysis published in JAMA Psychiatry, found that relatively small doses of even moderate physical activity (2 hours per week) were associated with substantially lower risks of depression. (Dr. Roger Seheult examines this and another recent study exploring depressive symptoms and sedentary behavior in adolescence in the video linked below.)

This spring a presidential panel of the American Psychological Association (APA) has produced recommendations for the use of social media by adolescents. The advisory panel was formed to provide recommendations grounded in research to ensure that adolescents develop healthy social media practices. The result is the American Psychological Association Health Advisory on Social Media Use in Adolescence. 

The report notes that while these platforms can promote healthy socialization, their use should be preceded by training in social media literacy to ensure that children and teens have skills that will maximize the chances for balanced, safe and meaningful experiences.

This report notes that social media use is not inherently beneficial or harmful to young people. The effects of social media depend on adolescents' personal and psychological characteristics, social circumstances, and the specific content, features, or functions they encounter on social media platforms. 

The report emphasizes that not all findings apply equally to all children and teens. Scientific findings should be used in conjunction with knowledge of specific kids’ strengths, weaknesses, developmental maturity, and contexts to make decisions tailored to each individual. 

​In addition to the new report, the APA's chief science officer, Dr. Mitch Prinstein, provides Q&A and recommendations for parents on how to help teens develop social media literacy skills. Dr. Prinstein specifically advises parents to:

• Monitor and discuss social media use. Take a multipronged approach to social media management by setting time limits, monitoring your child's online activities, and engaging in ongoing discussions about social media. Limit chat functions and exposure to adult content, and consider allowing social media use only when children are at home.
• Model healthy social media use. Be a positive role model by demonstrating healthy social media behavior. Avoid using social media during family time and set limits on your own social media use. Discuss your own social media use with your children and take social media holidays together as a family.
• Watch for problematic social media use. Be vigilant for signs that your child may be using social media in unhealthy ways. Look for interference with daily routines, excessive use over in-person interactions, lack of sleep or physical activity, inability to stop using social media, and deceptive behavior. If necessary, enforce new limits or seek help from a mental health professional.
• Teach social media literacy. Recognize that social media literacy is essential for adolescents. Work with social media platforms, schools, and your teen to promote social media literacy skills. Discuss topics like recognizing false information, understanding the meaning behind likes, preventing conflicts, promoting positive body image, addressing discrimination, and seeking reliable mental health information.

 
You can read the APA's recommendations in full here, and Dr. Prinstein's Q&A here.

Dr. Steven Stosny coined the term "election stress disorder” in 2016, with symptoms such as increased anxiety, insomnia, and difficulty concentrating. Dr. Stosny observed that "the pervasive negativity of political campaigns, amplified by the 24-hour news cycle and social media exposure," creates a significant level of stress, anxiety, or anger in many people.

The American American Psychological Association (APA) Stress in America Survey found that more than two-thirds of U.S. adults (68%) say that the 2020 U.S. presidential election is a significant source of stress in their life. This is a substantial increase from the 2016 presidential election when 52% of US adults reported the same.

“This has been a year unlike any other in living memory,” said Arthur C. Evans Jr., PhD, the APA's chief executive officer. “Not only are we in the midst of a global pandemic that has killed more than 200,000 Americans, but we are also facing increasing division and hostility in the presidential election. Add to that racial turmoil in our cities, the unsteady economy and climate change that has fueled widespread wildfires and other natural disasters. The result is an accumulation of stressors that are taking a physical and emotional toll on Americans.”

The APA offers the following evidence-based advice to help people manage their stress related to the election:

• Uncertainty is frequently stressful, and some people are better at dealing with uncertainty than others. The election, the global pandemic and social unrest are all adding to a sense of uncertainty in our lives. Avoid dwelling on things you can’t control. When uncertainty strikes, many people immediately imagine worst-case scenarios. Break the habit of ruminating on bad outcomes.
• Focus on what you can control. If following the news, watching the debates or scrolling through social media is causing you stress, limit your media consumption. Give yourself permission to take a break from the news.
• Engage in meaningful activities. Rather than fixating on news coverage, find an activity that you really enjoy and spend time doing it. Get involved in issues that are meaningful to you. By making a plan on how you will vote, for example — in person, by mail or as part of early voting — you are more likely to follow through.
• Stay socially connected. Go for a walk or spend time with friends and family. Research shows that people who have at least one or two friends or family members to turn to for emotional support during stressful times tend to cope better than people who don’t have such support.
• Stay active. Moving helps us release the energy we experience when we feel stressed.
• Realize that we might not know who won the election on Election Day. If you think this will raise your anxiety, keep busy with things that you enjoy and stay connected to social support so that you aren’t continually checking for what could be viewed as “bad” news.

Journaling can be an invaluable resource for therapy. When someone describes an unusually good (or bad) day in session, I often ask them to reflect on what was different. Answers of "I don't know." or "Nothing, I think." are supremely frustrating in that they leave a person feeling helpless, as though a good or bad day comes out of the blue or passes them by completely outside of their control. More often than not, there are concrete things someone did, thought, or felt that either contributed to a better day or perhaps kept a bad day or experience from "taking over" or becoming unmanageable.

Take for example the few pounds we all may or may not have added over the holidays. We can be perplexed when we look at the scale now and wonder, "How did that happen?" But we also know that people who log everything that they eat or drink 1) tend to eat and drink more mindfully and healthily, and 2) can readily identify that pumpkin cheesecake or second helping that likely added to the scale come January. Journaling can provide that level of insight for your mental health.

Identifying patterns can be empowering and can provide you with your own individual data on what works, and what doesn't, what contributes to a great week, and what behaviors, skills, and experiences help you nip anxiety or depression in the bud. This process can help you clarify thoughts and feelings and solve problems more effectively.

Journaling can improve your body as well as your mind. University of Texas social psychologist and researcher, James Pennebaker has found that regular journaling strengthens immune cells (lymphocytes). A study published in Advances in Psychiatric Treatment noted improvements in both physical and psychological health in clinical and non-clinical groups after just 3-5 15-20 minute journaling sessions. Other research suggests that journaling offers not just emotional, but physical benefits to individuals battling terminal or life-threatening illnesses. Perhaps we see these benefits because, as Pennebaker suggests, writing about stressful events helps you come to terms with them and reduces the impact of these stressors on your physical health. Remind you of therapy? Journaling and therapy can beautifully complement one another. The work that you do journaling over the week can build on the momentum, insights, and positive changes you are developing in therapy. 

Adding space for a gratitude journal can provide time and space to reflect on positive thoughts, feelings, and experiences in a way that can actually help re-train your brain to more readily identify (rather than discount) positive experiences.

Including self-care ideas for when you notice triggers or early signs of depression or anxiety can help you easily identify tried and true methods to change course or help manage those negative feelings before they become overwhelming.

Here are some additional tips to get you started:

• Write every day. Whether you are more comfortable writing page long entries, drawing about your day or feelings, or using bullet points to capture the essentials, writing every day can help you build a consistent practice of mindful reflection. This can begin to change not just how you reflect on experiences after the fact, but also how you live them in the moment. If you have a negative interaction with a co-worker or spouse, you may find yourself thinking, "This is definitely going in the journal." That thought begins to change the experience. You begin to think about how you might write about it. Will your journal entry say that this conversation kicked off a terrible day? Or will you write about how you used the opportunity to practice stopping a spiral of negative thoughts, or how you used other coping skills to turn it around?​
• ​Make it easy. Before you set up a goal or "resolution" (e.g., to exercise 5 times a day or get 8 hours of sleep each night) start with tracking where you are now. Be curious, mindful, and take some time to learn about your current baseline. Once you've established that, you'll be better able to set realistic goals. ​

​Make it yours. Your journal can be as minimalistic and straightforward or artistic and detailed as you want. Are you the type of person (this month) who delights in a To Do list? Or does a listing these tasks and obligations bring you additional stress? If so, you may find you are better served by a "Done" list. Find your own style and what works best for you. The beauty of making a journal your own is that it can change with you from week to week, and month to month. Build on what works for you, and leave what does not behind without guilt (recognizing each of these is progress in and of itself!).

​Finally, I'm personally a proponent of putting pen to paper. One of the benefits of a journal that you physically create yourself is that you have complete control in customizing it to fit your needs as opposed to having pre-printed pages that you don't love or use in a day planner or maintaining multiple tracking apps. That said, if a physical journal just feels too analog for your life, there are a number of apps out there that track habits, moods, and provide space for journaling. Just be aware of protecting your privacy and online presence if you choose a digital route.

Happy journaling!

Additional Journaling  Resources:

BulletJournal.com offers a videos, tips, and tutorials on how to start a bullet journal.

Rachel Wilkerson Miller and Anna Borges at Buzzfeed offer a lighthearted and insightful collection of ways to use journaling to track and improve your mental health.

Steven Stosney at Psychology Today, describes the research on the results of journaling and gives tips for reaping the benefits of journaling while avoiding the pitfalls. ​

This divisive political season and election have heightened anxiety throughout the US. A Harris Poll on behalf of the American Psychological Association found that 52 percent of American adults report that the 2016 election is a very or somewhat significant source of stress (read more here).

As we attempt as a country to come together with respect, compassion, and courage, psychologist Guy Winch gives us concrete advice on overcoming post-election anxiety. "Regardless of its source, anxiety tends to operate in similar ways, which means there are clear things you can do to manage post-election anxiety." Guy has recommendations on actions you can take now to begin lowering your anxiety. Read his full article here:

​Three Ways to Lower Post-Election Anxiety

And remember, "sitting with emotional distress of any kind is neither wise nor necessary. If you feel upset, unsettled, and anxious—take action and make decisions that prioritize your emotional health and make you feel better."

You can also view Guy's viral TED Talk on boosting emotional health below.

Take care of yourself and one another out there.

The field of social genomics is granting us new insight into the power of connection and meaning at the level of our DNA. Researchers have known for some time that the stress response stifles the body's immune system and increases the inflammatory response (which in turn promotes the growth of cancer cells, plaque in the arteries, and increases our susceptibility to neurodegenerative disease). Researchers John Cacioppo, professor of psychology and behavioral neuroscience at the University of Chicago, and Steve Cole, professor of medicine at the University of California, Los Angeles, revealed that the brains of many of their participants interpret loneliness as a danger or threat, in short, loneliness triggered a damaging chronic stress-response. Fascinatingly, this response is triggered at the level of genome expression. 

Inspired by Cacioppo and Cole's work, Barbara Fredrickson, noted positive psychologist from the University of North Carolina at Chapel Hill, became curious as to whether the opposite would hold true. The answer was yes. People who described feeling socially connected, engaged in personal projects, or that they were living in a way that fulfilled meaning and purpose showed the opposite response pattern to lonely and chronically stressed participants.

Read more about this Cacioppo, Cole, and Fredrickson's research here.

Today is National Psychotherapy Day, a day to reduce stigma and draw awareness to the effectiveness of therapy.

"People who support psychotherapy – therapists, clients, academics, policymakers, or any other interested party – are encouraged to talk about their own experiences with therapy, contribute to low-fee and community mental health clinics, share therapy effectiveness research, and wear turquoise to show support and start conversations."

If you haven't seen the Moments of Meaning series, they are definitely worth your while. Dr. Ryan Howes, founder of National Psychotherapy Day, and his team released this video series featuring therapists speaking from the heart about the transformations that take place between therapist and patient in psychotherapy. The whole series is well done and provides an insightful and moving glimpse into real therapy sessions (all stories are shared with the permission of individual patients, and altering identifying information).

You can read more about National Psychotherapy Day here, and find the Moments of Meaning video series here.