Night owls die young in a world scheduled for early birds

Living out of sync with the rest of the world may be to blame

by Maggie Fox and Erika Edwards / 

The stress of night owls trying to live against their nature could be a factor in their increased risk of dying over a given period of time.Luciano Lozano / Getty Images/Ikon Images

Are you a night owl? It might be killing you, researchers reported Thursday.

They found people with naturally late body clocks were about 10 percent more likely to die over a given period than early birds who rise with the sun.

It’s probably because living in a world geared for early starts is throwing off the circadian rhythms of the night owls, the researchers said.

Their findings fit in with other reports that show people who stay up later at night have higher risks of diabetes, high blood pressure and some types of cancer.

The researchers looked at surveys of more than 400,000 people taking part in a large British study of genes and health. As part of a detailed questionnaire, they were asked whether they tended to be night owls or morning larks.

There wasn’t much difference among people who fell in the middle. But there was a notable difference between the two extremes, said Kristen Knutson, associate professor of neurology at Northwestern University Feinberg School of Medicine.

“We found that the night owls had a 10 percent increased risk of dying over about a six and a half year period. And that was even after we took into account things like existing health problems,” Knutson told NBC News.

It’s not a lack of sleep — both groups got about the same amount, Knutson and her colleague Malcolm von Schantz, a professor of chronobiology at the University of Surrey, reported in the journal Chronobiology International.

“I think the problem arises because a night owl is trying to live in a morning lark world,” Knutson said. “If the body is expecting you to do something at a certain time like sleep or eat and you’re doing it at the quote ‘wrong’ time, then your body’s physiology may not be working as well.”

Researchers know the body clock is important. Three scientists who study the body’s internal clock won the Nobel Prize in Medicine last year. Their work, done over decades, helps explain how life adapts to the 24-hour cycle of day, and also how diseases such as cancer arise in the cells.

Studies indicate that switches to and from daylight savings time can raise the immediate risk of death over the following days, and others show the health risks of shift work.

The International Agency for Research on Cancer, an arm of the World Health Organization, says shift work probably causes cancer. It’s linked with breast cancer and other types of cancers, as well as diabetes and sleep disruption.

Those studies support the idea that working against the body’s natural inclination can be hazardous to your health.

Knutson and Von Schantz looked at how people answered the early bird question. “Approximately, 27 percent identified as definite morning types, 35 percent as moderate morning types, 28 percent as moderate evening types and 9 percent as definite evening types,” they wrote.

It was the 9 percent of people who said they were “definite” evening types who had the 10 percent increase risk of dying from something over the next six or so years.

“Neither of the two intermediate groups was associated with increased risk of all cause mortality,” they added.

There could be many reasons. People who stay up later eat fattier foods, drink more alcohol and are more likely to use recreational drugs. They have more exposure to artificial light, as well.

“Greater eveningness has also been associated with depression and mood disorders, particularly in those 50 years or older,” the researchers added.

But the stress of trying to live against their natures could be at fault, they proposed.

“The health of evening types could be compromised by misalignment between their endogenous biological clocks and the timing of social activities (e.g. work or meals), termed circadian misalignment,” they wrote.


“You can’t just suddenly go to bed three hours earlier tonight because it won’t work,” Knutson said.

Confirmed night owls must make sure to eat a healthy diet and exercise regularly, she said.

But society should also recognize that some people have a genetic tendency to sleep later.

“If we can recognize these chronotypes are, in part, genetically determined and not just a character flaw, jobs and work hours could have more flexibility for owls,” Knutson said.

“This is a public health issue that can no longer be ignored,” von Schantz added.

“We should discuss allowing evening types to start and finish work later, where practical. And we need more research about how we can help evening types cope with the higher effort of keeping their body clock in synchrony with sun time.”


Childhood TBI Increases Risk of ADHD for Several Years

Traumatic brain injury (TBI) during early
childhood is known to increase the risk of
developing attention-deficit/hyperactivity
disorder (ADHD) in the first two years
following the injury; this is known as
secondary ADHD (SADHD).

A study
published today in JAMA Pediatrics now
shows that the risk for SADHD can extend
for at least seven years after the TBI.
These findings “suggest that physicians and
other clinicians should continue to be vigilant
in monitoring attention problems in patients with a history of brain injury,
even if it has been a number of years since the injury, the injury was
moderate in nature, or the patient experienced a predominantly positive
recovery,” wrote Megan Narad, Ph.D., of Cincinnati Children’s Hospital
Medical Center and colleagues. This vigilance will aid in more timely
identification of SADHD cases, the authors continued, which could reduce
the functional impairments these children may face.
Narad and her team enrolled 187 children between the ages of 3 and 7
who were hospitalized overnight with either a TBI (81 children) or an
orthopedic injury (106 children; the control group). All participants were
periodically assessed for SADHD until they reached middle school. The
final assessments took place an average of 6.8 years after the initial
Of the 187 children, 48 (25.7%) met the researchers’ definition of SADHD
by the study’s end. These included 13 children with severe TBI at
by the study’s end. These included 13 children with severe TBI at
enrollment, 6 with moderate TBI, 13 with complicated mild TBI, and 16
with an orthopedic injury. Almost half of the children with TBI who later
developed SADHD (15 of 32) did so more than one year after their injury.
An analysis of these outcomes revealed a 3.62-fold increased risk of
SADHD among children with severe TBI compared with children with an
orthopedic injury. Children with mild or moderate TBI had about a 1.7-fold
increased risk of SADHD, but these data were not statistically significant.
The authors also found that among children with TBI, family dysfunction
was associated with a statistically significant 4.24-fold increased risk of
“Findings about the association of family functioning with the development
of attention problems after TBI also support previous research highlighting
the importance of allocating resources to the injured child’s family
throughout recovery,” Narad and colleagues concluded. “Assessing family
functioning, identifying families at risk, and developing programs to
promote healthy family functioning to foster positive outcomes should be
integrated into clinical practice when working with patients and families
with a history of TBI.”
To read more about TBI, see the Psychiatric News article “FDA Clears the
Way for First Blood Test to Evaluate Head Injuries.”

14 ways one type of exercise is the closest thing to a miracle drug we have

Want an all-natural way to lift your mood, improve your memory, and protect your brain against the decline that comes with aging?

Get moving.

Exercises that get your heart pumping and sweat flowing — known as aerobic exercise, or “cardio”— have significant andbeneficial effects on the brain and body, according to a wealth of recent research, including two new studies published this month.

“Aerobic exercise is key for your head, just as it is for your heart,” according to an article in a Harvard Medical School blog.

Here are some of the ways cardio is such a boon for our bodies.

The newest study, published March 14, suggests a potentially powerful link between regular aerobic exercise and a lower risk of dementia.

The newest study, published March 14, suggests a potentially powerful link between regular aerobic exercise and a lower risk of dementia.Shutterstock

study published this week in the journal Neurology suggested that women who were physically fit in middle age were roughly 88% less likely to develop dementia (defined as a decline in memory severe enough to interfere with daily life) than their peers who were only moderately fit.

Neuroscientists from the University of Gothenburg in Sweden studied 191 women whose average age was 50 for 44 years. First, they assessed their cardiovascular health using a cycling test and grouped them into three categories: fit, moderately fit, or unfit.

Over the next four decades, the researchers regularly screened the women for dementia. In that time, 32% of the unfit women were diagnosed with the condition; a quarter of the moderately fit women did. But only 5% of the fit women developed dementia.

Despite that strikingly positive finding, the research only showed a link between fitness and decreased dementia risk; it did not prove that one caused the other. Still, the work builds on several other studies that suggest a powerful tie between exercise and brain health.

Workouts may protect your immune system from some age-related decline as well.

Workouts may protect your immune system from some age-related decline as well.Shutterstock

For a small study published at the beginning of March in the journal Aging Cell, researchers looked at 125 amateur male and female cyclists aged 55 to 79. They compared those individuals with 75 people of a similar age who rarely or never exercised.

The cyclists were found to have more muscle mass and strength, and lower levels of body fat and cholesterol than the sedentary adults. The athletic adults also appeared to have healthier and younger-looking immune systems, at least when it came to a key organ called the thymus.

The thymus is responsible forgenerating key immune cells called T cells. In healthy people, it begins to shrink starting around age 20, and T cell production also starts to drop off around that time.

The study found that the thymus glands of the older cyclists looked like they belonged to younger people — their bodies were producing just as many T cells as would be expected from the thymus of a young person.

“We now have strong evidence that encouraging people to commit to regular exercise throughout their lives is a viable solution to the problem that we are living longer but not healthier,” Janet Lord, the director of the Institute of Inflammation and Aging at the UK’s University of Birmingham, said in a statement.

Cardio tones your muscles.

Cardio tones your muscles.Shutterstock

It was initially believed that when it comes to building muscle, cardio paled in comparison to exercises like resistance training, which are designed to help you gain strength. But a recent review of 14 studies published in the journal Exercise and Sport Sciences Reviews found that on average, men who did 45 minutes of moderate to intense cardio 4 days a week saw a 5%-6% increase in leg muscle size.

“Aerobic exercise, if done properly, can lead to as much muscle growth as you’d expect with resistance exercise,” Ball State University exercise scientist Matthew Harber, who authored the study, told Men’s Fitness.

It raises your heart rate, improving heart and lung health.

It raises your heart rate, improving heart and lung health.Al Bello/Getty Images

Aerobic workouts, especially swimming, train your body to use oxygen more efficiently, a practice that gradually reduces your resting heart rate and your breathing rate — two important indicators of cardiovascular health.

2008 study compared blood pressure, cholesterol levels, and other heart health metrics across close to 46,000 walkers, runners, swimmers, and sedentary people. The researchers found that the regular swimmers and runners had the best metrics, followed closely by the walkers.

Cardio exercise may even help reverse some heart damage from normal aging.

Cardio exercise may even help reverse some heart damage from normal aging.Shutterstock

Many of us become less active as we get older. Over time, this can lead some muscles in the heart to stiffen. One of those at-risk muscles is in the left chamber of the heart, a section that plays a key role in supplying the body with freshly-oxygenated blood.

A recent study split 53 adults into two groups, one of which did two years of supervised exercise four to five days per week while the other simply did yoga and balance exercises. At the end of the study, published in January in the journal Circulation, the higher-intensity exercisers saw significant improvements in their heart’s performance. Those results suggest that some stiffening in the heart can be prevented or even reversed with regular cardio.

“Based on a series of studies performed by our team over the past 5 years, this ‘dose’ of exercise has become my prescription for life,” Benjamin Levine, the author of the study and a professor of internal medicine at the University of Texas Southwestern, said in a statement.

Aerobic exercise benefits your mind, too — it can lift your mood, for example.

Aerobic exercise benefits your mind, too — it can lift your mood, for example.Shutterstock

Aerobic exercise “has a unique capacity to exhilarate and relax, to provide stimulation and calm, to counter depression and dissipate stress,” according to an article in the Harvard Medical School blog “Mind and Mood.”

The reason aerobic workouts lift our spirits seems related to their ability to reduce levels of natural stress hormones, such as adrenaline and cortisol, according to a recent study in the Journal of Physical Therapy Science. Activities like running and swimming also increase overall blood flow and provide our minds fresh energy and oxygen — another factor that could help us feel better

Heart-pumping workouts appear to have a positive impact on your gut.

Heart-pumping workouts appear to have a positive impact on your gut.Shutterstock

A small study published in Novembersuggests that cardio exercise changes the makeup of the microbes in our gut.

Those microbes play a role in inflammation levels, which can be an early warning sign of illness.

The researchers had study participants exercise three to five times per week for six weeks, and observed increases in their concentrations of butyrate, a type of fatty acid that helps keep our guts happy by tamping down on inflammation and producing energy.

“These are the first studies to show that exercise can have an effect on your gut independent of diet or other factors,” Jeffrey Woods, a professor of kinesiology and community health at the University of Illinois who led the research, said in a statement.

Cardio may improve cholesterol levels, too.

Cardio may improve cholesterol levels, too.sportpoint/Shutterstock

large recent review of research on how cardio affects cholesterol levels looked at 13 studies on the topic. It found that aerobic exercise was tied with reductions in LDL, which is also known as “bad” cholesterol because it can build up on the walls of your arteries and raise your risk of heart disease.

Cardio exercise was also linked with increases in HDL, also known as “good” cholesterol because it mobilizes the cholesterol in your blood.

“Prolonged moderate-intensity aerobic exercise should be recommended as a starting point for those who have previously been sedentary or are new to exercise,” the authors wrote.

Aerobic exercise helps prevent and manage diabetes by improving the way the body uses blood sugar.

Aerobic exercise helps prevent and manage diabetes by improving the way the body uses blood sugar.Getty Images / Anthony Kwan

Several studies have found that cardio exercise helps people both prevent Type 2 diabetes and manage its symptoms — mostly by improving the way the body uses blood sugar.

large Chinese study found that even modest changes in aerobic exercise (20 minutes of mild or moderate activity, 10 minutes of strenuous activity, or just 5 minutes of very strenuous activity 1-2 times per day) cut participants’ diabetes risk by close to half.

single session of cardio has been found to increase insulin action and glucose tolerance for more than 24 hours; one week of it can improve whole-body insulin sensitivity.

Cardio workouts may even improve the look and feel of your skin.

A study from researchers at McMaster University found that people over age 40 who engaged in regular cardio activity tended to have healthier skinthan their sedentary peers. The overall composition of the regular exercisers’ skin was more comparable to that of 20- and 30-year-olds.

It’s not yet clear why our workouts appear to play a role in skin health, but the researchers found elevated levels of a substance critical to cell health called IL-15 in skin samples of participants after exercise. That finding that could shed light on why cardio seems to make our skin look better.

Workouts may reduce the symptoms of depression.

In addition to boosting the moods of healthy people, aerobic exercise may have a uniquely powerful positive impact on people with depression.

In a pilot study, people with severe depression spent 30 minutes walking on treadmill for 10 consecutive days. The researchers found the activity was “sufficient to produce a clinically relevant and statistically significantreduction in depression.”

Aerobic exercise may help protect against memory difficulties in people undergoing chemo as well.

Aerobic exercise may help protect against memory difficulties in people undergoing chemo as well.cdrin/shutterstock

In a July study, researchers examined hundreds of breast cancer survivors to see if activities like walking and swimming have an effect on “chemo brain,” a commonly reported side effect of breast cancer treatment that involves memory loss and difficulties focusing.

They gave nearly 300 breast cancer survivors accelerometers to track their activity, and provided them with an iPad app that featured quizzes designed to measure their attention and memory. At the end of a week, people who’d done aerobic exercise every day were significantly less tired than those who did little to no exercise, and also performed better on the app’s quizzes.

“The message for cancer patients and survivors is, get active!” Diane Ehlers, the lead author on the study and a professor of exercise psychology at the University of Illinois at Urbana Champaign, said in a statement.

Cardio may also be tied to increases in the size of brain areas linked to memory, but more research is needed.

A study of older women with MCI found that aerobic exercise was tied to an increase in the size of the hippocampus, a brain area involved in learning and memory.

For the study, 86 women with MCI between 70 and 80 years old were randomly assigned to do one of three types of exercise twice a week for six months. Some did aerobic training (like walking and swimming), others focused on resistance training (like weight-lifting), or balance training.

Afterwards, only the women in the aerobic group were found to have significant increases in hippocampal volume, but more studies are needed to determine what effect this has on cognitive performance.



How to Be Healthier, Happier and More Productive: It’s All in the Timing

When is the best time to exercise or do creative work? Research on the science of timing has answers


You’ve probably made a few New Year’s resolutions, solemn promises to yourself to behave better in 2018. You might have pondered how you’re going to accomplish those goals, who could help you and why you need to change.

But if you’re like most people—and social science suggests that you and I are like most people—you’ve neglected a question that could help you actually stick to those resolutions: “When?”

We all know that timing matters. But most of our decisions on this front are intuitive and haphazard. Timing, we believe, is an art.

In fact, timing is really a science. For several decades, researchers in dozens of fields—from economics to anesthesiology to social psychology—have been unearthing the hidden science of timing. In randomized controlled experiments, field studies and the analysis of massive data sets, they are exploring questions that span the human experience. How do beginnings, midpoints and endings alter our actions and memories? How do groups synchronize in time? How do even the verb tenses we use affect our behavior? Time, they have discovered, shapes our productivity, health and well-being in powerful but often invisible ways.

Much of what we consider “natural” units of time—seconds, hours, weeks—are really fences that our ancestors constructed to corral time. But one unit remains beyond our control: We inhabit a planet that turns on its axis at a steady speed in a regular pattern, exposing us to consistent periods of light and dark. The day is perhaps the most important way that we divide, configure and evaluate our time. By understanding the science of the day—and by giving more attention to the question of “when”—we can improve the effectiveness and success of our resolutions.

So how can we harness time to be healthier, happier and more productive?

Resolution: Get a promotion, get a raise or otherwise do well at work. Each year, many of us vow to get more done at work and perhaps even make a few creative breakthroughs. Yet many of us don’t realize how much the time of day matters to our performance.

Scientists began measuring the effect of the time of day on human brain power more than a century ago, when the pioneering German psychologist Hermann Ebbinghaus conducted experiments showing that people learned and remembered strings of nonsense syllables more effectively in the morning than at night. Since then, researchers have continued that investigation for a range of mental pursuits. They’ve drawn three big conclusions.

First, our cognitive abilities don’t remain static over the course of a day. During the 16 or so hours we’re awake, they change—often in a regular, foreseeable manner. We are smarter, faster and more creative in some parts of the day than others.

Second, these daily fluctuations can be extreme. “The performance change between the daily high point and the daily low point can be equivalent to the effect on performance of drinking the legal limit of alcohol,” write Russell Foster, a neuroscientist and chronobiologist at the University of Oxford, and Leon Kreitzman in their book “Rhythms of Life.” Other research has shown that time-of-day effects can explain 20% of the variance in human performance on cognitive undertakings.

Third, how we do depends on what we’re doing. We’re more effective at some tasks early in the day and at other tasks later in the day.

From big-data analyses of 500 million tweets to studies led by Nobel Prize-winning scientists, research has shown that we generally experience the day in three acts: a peak, a trough and a rebound. Most of us experience the pattern in that order. But the roughly one in five of us who have evening “chronotypes”—people who are night owls—tend to proceed in reverse order. (To determine whether you’re an owl, consider a day when you don’t have to awaken to an alarm clock. What is the midpoint between the time you go to sleep and the time you wake up? If it’s 5:30 a.m. or later, you’re probably an owl.)

During the peak, our ability to focus is at its best. When we wake up, our body temperature slowly rises. That rising temperature gradually boosts our energy level and alertness—and that, in turn, enhances our executive functioning, our ability to concentrate and our powers of deduction. For most of us, these sharp-minded analytic capacities crest in the late morning or around noon. This is when we are most vigilant, when we can keep distractions from penetrating our cerebral gates. That makes the peak the best time to tackle work that requires heads-down attention and analysis, such as writing a legal brief or auditing financial statements.

Vigilance, though, has its limits. Alertness and energy levels tend to plummet during the afternoons. And with that drop comes a corresponding fall in our ability to remain focused and constrain our inhibitions. This is the second stage: The trough, which usually occurs in the early to midafternoon.

The afternoon trough is the Bermuda Triangle of our days.

The effects of the trough can be significant. In a 2016 study, Harvard University’s Francesca Gino and two Danish researchers examined four years of standardized test results for two million students in Denmark and matched scores to the time of day the students took the test. They found that students randomly assigned to take the tests in the afternoon scored considerably lower than those who took the test in the morning—an effect equivalent to missing two weeks of school.

The trough is an especially dangerous time for health-care professionals and their patients. In a study published in 2006 in Quality and Safety in Health Care, researchers at Duke Medical Center reviewed about 90,000 surgeries at the hospital and found that harmful anesthesia errors were three times more likely in procedures that began at 3 p.m. than at 8 a.m.

The afternoon trough is the Bermuda Triangle of our days—the place where effectiveness and good intentions disappear. This is the time to do your mindless administrative work, such as answering email, filing papers and filling out expense reports.

The third stage is the rebound, which for most of us occurs in the late afternoon and early evening. During this stage, we tend to excel at a different type of work. In 2011, two American psychologists, Mareike Weith and Rose Zacks, posed what are called “insight problems”—which require creative, rather than algorithmic, thinking and have nonobvious, surprising solutions—to 428 people, about half of whom were vigilant morning thinkers. These participants fared better on these problems not during their supposedly more optimal mornings but much later in the day—a phenomenon the researchers dubbed “the inspiration paradox.”

In the late afternoons and early evenings, most people are somewhat less vigilant than during the peak, but more alert and in a better mood than during the trough. That combination has advantages. A boosted mood leads to greater openness. A slight reduction in vigilance lets in a few distractions—but those distractions can help us spot connections that we might have missed when our filters were tighter. So we should move brainstorming sessions and other creative pursuits to the rebound stage. (Again, because night owls move through the day in the reverse order, their rebound period is the morning.)

The key is to seek what psychologists call the “synchrony effect”—to bring your own daily rhythms, your task (is it analytical, administrative or insight?) and your time (is it early, midday or later?) into alignment. Doing your analytic work during the rebound or your creative work during the trough is an ideal way to sabotage your resolutions.

Resolution: Get more exercise. It’s the most common New Year’s resolution. But when is the best time to hit the gym? Science has some answers, and most of them depend on the nature of our exercise goals.

Schedule exercise in the morning if you want to:

Lose weight. When we first wake up, having not eaten for at least eight hours, our blood sugar is low. Since we need blood sugar to fuel a run, morning exercise will use the fat stored in our tissues to supply the energy we need. (When we exercise after eating, we use the energy from the food we’ve just consumed.) In many cases, morning exercise may burn 20% more fat than later, post-food workouts.

Boost mood. Cardio workouts—swimming, running, even walking the dog—can elevate mood. When we exercise in the morning, we enjoy these effects all day. If you wait to exercise until the evening, you’ll end up sleeping through some of the good feelings.

Keep a routine. Some studies suggest that we’re more likely to adhere to our workout routine when we do it in the morning. So if you find yourself struggling to stick with a plan, morning exercise, especially if you enlist a regular partner, can help you form a habit.

Exercise in the late afternoon or evening if you want to:

Avoid injury. Studies have found that injuries are less common in workouts later in the day. Our body temperature reaches its high point in the late afternoon and early evening, and when our muscles are warm, they’re more elastic and less prone to injury.

Perform your best. In a 2015 study of 121 athletes, Elise Facer-Childs and Ronald Brandstaetter of the University of Birmingham found that individual performance can vary by as much as 26% based solely on time of day—and that performance typically peaks between 10 and 12 hours after awakening. So working out in the afternoons can help you sprint faster and lift more. Lung function is highest this time of the day, so your circulation system can distribute more oxygen and nutrients. This is also the time of day when strength peaks, reaction time quickens, hand-eye coordination sharpens, and heart rate and blood pressure drop. In fact, a disproportionate number of athletic records, especially in speed events, are set in the late afternoon and early evening.

Enjoy the workout a bit more. People typically perceive that they’re exerting themselves a little less in the afternoon even if they’re doing exactly the same exercise routine as in the morning, according to the American Council on Exercise.

Source site:

Anxiety and Stress in the Workplace


Having an anxiety disorder can make a major impact in the workplace. People may turn down a promotion or other opportunity because it involves travel or public speaking; make excuses to get out of office parties, staff lunches, and other events or meetings with coworkers; or be unable to meet deadlines.

In a national survey on anxiety in the workplace, people with anxiety disorders commonly cited these as difficult situations: dealing with problems; setting and meeting deadlines; maintaining personal relationships; managing staff; participating in meetings, and making presentations.

Tell Your Employer?

It’s your decision to tell your employer about your anxiety disorder. Some people do so because they need accommodations, others want to educate people about their condition, and some do not want to hide their illness.

If you have a physical or mental disability and are qualified to do a job, the Americans with Disabilities Act of 1990 (ADA) protects you from job discrimination. Being qualified means you must satisfy an employer’s requirements for the job and be able to perform essential functions on your own or with reasonable accommodation. An employer cannot refuse to hire you because your disability prevents you from performing duties that are not essential to the job. Find out more about employment rights.  

Tips to Manage Stress and Anxiety at Work

Getting stressed out at work happens to everyone, and it’s perfectly normal. But stress that is persistent, irrational, and overwhelming and impairs daily functioning may indicate an anxiety disorder. Keep these ideas in mind to keep your work life manageable:

  • Work! In addition to financial reasons, working can be important for your self-esteem and it adds to your social identity.
  • Tell a trusted coworker.Knowing that someone accepts your condition can be comforting and it may reduce any anticipatory anxiety about having a panic attack at work.
  • Educate yourself.Learn to recognize the symptoms of your disorder and how to handle them if you experience any at work.
  • Practice time management.Make to-do lists and prioritize your work. Schedule enough time to complete each task or project.
  • Plan and prepare.Get started on major projects as early as possible. Set mini-deadlines for yourself. Anticipate problems and work to prevent them.
  • Do it right the first time.Spend the extra time at the outset and save yourself a headache later when you have to redo your work.
  • Be realistic.Don’t over commit or offer to take on projects if you don’t realistically have enough time.
  • Ask for help.If you’re feeling overwhelmed, ask a coworker for help. Later you can return the favor.
  • Speak up calmly and diplomatically if you have too much to handle. Your supervisor may not realize you’re overextended.
  • Stay organized.Filing and clearing your desk and computer desktop may rank low on your priority list, but they can save you time in the long run and may prevent a crisis later.
  • Avoid toxic coworkers.Try to ignore negativity and gossip in your workplace.
  • Take breaks.A walk around the block or a few minutes of deep breathing can help clear your head.
  • Set boundaries.Try not to bring work home with you. Don’t check your work e-mail or voice mail after hours.
  • Savor success.Take a moment to celebrate your
  • good work before moving on to the next project. Thank everyone who helped you.
  • Plan a vacation.You’ll be rejuvenated and ready to work when you come back.
  • Take advantage of employer resources and benefits. Your workplace may offer an Employee Assistance Program (EAP), discounts to gyms, or skill-building courses. Learn what’s available to you.
  • Be healthy. Eat healthfully, get enough sleep, exercise regularly, and limit caffeine and alcohol. Try to keep your body and mind in shape to handle challenging situations.

Getting Help

It’s important to find help for anxiety, stress, and related disorders. Find a therapist near you.

With treatment, most people find significant improvement. Several standard approaches have proved effective. Your health care professional will use one or a combination of these treatments:




Depression, ADHD, Anxiety Medications Not Overprescribed in Children, Study Shows

Boy teenager at a psychologist at the office’s

Psychiatric medications—especially stimulants and antidepressants—do not appear to be overprescribed to children and adolescents, according to a report published Monday in the Journal of Child and Adolescent Psychopharmacology.

“Among young people, the population level prescribing rates as well as age and sex distributions [of children who received stimulant and antidepressant prescriptions] are broadly consistent with known epidemiologic patterns of their established indications for ADHD, anxiety, and depression,” wrote lead author Ryan Sultan, M.D, of Columbia University and colleagues.

The researchers analyzed data contained in the 2008 IMS LifeLink LRx Longitudinal Prescription database on U.S. youth aged 3 to 24 years of age who had filled at least one prescription for stimulants, antidepressants, or antipsychotics during the study year. In total, the 2008 IMS LRx database included 131,291 younger children (aged 3 to 5), 2,140,289 older children (6 to 12), 2,163,202 adolescents (13 to 18), and 1,916,700 young adults (19 to 24) who filled at least one stimulant, antidepressant, or antipsychotic prescription.

The analysis revealed that 4.6% of older children and 3.8% of adolescents were prescribed stimulants; this is well below published national community ADHD prevalence estimates of 8.6%. Similarly, just 2.8% of adolescents, 1% of older children, and 0.1% of younger children received a prescription for an antidepressant; yet the prevalence rates for depression among adolescents alone range from 4% to 5%, while the prevalence rates for anxiety disorders in children and adolescents range from 15% to 20%.

Although annual antipsychotic prescription percentages were lower than antidepressant or stimulant percentages for all age groups, with a peak in adolescence (age 16 = 1.3%), it remains unclear whether antipsychotic prescribing is above or below prevalence rates of the disorders for which these medications are prescribed. “Patterns of antipsychotics are more complex and may reflect the heterogeneity of the approved and off-label conditions and disorders treated with this medication class,” the authors wrote.

“Overall, the findings provide some reassurance regarding population level prescribing patterns of psychotropic medications in youth in relation to the epidemiologic distribution of major child and adolescent mental disorders,” they wrote. “However, we should continue to monitor psychotropic medication prescriptions over time to assess whether U.S. prescribing practices remain broadly consistent with underlying disorder prevalence.”

For related information, see the Psychiatric News article “Prescribing for Mentally Ill Children Generally in Line With Best Practices.”

Adolescent Alcohol Use: Risks and Consequences

Adolescent Alcohol Use: Risks and Consequences
Alcohol and Alcoholism, Volume 49, Issue 2, 1 March 2014, Pages 160–164,
08 January 2014



Aims: The aim of the study was to summarize results of recent epidemiological research on adolescent alcohol use and its consequences, to outline the risk factors for drinking in adolescents and to consider effective treatment and preventative interventions. Methods: A literature review of relevant studies on adolescent alcohol use. Results: Alcohol use and other risk-taking behaviours such as smoking, substance use and risky sexual behaviour emerge in adolescence and tend to cluster together. Heavy alcohol consumption in late adolescence appears to persist into adulthood and is associated with alcohol problems, including dependence, premature death and diminished work capacity. Early identification of adolescent risk factors may be helpful in preventing and/or attenuating risk. Conclusion: There is a need for high-quality long-term prospective cohort studies to investigate the long-term consequences of adolescent drinking and further work is needed to identify the most effective intervention strategies.


The term ‘adolescent’ is an adjective describing a young person in the process of developing from a child into an adult and dates from the late 18th century (Oxford English Dictionary). It is derived from the Latin verb ‘adolescere’ which means ‘to grow up’. This short paper will review patterns of drinking in adolescence and the risk factors that are thought to predispose to the development of alcohol use and other co-morbid disorders in this age group.

Alcohol is the world’s third largest risk factor for disease and contributes to 4% of the global burden of disease (Rehm et al., 2009). It is estimated that ∼2.5 million deaths each year are directly attributable to alcohol, with 9% of deaths in the 15- to 29-year age group being alcohol-related (WHO, 2011).

When data from the World Health Organization’s Global Burden of Disease study were used to calculate cause-specific disability-adjusted life years (DALYs) for young people aged 10–24 years, the main risk factors were found to be alcohol (7% of DALYs), unsafe sex (4%), iron deficiency (3%), lack of contraception (2%) and illicit drug use (2%) (Gore et al., 2011). The contribution of other risk factors to disease, such as tobacco use, low physical activity and overweight/obesity only emerged in mid-to-late adulthood. These findings suggest that public health strategies should focus on child and adolescent health, and that adolescent drinking should be given priority (Gore et al., 2011).

Regular alcohol use, binge drinking and other risk-taking behaviours such as smoking, substance use and risky sexual behaviour emerge in adolescence and there is evidence that these behaviours tend to cluster together (Wiefferink et al., 2006). The adolescent brain, especially the hippocampus, may be particularly vulnerable to the effects of alcohol (Welch et al., 2013), thus predisposing the young drinker to alcohol, mental health and neuro-cognitive problems which can persist into adulthood (Hanson et al., 2011Welch et al., 2013). Young people who start to drink before the age of 15 years are reported to be four times more likely to meet criteria for alcohol dependence at some point in their lives (Grant and Dawson, 1997). Early alcohol use is associated not only with more regular and higher levels of alcohol use and dependence in adulthood, but also with more mental health and social harms (McCambridge et al., 2011).

In the US National Co-morbidity Study-AdolescentSupplement (NCA-S), over ¾ of adolescents (78.2%) had consumed alcohol by late adolescence, and 15.1% met criteria for DSM-IV lifetime alcohol abuse (Swendsen et al., 2012). The median age at onset was 14 years for alcohol abuse with or without dependence. This was a nationally representative survey in which over 10,000 young people between the ages of 13 and 18 were interviewed using a modified version of the Composite International Diagnostic Interview. Rates of alcohol use were lowest for black and other racial/ethnic groups compared with white or Hispanic adolescents. The increase in prevalence rates over the years from 13 to 18 indicates that this is a key period in the development of alcohol use disorders (AUDs). By the time they were 17–18 years of age male adolescents had higher rates of alcohol use than in early adolescence (use, regular use, abuse without dependence and abuse with dependence).

The 2011 European School Survey Project on Alcohol and Other Drugs (ESPAD) was carried out in 37 countries, and data are available for 36 countries (Hibell et al., 2012). The target population was students born in 1995 and the mean age at the time of data collection was 15.8 years. In all ESPAD countries except Iceland, 79% of students had consumed alcohol at least once in the past 12 months and 57% had consumed alcohol in the past 30 days. Figures were similar for boys and girls. The estimated average consumption on the most recent drinking day was a third higher for boys who were more likely to drink beer. Spirits were the most common beverage for girls in over half of countries. Rates of ‘heavy episodic drinking’, defined as more than five or more drinks on the same occasion in the past 30 days, were 43% for boys and 38% for girls. This was a slight decrease since 2007 when the figures were 45 and 41%, respectively. More boys than girls reported heavy episodic drinking in 22 countries. More girls than boys reported heavy episodic drinking in Sweden, and rates were the same for boys and girls in Finland, Iceland, Norway, Ireland and the UK, France, Monaco, Belgium, Estonia and the Russian Federation.

Analysis of 2011 data on smoking, drinking and drug use in 11–15 year olds in England showed that 12% had consumed alcohol in the past week, 8% had smoked over the same period and 6% had taken drugs in the past month (Health and Social Care Information Centre, 2012). Levels of alcohol consumption had decreased since 2001 when the figure was 26%. Mean alcohol consumption in 2011 was 10.7 units and the median 7 units. Drinking was associated with smoking and drug use, and having truanted from school.

A recent study of English students aged 13–14 years and 15–16 years found that most had had an alcoholic drink (70 and 89%, respectively), and that the first drink had most often been taken at about the age of 12–13 years, and usually in the company of an adult on a special occasion (Bremner et al., 2011). One fifth of 13–14 years olds who drank were drinking weekly, and the figure was 39% for the 15–16 year olds. One quarter of the older students had consumed six or more drinks on the last occasion they had taken a drink. The 13–14 year olds were more likely to have been drinking alcopops in the 7 days before the survey, whereas the 15–16 year olds were most likely to have been drinking beer, lager, spirits or liqueurs. By the age of 15–16 years, 79% of the students had been drunk and two-thirds of this group (66%) said they drank to get drunk at least once a month.

The Australian Secondary Students’ Alcohol and Drug Survey (ASSAD) is carried out every 3 years. The 2011 survey, the tenth in the series, included responses from just under 25,000 secondary students (White and Bariola, 2012). About three out of four students had tried alcohol at some point in their lives, 51% consuming alcohol in the 12 months before the survey. Just under one-fifth (17%) had consumed alcohol in the 7 days before the survey, 8% of 13 year olds and 37% of 17 year olds. About one-fifth (19%) of 17 year olds had consumed more than four drinks on at least one of the preceding 7 days. The proportion of students drinking in 2011 was less than that found in the 2008 and 2005 surveys.


What are the consequences in adulthood of late adolescent drinking? McCambridge et al. (2011) carried out the first systematic review of general population cohort studies where data on baseline alcohol consumption had been obtained from adolescents between the ages of 15 and 19 years, and follow-up data had been obtained from the same cohort at time points that were at least 3 years apart. The review included 54 studies, of which 35 were multiple reports from ten cohorts including 9 reports from the (all male) Swedish Conscript Study (SCS). Almost one half of studies (n = 26) were from the USA with the remainder coming from Sweden, Britain, New Zealand, Australia, Finland and the Netherlands (McCambridge et al., 2011). The main conclusion was that late adolescent alcohol consumption persisted into adulthood and was associated with alcohol problems, including dependence. Non-alcohol outcomes such as the mental health and social consequences of adolescent drinking could not be fully explored due to lack of evidence. The SCS evaluated the risk of premature death with late adolescent drinking after 15, 20 and 25 years and found that by the age of 34 years heavier drinkers were twice as likely as moderate drinkers to have died (Andreasson et al., 19881991Romelsjo et al., 1999). This finding was attenuated by the age of 39, but the main causes of death at both time points were car crashes (mainly at younger ages) and suicide (at older ages) (Andreasson et al., 1991). Good psychosocial adjustment did not protect heavier drinkers from an increased risk of premature mortality (Andreasson et al., 1991).

A recent paper from the SCS series reported that alcohol use in adolescence, particularly ‘risky’ use, was associated with an increased risk of obtaining a future disability pension (Sidorchuk et al., 2012). The association was stronger for early disability, indicating that risky adolescent alcohol use is a risk factor for diminished work capacity.

McCambridge et al. (2011) noted that few studies had addressed family influences and only one had investigated genetic aspects (Viken et al., 2007). The Viken et al. (2007) study of Finnish twins suggested that genetic and environmental influences on the development of alcohol problems between the ages of 18 and 25 years were different for men and women, such that genetic influences remained stable over time for men, but declined for women.

A recent study from a prospective UK birth cohort reported on alcohol use at 10, 13 and 15 years and found that by the age of 15 over half of the boys and girls had consumed alcohol and one-fifth reported drinking in a binge fashion (MacArthur et al., 2012). There were no gender differences in drinking behaviour. Higher alcohol consumption at 15 was associated with a significantly higher prevalence of engagement in other risk behaviours at 16 years, in particular substance use and sexual risk behaviours. Those who met criteria for hazardous drinking at 16 were six times more likely to engage in substance use behaviours than those who did not meet these criteria.

Another study of the same birth cohort used longitudinal latent class analysis to categorize alcohol use in the 13–15 year olds as low, medium and high, in terms of frequency and quantity of alcohol consumption (Heron et al., 2013). When they were 16, the young people completed a postal alcohol use disorders identification test (AUDIT) questionnaire: 29% met criteria for hazardous alcohol use (AUDIT score 8–15) and 5.6% met criteria for harmful use (AUDIT score >16). Being in the high class for either drinking frequency or consumption was associated with an 8- to 10-fold increase in odds of harmful alcohol use at 16 years.

A systematic review of longitudinal studies that examined the association between childhood socio-economic status and alcohol use later in life found that there was little evidence to support the association (Wiles et al., 2007).

Alcohol use, and particularly binge drinking, is associated with sleep disorders in a dose–response relationship (Popovivi and French, 2013). These findings were reported from the National Longitudinal Study of Adolescent Health which examined a sample of just over 14,000 adolescents and young adults. Further work is needed to explore the association.

There is clearly a need for high-quality long-term prospective cohort studies to investigate the long-term consequences of adolescent drinking. There is already enough evidence in the literature to warrant interventions to reduce drinking in adolescents (McCambridge et al., 2011).


The adolescent brain undergoes profound neuro-developmental change, in turn influenced by genetic, environmental and sex hormonal factors (Arain et al., 2013). Glutamatergic neurotransmission is predominant and the maturation of neural circuits facilitates social-emotional development (Nelson et al., 2005). At the same time puberty manifests itself in outward bodily change.

The risk factors for adolescent AUDs can be divided into environmental, genetic and phenotypic. Genetic-environmental interaction determines individual alcohol use and AUDs.

Environmental factors

As adolescents become more autonomous so the influence of the peer group becomes more important and family influences wane (Bremner et al., 2011). Adolescence sees a clustering of risk-taking behaviours such as smoking, drinking, drug-taking and sexual activity. Peer effects on risk-taking are strong in this age group, and adolescents affiliated with substance-using peers are at greater risk of engaging in similar behaviours themselves (Gardner and Steinberg, 2005). Peer acceptance is a potent social reward for adolescents (Rubin et al., 2006Guyer et al., 2012) and is associated with high self-esteem and social competence. Having friends who drink increases the likelihood that young people will drink too. Young people are also influenced by how much their friends are drinking. Having older friends and spending more time with drinking friends are likely to promote excessive drinking (Bremner et al., 2011).

Parental expectation and involvement in social activities has been shown to moderate alcohol use (Nash et al., 2005Wichers et al., 2013) and religious affiliation also shows a protective effect. Factors that influence drinking, drinking frequently and drinking to excess include lower levels of parental supervision, exposure to a close family member who drinks or becomes intoxicated, easy access to alcohol and positive expectations of alcohol (Bremner et al., 2011).

Genetic factors

Genetic predisposition accounts for about half of the risk in the development of alcohol dependence. Adolescents with a positive family history of alcohol problems are at greater risk of developing an alcohol problem, and at a younger age, than their peers with negative family histories. Genetic factors may have more influence on drinking behaviour in late than in earlier adolescence (Rose et al., 2001).

Certain childhood characteristics are thought to increase the risk of adolescent AUDs and early identification of these characteristics can be helpful in preventing or attenuating the risk (Thatcher and Clark, 2008). For instance childhood psychological dysregulation is a behavioural phenotype that reflects an individual’s vulnerability to developing an AUD in adolescence (Tarter et al., 2003Thatcher and Clark, 2008). Other characteristics that have been identified and can be measured, but cannot be seen, are known as endophenotypes. Endophenotypes are not an element of the disorder but are associated with it, contribute to individual vulnerability and are seen in the families of affected individuals (Laucht et al., 2007). A range of endophenotypes has been identified as markers for AUDs in young people, including behavioural sensitivity to alcohol and event-related potentials (e.g. P300). Schuckit and colleagues have shown that a low level of response (LR) to alcohol is associated with heavier drinking and alcohol problems (Schuckit et al., 20052008). Adolescent children of alcoholics have been shown to have an abnormal P300 response and abnormalities in brain structure and function (Hill and Steinhauer, 1993Iacono et al., 2002Yoon et al., 2006).

Sensation seeking and behavioural disinhibition are associated with an increased risk of developing substance use disorders in adolescence and may mediate genetic risk (Laucht et al., 2007Iacono et al., 2008).

Externalizing problems in childhood, in particular conduct disorder, have been shown to predict adolescent alcohol and substance use disorders (White et al., 2001King et al., 2004Fergusson et al., 2007Young et al., 2008). A longitudinal study from the West of Scotland (N = 2586 pupils) explored the causal effects of alcohol (mis)use and antisocial behaviour in pupils followed up between the ages of 11 and 15 years (Young et al., 2008) and the findings suggested that antisocial behaviour was the main predictor of alcohol misuse and alcohol-related trouble in this under-age cohort. An American study of 429 rural youths found that delinquency at the age of 11 was a positive predictor of alcohol use at 16 for both boys and girls (Mason et al. (2007). However other studies have reported a reciprocal relationship (D’Amico et al., 2008) and Iacono et al. (2008)propose that a common genetic liability to behavioural disinhibition underlies the co-occurrence of early onset substance use disorders and these other disorders. A recent study of male twins found that genetic risk of externalizing disorder and peer deviance predicted the greatest risks of unfavourable alcohol trajectories (Wichers et al., 2013).

Adolescents with attention deficit hyperactivity disorder appear to have an increased risk of drug use disorders but the evidence for an association with AUDs is mixed (Molina and Pelham, 2003Molina et al., 20072012). Parental knowledge may confer a protective effect in relation to alcohol use in adolescents with ADHD (Walther et al., 2012).

Of internalizing disorders, only depression at the age of 11 years was shown to have a significant relationship with substance use at the age of 14 years (King et al., 2004).

Adolescents with poor affect regulation and depression or who are experiencing high levels of environmental stress may drink or use drugs to self-medicate as a maladaptive coping mechanism. The association between low mood and alcohol use appears to be stronger in adolescents with fewer conduct problems (Hussong et al., 2008)

Adolescents are able to tolerate higher levels of alcohol than adults and they are also more likely to experience the positive effects of alcohol. This may contribute to the development of binge drinking.


A meta-analysis of treatments for adolescent substance abuse found that treatment was effective in reducing alcohol use and that individual interventions performed better overall than family interventions (Tripodi et al., 2010). The number of studies included was relatively small (n = 16 and 26 outcomes), so the results should be interpreted with caution. However both individual and family-based behavioural treatments were effective in promoting long-term reduction in alcohol consumption (i.e. at 12-month follow-up). Behavioural interventions, either of an individual or of a familial nature, appear to be associated with long-term change. Further work is needed to identify the most effective interventions (Tripodi et al., 2010). Caselanos-Ryan et al. (2013) argue for the development and testing of preventative interventions to target early key risk factors for substance use disorders. Such interventions should be embedded in a public health policy that seeks to minimize or delay early onset of alcohol use in adolescents.


What Is Psychiatry?

What Is Psychiatry?

Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders.

A psychiatrist is a medical doctor (an M.D. or D.O.) who specializes in mental health, including substance use disorders. Psychiatrists are qualified to assess both the mental and physical aspects of psychological problems.

People seek psychiatric help for many reasons. The problems can be sudden, such as a panic attack, frightening hallucinations, thoughts of suicide, or hearing “voices.” Or they may be more long-term, such as feelings of sadness, hopelessness, or anxiousness that never seem to lift or problems functioning, causing everyday life to feel distorted or out of control.

Diagnosing Patients

Because they are physicians, psychiatrists can order or perform a full range of medical laboratory and psychological tests which, combined with discussions with patients, help provide a picture of a patient’s physical and mental state. Their education and clinical training equip them to understand the complex relationship between emotional and other medical illnesses and the relationships with genetics and family history, to evaluate medical and psychological data, to make a diagnosis, and to work with patients to develop treatment plans.

Specific diagnoses are based on criteria established in APA’s Diagnostic and Statistical Manual of Mental Disorders(DSM-5), which contains descriptions, symptoms and other criteria for diagnosing mental disorders.

What Treatments Do Psychiatrists Use?

Psychiatrists use a variety of treatments – including various forms of psychotherapy, medications, psychosocial interventions and other treatments (such as electroconvulsive therapy or ECT), depending on the needs of each patient.

Psychotherapy, sometimes called talk therapy, is a treatment that involves a talking relationship between a therapist and patient. It can be used to treat a broad variety of mental disorders and emotional difficulties. The goal of psychotherapy is to eliminate or control disabling or troubling symptoms so the patient can function better. Depending on the extent of the problem, treatment may take just a few sessions over a week or two or may take many sessions over a period of years. Psychotherapy can be done individually, as a couple, with a family, or in a group.

There are many forms of psychotherapy. There are psychotherapies that help patients change behaviors or thought patterns, psychotherapies that help patients explore the effect of past relationships and experiences on present behaviors, and psychotherapies that are tailored to help solve other problems in specific ways. Cognitive behavior therapy is a goal-oriented therapy focusing on problem solving. Psychoanalysis is an intensive form of individual psychotherapy which requires frequent sessions over several years.

Most medications are used by psychiatrists in much the same way that medications are used to treat high blood pressure or diabetes. After completing thorough evaluations, psychiatrists can prescribe medications to help treat mental disorders. Psychiatric medications can help correct imbalances in brain chemistry that are thought to be involved in some mental disorders. Patients on long-term medication treatment will need to meet with their psychiatrist periodically to monitor the effectiveness of the medication and any potential side effects.

Class of Medications

  • Antidepressants – used to treat depression, panic disorder, PTSD, anxiety, obsessive-compulsive disorder, borderline personality disorder and eating disorders.
  • Antipsychotic medications – used to treat psychotic symptoms (delusions and hallucinations), schizophrenia, bipolar disorder.
  • Sedatives and anxiolytics – used to treat anxiety and insomnia.
  • Hypnotics – used to induce and maintain sleep.
  • Mood stabilizers – used to treat bipolar disorder.
  • Stimulants – used to treat ADHD.

Psychiatrists often prescribe medications in combination with psychotherapy.

Other treatments are also sometimes used. Electroconvulsive therapy (ECT), a medical treatment that involves applying electrical currents to the brain, is used most often to treat severe depression that has not responded to other treatments. Deep brain stimulation (DBS), vagus nerve stimulation (VNS), and transcranial magnetic stimulation (TMS) are a few of the newer therapies being used to treat some mental disorders. Light therapy is used to treat seasonal depression.

Psychiatric Training

To become a psychiatrist, a person must complete medical school and take a written examination for a state license to practice medicine, and then complete four years of psychiatry residency. The first year of residency training is typically in a hospital working with patients with a wide range of medical illnesses. The psychiatrist-in-training then spends at least three additional years learning the diagnosis and treatment of mental health, including various forms of psychotherapy and the use of psychiatric medications and other treatments. Training takes place in in-patient, out-patient, and emergency room settings.

After completing residency training, most psychiatrists take a voluntary written and oral examination given by the American Board of Psychiatry and Neurology to become a “board certified” psychiatrist. They must be re-certified every 10 years.

Some psychiatrists also complete additional specialized training after their four years of general psychiatry training. They may become certified in:

  • Child and adolescent psychiatry
  • Geriatric psychiatry
  • Forensic (legal) psychiatry
  • Addiction psychiatry
  • Pain medicine
  • Psychosomatic (mind and body) medicine
  • Sleep medicine

Some psychiatrists choose additional training in psychoanalysis or in psychiatric research.

Where Do Psychiatrists Work?

Psychiatrists work in a variety of settings, including private practices, clinics, general and psychiatric hospitals, university medical centers, community agencies, courts and prisons, nursing homes, industry, government, military settings, rehabilitation programs, emergency rooms, hospice programs, and many other places. About half of the psychiatrists in the U.S. maintain private practices and many psychiatrists work in multiple settings. There are about 45,000 psychiatrists in the U.S.

What Is the Difference Between a Psychiatrist and Psychologist?

A psychiatrist is a medical doctor (completed medical school and residency) with special training in psychiatry. A psychiatrist is able to conduct psychotherapy and prescribe medications and other medical treatments.

A psychologist usually has an advanced degree, most commonly in clinical psychology, and often has extensive training in research or clinical practice. Psychologists treat mental disorders with psychotherapy and some specialize in psychological testing and evaluation.


We Need to Talk About Kids and Smartphones

Markham Heid

Updated: Oct 10, 2017 8:24 AM ET
TIME Health
For more, visit TIME Health.

Nina Langton had no right to be depressed. At least, that’s how she saw it.

She had a great group of friends, lived in a prosperous neighborhood, and was close with her parents. Like most 16-year-olds at her Connecticut high school, Nina spent much of her free time on her smartphone. But unlike many of her classmates, she was never “targeted” on social media—her word for the bullying and criticism that took place daily on sites like Snapchat. “Part of what made my depression so difficult was that I didn’t understand why I was feeling so sad,” she says.

Later, after her attempted suicide and during her stay at a rehabilitation facility, Nina and her therapist identified body image insecurity as the foundation of her woe. “I was spending a lot of time stalking models on Instagram, and I worried a lot about how I looked,” says Nina, who is now 17. She’d stay up late in her bedroom, looking at social media on her phone, and poor sleep—coupled with an eating disorder—gradually snowballed until suicide felt like her only option. “I didn’t totally want to be gone,” she says. “I just wanted help and didn’t know how else to get it.”

Nina’s mom, Christine Langton, has a degree in public health and works at a children’s hospital. Despite her professional background, she says she was “completely caught off guard” by her daughter’s suicide attempt. “Nina was funny, athletic, smart, personable . . . depression was just not on my radar,” she says.

Nina, TIME Magazine

In hindsight, Langton says she wishes she had done more to moderate her daughter’s smartphone use. “It didn’t occur to me not to let her have the phone in her room at night,” she says. “I just wasn’t thinking about the impact of the phone on her self-esteem or self-image until after everything happened.”

It seems like every generation of parents has a collective freak-out when it comes to kids and new technologies; television and video games each inspired widespread hand-wringing among grown-ups. But the inescapability of today’s mobile devices—coupled with the personal allure of social media—seems to separate smartphones from older screen-based media. Parents, teens and researchers agree smartphones are having a profound impact on the way adolescents today communicate with one another and spend their free time. And while some experts say it’s too soon to ring alarm bells about smartphones, others argue we understand enough about young people’s emotional and developmental vulnerabilities to recommend restricting kids’ escalating phone habit.

The latest statistics on teen mental health underscore the urgency of this debate.

Between 2010 and 2016, the number of adolescents who experienced at least one major depressive episode leapt by 60%, according to a nationwide survey conducted by the U.S. Department of Health and Human Services. The 2016 survey of 17,000 kids found that about 13% of them had a major depressive episode, compared to 8% of the kids surveyed in 2010. Suicide deaths among people age 10 to 19 have also risen sharply, according to the latest data from the Centers for Disease Control and Prevention. Young women are suffering most; a CDC report released earlier this year showed suicide among teen girls has reached 40-year highs. All this followed a period during the late-1990s and early 2000s when rates of adolescent depression and suicide mostly held steady or declined.

“These increases are huge—possibly unprecedented,” says Jean Twenge, a professor of psychology at San Diego State University and author of iGen, which examines how today’s super-connected teens may be less happy and less prepared for adulthood than past generations. In a peer-reviewed study that will appear later this year in the journal Clinical Psychological Science, Twenge shows that, after 2010, teens who spent more time on new media were more likely to report mental health issues than those who spent time on non-screen activities.

Using data collected between 2010 and 2015 from more than 500,000 adolescents nationwide, Twenge’s study found kids who spent three hours or more a day on smartphones or other electronic devices were 34% more likely to suffer at least one suicide-related outcome—including feeling hopeless or seriously considering suicide—than kids who used devices two hours a day or less. Among kids who used electronic devices five or more hours a day, 48% had at least one suicide-related outcome.

Twenge also found that kids who used social media daily were 13% more likely to report high levels of depressive symptoms than those who used social less frequently. Overall, kids in the study who spent low amounts of time engaged in in-person social interaction, but high amounts of time on social media, were the most likely to be depressed.

Twenge is quick to acknowledge that her research does not prove a cause-and-effect relationship exists between smartphones and depression. “It’s possible that depressed kids are just more likely to spend time on their devices,” she says. “But that doesn’t answer the question of what caused this sudden upswing in teen depression and suicide.”

Some experts have pointed to the aftermath of the Great Recession, or rising student workloads, as possible non-device explanations for young people’s recent struggles. “But when you look at the economic or homework data, it doesn’t line up with the rise in teen suicide or depression,” Twenge says. Youth smartphone ownership does. “I’m open to exploring other factors, but I think the more we learn about kids and smartphones, the more we’re going to see that limiting their exposure is a good idea.”

Others agree it’s time to approach adolescent device use with greater caution. “What this generation is going through right now with technology is a giant experiment, and we don’t know what’s going to happen,” says Frances Jensen, chair of neurology at the University of Pennsylvania’s Perelman School of Medicine. While the science on kids and technology is incomplete, Jensen says what we already know about the minds of tweens and teens suggests giving a young person all-the-time access to an Internet-connected device “may be playing with fire.”

The teenage brain

To understand how device use may be affecting a young person’s mental health, it’s important to recognize the complex changes occurring in an adolescent’s still-developing brain.

For one thing, that brain is incredibly plastic and able to adapt—that is, physically change—in response to novel activities or environmental cues, says UPenn’s Jensen, who is the author of The Teenage Brain.

Some research has already linked media multitasking—texting, using social media and rapidly switching among smartphone-based apps—with lower gray-matter volume in the brain’s anterior cingulate cortex (ACC), a region involved in emotion processing and decision making. More research has associated lower ACC volumes with depression and addiction disorders.

“We know for a fact teens have very underdeveloped impulse control and empathy and judgment compared to adults,” Jensen says. This may lead them to disturbing online content or encounters—stuff a more mature mind would know to avoid. Teens also have a hyperactive risk-reward system that allows them to learn—but also to become addicted—much more quickly than grown-ups, she says. Research has linked social media and other phone-based activities with an uptick in feel-good neurochemicals like dopamine, which could drive compulsive device use and promote feelings of distraction, fatigue, or irritability when kids are separated from their phones.

Even if smartphones aren’t the root cause of a teen’s anxiety or other issues, Jensen adds, they may turn out to be an accelerant—the gasoline that turns a flicker of adolescent angst into a blaze.

Another area of the brain—the prefrontal cortex—is critical for focus and interpreting human emotion, and doesn’t fully develop until a person’s mid-20s, says Paul Atchley, a professor of psychology at the University of Kansas. “During our teenage years, it’s important to train that prefrontal cortex not to be easily distracted,” he says. “What we’re seeing in our work is that young people are constantly distracted, and also less sensitive to the emotions of others.”

While the research on smartphones is preliminary, Atchley says he believes studies will eventually show a clearer connection between the negative trends in teen mental health and rising smartphone use. But some scientists contend there isn’t enough cause-and-effect evidence to condemn smartphones.

“I see the rise in depression, especially among girls, and I understand why people are making these connections with new technologies,” says Candice Odgers, a professor of psychology and neuroscience at Duke University who has published research on teens and tech. “But so far, we have very little data to suggest mobile technologies are causing anxiety or social impairments.” She points to evidence that some young people, particularly marginalized groups like LGBT youth, can derive benefits from online communication through supportive exchanges with friends and family.

Odgers adds that jumping to conclusions and vilifying smartphones may lead us away from factors that may turn out to be more significant—a worry raised by other experts. “This is such a serious and polarizing issue that I think we need to set aside our assumptions until we have stronger data,” she says. At the same time, she doesn’t condone unrestricted smartphone access at any age. “I’m certainly not advocating giving an 8-year-old a smartphone,” she says. “But if you ask me what age is appropriate, or how much use is safe, I don’t think the existing evidence provides those answers.”

As researchers debate appropriate public health messaging, kids are receiving their first smartphone at ever-younger ages—the average is 10, according to one recent estimate—and they’re spending more and more time on their devices.

“I am probably on my phone 10 hours a day,” says Santi Potočnik Senarighi, a 16-year-old eleventh grader in Denver. Even when he’s not actively using his phone, Santi says it’s always with him, and he never considers taking a break. “This is part of my life and part of my work, and [that] means I need to be in constant contact.”

Santi’s dad, Billy Potočnik, says he worries about his son’s phone habit, as Santi is struggling in school. But every one of Santi’s friends has a smartphone and uses it constantly, and so Potočnik says confiscating his son’s phone feels oppressive. “If I try to take it away from him, he tells me he’s not doing anything bad on it,” which Potočnik says is usually true, “and it turns into a struggle.”

He and other parents say enduring that struggle day after day feels overwhelming. And to complicate matters, many schools and after-school groups now use social media or online platforms to coordinate events, or to post grades and homework. “It’s not as simple as saying, okay, time to take a break from your phone,” Potočnik says.

How teens ‘talk’

Colleen Nisbet has been a high school guidance counselor for more than two decades. One of her duties at Connecticut’s Granby Memorial High School is to monitor students during their lunch periods. “Lunch was always a very social time when students were interacting and letting out some energy,” she says. “Now they sit with their phones out and barely talk to each other.”

This scene—of kids collecting in parks or at one another’s houses only to sit silently and stare at screens—comes up over and over again when talking with parents and kids. “When you’re with people you don’t know well or there’s nothing to talk about, phones are out more because it’s awkward,” says Shannon Ohannessian, a 17-year-old senior at Farmington High School in Connecticut.

That avoidance of face-to-face interaction worries Brian Primack, director of the University of Pittsburgh’s Center for Research on Media, Technology, and Health. “Human beings are social animals,” he says. “We evolved over millions of years to respond to eye contact and touch and shared laughter and real things right in front of us.” There’s strong research linking isolation to depression, and time spent socializing with improved mood and well-being. If smartphones are getting between an adolescent and her ability to engage in and enjoy face-to-face interaction—and some studies suggest that’s happening—that’s a big deal, Primack says.

But while they’re not always speaking out loud, kids today are talking to each other—and about each other. They’re just doing it on their phones. Not all that talk is friendly. “They tell me they’re making comments or criticizing each other to friends while they’re all sitting together,” says Nisbet, the guidance counselor. Something about the phone just seems to “take the filter off,” she adds.

Backbiting and mean-girl gossip are nothing new, of course. But research suggests that, even among adults, the Internet has a disinhibition effect that leads people to speak in coarser, crueler ways then they would offline.

Maryellen Pachler, a Yale-trained nurse practitioner who specializes in the treatment of adolescent anxiety disorders, says her job used to involve convincing her patients that their fears were largely irrational. “Now I don’t think they’re irrational at all,” she says. “If you raise your hand in class or say something silly, I think it’s likely your classmates will be texting or posting something about it.”

She says the glamor and gleam of social media is also fueling a rise in teen anxiety. “My patients see their friends’ Snapchat or Instagram photos where they look so happy, and they feel like they’re the only ones who are faking it,” she says, referencing what researchers call the highlight reel effect of social media. “I want to tell them, listen, this girl you’re jealous of—she was in here with me yesterday!”

Teens agree social-media whitewashing is the rule, not the exception. “No one’s going to post something that makes them look bad,” Ohannessian says. “I know that, but it’s still hard to separate what you see on social media from real life.”

What’s next for teens and phones

There are doubtless many factors contributing to teen depression. Parents say kids today are busier than ever before—their lives increasingly crammed with the extracurriculars required to gain admission to a good college. But even those researchers who aren’t ready to slam smartphones say it’s important to restrict an adolescent’s device habit, and that too much social media or media multitasking is likely harmful.

“I don’t think these devices are the main cause, but I think they contribute to a lot of the things we worry about,” says David Hill, director of the American Academy of Pediatrics (AAP) Council on Communications and Media. “I speak to parents who are very concerned, and my take is to be much more rigid about setting limits—especially when it comes to phones in the bedroom at night.”

But the AAP’s current guidelines do not offer specifics when it comes to appropriate smartphone limits for children older than 6, and public health officials generally say parents should decide what is right for their kids, without offering specifics.

Educators are also grappling with smartphone-related dilemmas. Most schools allow smartphone use between classes and during free periods, but teachers say keeping students off their phones during class has become a tremendous burden.

Gina Spiers, an English teacher at San Lorenzo High School near Oakland, Calif., says she used to confiscate phones, but students would panic and cause a disruption in class. She and her school are fighting back—with encouraging results.

Starting this fall, San Lorenzo High joined several schools nationwide in working with a company called Yondr to restrict smartphone access during school hours. Yondr makes small, lockable phone pouches that students keep with them, but that can’t be opened until the end of the day.

“The changes have already been profound,” says Allison Silvestri, San Lorenzo’s principal. Kids are more focused and engaged during class, and student journals suggest the high schoolers are feeling less anxious and more relaxed. Silvestri says fewer fights have broken out this semester—a benefit she attributes to the absence of social media. “They have to look each other in the eye to make conflict happen,” she says. “There’s so much more joy and interaction, and I can’t count the number of parents who have asked me, ‘How do I buy this for my home?’”

The smartphone experiment at San Lorenzo doesn’t meet the standards of the scientific method. But it’s one more piece of evidence linking mobile devices with the troubles today’s teen are facing. While there are no doubt helpful and healthy ways young people could use smartphones to enrich their lives, it’s becoming harder to argue that the status quo—near-ubiquitous teen smartphone ownership, coupled with more-or-less unfettered Internet access—is doing kids good.

A few months after her suicide attempt, Nina Langton addressed her high school classmates and spoke openly about her depression. She described the stigma of mental illness, and lamented the fact that, while many teens experience depression, very few are willing to talk about it or ask for help. “I was worried for so long about opening up about my struggles because I thought I would be judged,” she said.

After she gave the speech, “so many people my age reached out to me about their own experiences with technology and depression and therapy,” she says. “I think this is a big problem that needs to be talked about more.”


Resistance Exercise Linked to Reduced Anxiety

The Effects of Resistance Exercise Training on Anxiety_ A Meta-Analysis and Meta-Regression Analysis of Randomized Controlled Trials _ SpringerLink (1)

Resistance Exercise Linked to Reduced Anxiety

By Lisa Rapaport

People who do resistance exercises like weight lifting may experience less anxiety than people who don’t work out, a research review suggests.

Researchers analyzed data from 16 previously published studies with a total of 922 participants who were randomly assigned to do resistance training or be inactive. The study was published in Sports Medicine, online August 17.

Resistance workouts were associated with a reduction in anxiety symptoms whether or not participants had a mental health disorder, though the effect was more pronounced in healthy people who didn’t report any physical or psychological problems.

“The positive effects of exercise training on mental health are well established; however, the majority of this knowledge is based on studies involving aerobic-based training,” said lead study author Brett Gordon, a physical education and sports researcher at the University of Limerick in Ireland.

“RET (resistance exercise training) significantly reduced anxiety in both healthy participants and those with a physical or mental illness, and the effect size of these reductions is comparable to that of frontline treatments such as medication and psychotherapy,” Gordon said by email. “RET is a low-cost behavior with minimal risk, and can be an effective tool to reduce anxiety for healthy and ill alike.”

Because the analysis only focused on resistance training, the results can’t show whether this type of activity might be better or worse than aerobic or other types of exercise for easing anxiety symptoms.

While the effects of resistance exercise on the brain are not as well understood as the impact of aerobic workouts, emerging research has also linked resistance training to less shrinkage of white matter in the brain, said Dianna Purvis Jaffin of the Brain Performance Institute at the University of Texas at Dallas.

White matter is composed of nerve fibers that connect neurons in different parts of the brain. Changes in white matter can occur with age, and are thought to be involved in cognitive and behavioral problems.

It’s possible that exercise might help ease anxiety simply by distracting people from how they’re feeling and giving them something else to focus on, Jaffin, who wasn’t involved in the current study, said by email.

“Exercise generally requires some level of concentration on the activity and may serve as a distraction, and at least acutely (meaning – during that bout of exercise and a bit after) interrupt rumination and obsessive worrying,” Jaffin said.

“Finally, since people with anxiety tend to have uncertainty about their future, they may obsessively worry and lack confidence,” Jaffin added. “Exercise can improve self-efficacy, the belief that one can succeed in particular situations, which may make someone feel more empowered.”

While the amount of exercise may influence the impact of workouts on mental health, there isn’t enough evidence available yet to prescribe a specific amount of activity, said Steven Petruzzello, a body mechanics researcher at the University of Illinois Urbana-Champaign who wasn’t involved in the study.

Absent this sort of prescription, choosing an enjoyable workout makes sense, Petruzzello said by email.

In the current analysis, people did resistance exercises on two to five days per week for an average of 11 weeks.

“The best advice at the present time is to ‘just do it’ – it being whatever the person finds enjoyable or at least tolerable,” Petruzzello said. “For some that might mean going for a walk, for others it might entail more vigorous forms of activity.”


Sports Med 2017.

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