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Minimizing successes and magnifying failures? Change your distorted thinking

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Some things are not debatable. Rain falls from the sky. Elevators go up and down. Orange traffic cones are orange. But because we interpret the world through our experiences, a lot isn’t so definitive.

The boss might say, “Good job,” and we wonder why they didn’t say, “Great job.” We see someone looking in our direction and they seem angry, so we believe that they’re mad at us, and no other explanation makes sense.

What’s happening is that we’re distorting our experience, jumping to conclusions, mind reading, and going to the worst-case scenario. When we do this, we shrink our successes and maximize our “failures,” and because it can be an automatic process, it’s hard to tell when it’s happening. “You don’t know you’re wearing magnifying glasses,” says Dr. Luana Marques, associate professor of psychology at Harvard Medical School.

So what can you do to see things more clearly and with a more balanced perspective? It takes practice and a willingness to tolerate discomfort, but as with addressing any problem, it starts with awareness.

What’s happening when we magnify failures and jump to negative conclusions?

We like to process information quickly, and we use filters to help do that. If we believe, “I’m no good,” all words and behaviors that support that contention just make everything easier.

“The brain doesn’t want to spend energy trying to fight that,” Marques says. And the brain responds depending on the distortion. If something causes anxiety, say from a curious look or comment, the limbic system is activated and we’re in fight-or-flight mode, hyper-focused on the threat, not thinking creatively or considering alternative, less threatening options.

But sometimes, there’s no threat in play. We’re just thinking, probably overthinking, when we question our abilities and minimize our accomplishments.

So what can you do about it?

Label the type of thinking distortion

It helps to define our distortions, the common ones being:

  • Catastrophizing: Taking a small incident and going to the worst-case scenario.
  • Black-and-white thinking: Seeing only all-or-nothing possibilities.
  • Jumping to conclusions: Assuming what will happen rather than waiting to see what will actually happen.
  • Mind reading: Assuming what someone is thinking without much evidence.

When you label it, you can better understand and recognize what your go-to distortion is, because “we tend to do one more than another,” Marques says.

After that, it helps to take your emotional temperature by asking: Am I stressed? Am I sweating? Is my heart pounding or my breathing shallow? It brings you more into the moment and it allows you to think about what you were doing that brought on the response, such as, “I was trying to guess the outcome.” It’s another way to pinpoint the distortion you tend to favor, she says.

Challenge the distortion

Whichever distortion it is, you want to examine your assumption by looking for other evidence. If you question your boss’s reaction to you, ask yourself: What does my boss really say? What does this person say about other people? Have I received raises and promotions? Am I given good projects?

An easy trap with distortions is that they’re plausible. A person who is mad at me would give me a look. A person who hated me wouldn’t text me back. Maybe so, but think of five other possible explanations, Marques says. This exercise engages the prefrontal cortex, which takes you out of the fight-or-flight mode and expands your thinking. You’re then problem-solving and not solely keyed on one option.

You also want to ask an essential question: is this thinking helpful? You might realize that all your thinking/wondering/worrying does is make you anxious. Gaining that presence might be enough to get you off the path of distorted thinking. “Asking and answering the question about your thinking pauses the brain, and you potentially see the world differently,” she says.

Being balanced and kind to ourselves

As you examine and attempt to control your distortions, be mindful of how you treat yourself. Self-criticism is a really easy trap to fall into, but try talking to yourself as you would a friend. Better yet, imagine you’re speaking to a child. Your language would be considerate, supportive, and you wouldn’t use words such as “stupid” or “dumb.” This approach also shifts you into the detached, third person. “You get out of your head,” Marques says. “We’re cleaning our magnifying glasses a little bit.”

Lastly, realize that you’re not looking to switch your attitude from “I’m unworthy” to “I’m super-great.” That’s just trading one extreme for another. All you want is to counterbalance your distortion, then let it go. Countering thinking distortions is a lot like meditation, where you practice acknowledging your thoughts without getting hooked onto them.  “You don’t have to magnify or minimize.” Marques says.

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4 immune-boosting strategies that count right now

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It’s winter, as a glance outside your window may tell you. COVID-19 is circulating at record levels across much of the country. Keeping our immune systems healthy has taken on new importance, as many of us hope to ward off flu and winter colds as well as worrisome variants of the virus that causes COVID-19, whether Delta or Omicron.

Not surprisingly, marketers are taking advantage of our concerns. A whole cottage industry is devoted to chewables, pills, and powders that claim to “boost” or “support” your immune system. Some people even claim that healthy eating and vigorous workouts are all you truly need to avoid getting sick. But are any of these claims true?

The best strategies for staying healthy

I asked Michael Starnbach, professor of microbiology at Harvard Medical School, for his advice on steps that can help us stay in good health this winter.

“Vaccination, skepticism of any other products claiming immune benefits, and staying away from places without universal masking are the best strategies,” he says. Here’s why these approaches count.

Get vaccinated

When it comes to improving your immune response, getting the COVID vaccine and booster shot, along with other recommended vaccinations, is best. Think of vaccination as a cheat sheet for your immune system. When a viral invader makes its way into your body, your immune system prepares to fight. But first it has to figure out what’s attacking, which takes time — time that allows the virus to keep multiplying inside your body.

A vaccine introduces the immune system to the invader ahead of time and allows it to develop a battle plan. So when the virus does show up at the door, your immune system can react quickly, which may mean no symptoms, or at least preventing serious illness. A booster shot is a refresher course to keep those lessons fresh.

While it is possible to become infected even if you are vaccinated, your immune system is primed to clear the virus more rapidly, so the infection is far less likely be severe or life-threatening. “We should get all available vaccines and boosters so that if we do get infected, we have a better chance of having a mild case,” says Starnbach.

Be skeptical

Any number of vitamin formulations and probiotics claim to boost or support your immune system. And while there is a grain of truth to some of those claims, the big picture is that they often don’t work. For example, vitamins do help immune function, but really only in people who have a vitamin deficiency — not in an average, healthy adult.

Probiotics also hold promise. This mini-universe of organisms living in your gut called the microbiome does play an important role in immunity. But experts don’t know enough about that role to create a product that can manipulate the microbiome to enhance immunity. That may change over the next decade — but for now, view probiotic claims with a healthy dose of skepticism, says Starnbach.

Mask up

Ultimately, nothing is better at keeping you well than avoiding exposure to a virus altogether. Wearing a mask isn’t on anyone’s favorites list, but it can help reduce the risk of spreading COVID (and some other viruses) to people who are unvaccinated, including children who aren’t yet eligible for the shot, and people with immune system deficiencies who don’t get adequate protection from the vaccine, says Starnbach. Masks are most effective when everyone around you is wearing one. “We now know clearly that the best way to prevent the unvaccinated from becoming infected is by indoor mask mandates,” says Starnbach.

Practice good health habits

But what about exercise and good nutrition? Do they have a role in supporting your immune system?

The answer is yes. Strategies to improve your overall health are never wasted. Healthy people are more resistant to disease, and often fare better if they are infected. Good health habits can help your immune system operate at its peak. Exercise and good nutrition aren’t the only habits that can help. You should also try to get consistent, high-quality sleep and manage your stress level. Lack of sleep and chronic stress can impair immune function.

But if you hope to avoid COVID-19 and other viruses, these strategies should come in addition to — not as a substitute for — vaccination and other protective measures.

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If you have knee pain, telehealth may help

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Just about everyone experiences knee pain at some point in their lives. Most of the time, it follows an injury or strenuous exercise and resolves in a few days, but knee pain can last months or even years, depending on the cause. A new study suggests telehealth programs designed for people with knee osteoarthritis may help ease pain, improve ability to function, and possibly even lead to weight loss.

What is osteoarthritis of the knee?

Osteoarthritis (OA) — the age-related, “wear-and-tear” degeneration of the knee joint — is the number one cause of chronic knee pain, affecting nearly a quarter of people age 40 or older. It’s responsible for most of the 600,000 knee replacements in the US each year, and more than $27 billion in annual healthcare spending.

How is it treated?

No treatment for knee OA is ideal or works in every case. Standard approaches to treatment include pain management, exercise, and loss of excess weight.

For pain, people with knee OA may consider

  • anti-inflammatory drugs that are rubbed on the skin, such as diclofenac gel
  • anti-inflammatory medicines, such as ibuprofen
  • pain relievers, such as acetaminophen
  • injections of corticosteroids.

Opiates, arthroscopic surgery, and other injected treatments are not routinely recommended due to risks, lack of proven benefit, or both. Knee replacement surgery has a high success rate for knee OA, but is generally considered a last resort because it’s major surgery that requires significant recovery time.

Virtual visits can help

Before the COVID-19 pandemic, many people with knee OA regularly saw their healthcare providers to

  • monitor their pain and ability to function
  • consider changes in treatment
  • check for treatment side effects
  • determine if other problems are contributing to symptoms.

It turns out, much of this can be done virtually. The pandemic made it a necessity. And a new study suggests it works.

What did the study on knee osteoarthritis find?

The study demonstrated that telehealth visits are a good way to provide care to people with knee OA. The researchers enrolled nearly 400 participants who had knee OA and were overweight or obese. They were divided into three groups:

  • Group 1 was given access to a website that provided information about OA, including pain medications, exercise, weight loss, and pain management.
  • Group 2 received the same information as group 1, and also engaged in six exercise sessions with a physical therapist by videoconference. These sessions lasted 20 to 45 minutes and included advice about self-management, behavioral counseling, and education about choosing exercise equipment.
  • Group 3 followed the same format as group 2, and also had six consults by videoconference with a dietitian about weight loss, nutrition, and behavioral resources. These sessions also lasted 20 to 45 minutes.

After six months, participants in groups 2 and 3 reported pain relief compared to Group 1. On a pain scale of 1 to 10:

  • group 3 improved more than group 1 by 1.5 points
  • group 2 improved more than group 1 by about 1 point.

People in groups 2 and 3 also had better scores for function compared to group 1. All of these improvements were considered meaningful and held up for at least 12 months.

In addition, those assigned to group 3 lost about 20 pounds over the course of the study, while the other groups’ weights were nearly unchanged. That’s an important finding, because excess weight can worsen osteoarthritis of the knee. Losing excess weight can improve symptoms and help prevent the arthritis from getting worse.

Since there was no comparison with in-person care, it’s impossible to say whether these virtual visits were better, worse, or similar to an office visit. In addition, this study did not report the costs of these virtual sessions, the long-term impact of virtual visits, or whether repeated virtual visits could maintain the improvements people reported.

The bottom line

The pandemic is giving researchers an opportunity to seriously study the potential value and limitations of virtual care on a large scale. If these visits are as good as or better than in-person visits for certain conditions and the costs are no greater, that’s a big deal. A virtual visit can eliminate time spent in travel and the waiting room, and possible parking fees that can make a brief doctor’s visit an expensive undertaking that takes half the day. Virtual care also has the potential to reach patients who otherwise cannot get to their doctor’s office.

Of course, telehealth isn’t equally available to everyone due to language barriers, technical abilities, health insurance plans, or simply not having access to smartphones, computers, or data plans. Some states are letting emergency measures supporting telehealth services expire. And some insurers may resort to pre-pandemic rules about coverage or physician licensing that create uncertainty about the future of telehealth.

This study and others suggest that it may be a mistake to curb telehealth just when it’s catching on. More studies like the one described here may make the case to insurers, regulatory agencies, healthcare providers, and patients that the future of medical care should rely on more, not less, virtual healthcare, and encourage approaches that overcome barriers to its use.

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Paths to parenthood: Receiving an embryo donation

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Embryo donation — the process by which a family donates their “extra” embryos to a couple or individual — is a viable path to parenthood. In a previous blog post, I addressed some of the reasons why people who consider their families complete after in vitro fertilization (IVF) might choose to donate embryos.

Who, then, is on the receiving end? Often, this option interests people considering adoption, and individuals or couples who need donated eggs or sperm, or both, to achieve pregnancy. If you find yourself in one of these groups, here are some initial questions and issues you might consider as you make your decision.

Embryo donation or adoption: A few points to compare

Pregnancy. The opportunity to experience pregnancy draws some prospective adoptive parents to seek embryo donation. This may be important to you. It may be a life experience you always looked forward to, or hoped to share with a spouse or partner. Or perhaps you are concerned about having someone else carry your baby. For example, prospective adoptive parents often worry that their future child could be affected before birth by a birth mother’s choices around drugs and alcohol, or exposures to unavoidable stresses.

Time frame and cost. The pandemic fueled already significant declines in the number of babies placed for adoption. If you are seeking to adopt a newborn, you are likely to face a wait of two years or more. By contrast, embryos are available, and an embryo transfer often occurs within six months of making the decision to seek donated embryos.

The cost of embryo donation is considerably less than adoption. If you go through an agency there will be a fee, as well as costs related to moving embryos from one clinic to another and (depending on your medical insurance) costs associated with medications and with the embryo transfer. While costs are substantial and vary across the US, fees are much higher for infant adoption than for embryo donation.

Although the short wait and lower costs are attractive when comparing embryo donation to adoption, it is important to know that embryo donation does not always result in a live birth, while adoption — with a reputable agency — will bring a baby into your home.

Your child’s story. All of us want our children to feel good about their origin stories. Adoptive families have long recognized that some adoptees have enduring feelings of loss because their birth parents chose to make an adoption plan. Some people believe embryo donation mitigates these losses because the child is born into the family they will be raised in. However, others see it differently: they feel that embryo donation brings with it a more complicated origin story. How will a child make sense of the fact that they began as an embryo created by people longing for a baby, but an embryologist chose another embryo for transfer, making them “extra”? Might this lead to a greater sense of displacement, and perhaps to feeling like a bit of a science experiment?

Choosing family backgrounds. If you pursue adoption, you’ll weigh in on the race of your child. You may be able to request birth parents who avoided drugs or alcohol during the pregnancy and/or have family histories free of serious physical or mental health problems. You will not be able to narrow your match to people you like or feel are compatible, people who feel familiar, and whose interests and values align with yours.

If you pursue embryo donation, you and the donor family get to choose each other. Before anyone makes a commitment, you can confirm with the donor family that you have a shared perspective of how much contact you want to have, and what each of you believes is in the best interest of the children involved. Decisions tend to feel more collaborative than in adoption, where it may feel like “birth parents get to make all the decisions.”

Embryo donation or egg or sperm donation: A few points to compare

If you are in a position to need sperm or egg donation, or both, you might be comparing this with embryo donation as a path to pregnancy. Below are key points to consider, and some questions that may arise as you sort through your options.

Since pregnancy is your primary goal here, you are probably thinking about which option is likely to work best. With embryo donation, one might say you get a head start, since you begin with healthy embryos. However, the number of embryos you receive will be limited.

You could decide to seek a second donor family if you don’t achieve pregnancy with embryos from the first donor, although this would be a long, discouraging path. By contrast, if you seek donated sperm and eggs separately and begin with a large number of eggs, you may have a larger number of embryos to work with.

Time frame and cost. The good news is that each of these options can be available to you without delay. You can obtain donor sperm from a donor known to you, or from major cryobanks within days of choosing a donor. If you choose frozen eggs, these can be secured quickly also. Donated embryos take longer to locate and arrange for their transfer from one family to another.

Your medical insurance will play a big role in determining the expenses associated with each option. Sperm from a known donor usually is free. With egg and sperm donation from a cryobank, you will owe a fee to the donors. In the case of egg donors, fees can be high. With embryo donation, no fee is paid to the donating family.

Your child’s story. If you opt for embryo donation, your child’s story began with another family planning to have a baby. You may wonder if your child will have feelings of displacement similar to what some adoptees report. Or, carrying and giving birth to your baby may make embryo donation feel fundamentally different from adoption. Double donation — conceiving a child with both donated eggs and sperm — also offers the connection that comes with pregnancy, although you may wonder how your child will make sense of being conceived by two people who never knew each other. A single donation of either egg or sperm offers a genetic connection to one parent, which some feel helps root a child in the family. Yet each of these origin stories is complicated, making it essential that you feel comfortable with the story before you move forward. Long before being able to understand the story, your child can sense that you feel secure in the rightness of your decision.

Decisions like these abound worldwide

If you are taking a serious look at embryo donation and comparing it to other parenthood options available to you, you are not alone. The arrival of IVF in 1978 has led to a series of new paths to parenthood. Each one drew pioneers who took a careful look before moving forward into new and unfamiliar territory. Making the decision with patience, thoughtfulness, and information has enabled them to embrace and celebrate the families that they have built.

For more information

Regulations, rules, and costs of different paths to parenthood vary by state and other factors. These resources may help you track down information you need to make a decision.

Resolve

Parents Via Egg Donation (PVED)

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Seeing red? 4 steps to try before responding

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Breathe. Count to 10. Take a walk. These strategies have long been advised to help you pause and rethink your reaction when you’re seeing red and an inch away from exploding. Under normal circumstances — maybe a little stress at home or at work — those strategies can be useful. But you may find they’re less effective in the pressure cooker we’ve been living in since the pandemic began. What can you do to avoid reaching your boiling point?

For insight, I turned to psychologist Stuart Ablon, founder and director of Think:Kids in the department of psychiatry at Harvard-affiliated Massachusetts General Hospital. Ablon is an expert at defusing explosive behavior among kids and teens with severe developmental delays in problem solving, flexibility, and tolerance to frustration — the skills that keep us from melting down.

Pandemic stress blocks our coping abilities

Ablon says many adults are struggling with a lack of these skills right now — not because we haven’t developed them, but because pandemic stress is blocking them. “When we humans are chronically stressed, we lose access to the part of our brain that performs skills like flexibility and tolerance,” Ablon says.

Blocked skills can reduce our coping abilities to those of little children, like toddlers who scream when they don’t get their way.

Practice empathy

Ablon says it’s crucial to stay calm or “regulated” when you’re feeling mad or upset, so you can access the skills needed to maintain control. And the best way to remain calm, Ablon says, is by practicing empathy — trying to sense another person’s perspective or point of view.

“Empathy is the most powerful human regulator we have. It’s been proven to de-escalate people in the most challenging of prison settings, and it can also work on an airplane or in line at Starbucks,” Ablon says. “Think about it: when someone listens to you and tries to understand your point of view, it calms you. You can feel your heart rate drop.”

How does empathy help you?

Calming others is great, but how does being empathetic keep you from exploding? It has a domino effect.

  • Trying to understand someone else's point of view may change your mind about how you want to react. It will also give you something important to do, which will keep you focused so you can remain calm.
  • Being calm enables you to access coping skills like problem solving, flexibility, and tolerance to frustration.
  • Accessing your coping skills strengthens your ability to keep your cool.
  • Because you’re calm, you’ll keep someone else from exploding, which in turn helps you continue to stay calm.

Four steps to help you stop seeing red

To practice empathy, Ablon recommends the following steps.

  • Adopt a mindset that people are doing the best they can. “We’re all trying our best to handle what the world is throwing at us, with the skills we’re able to access at that moment. None of us wants to be losing it,” Ablon says. “Think to yourself, ‘This person I’m interacting with isn’t giving me what I want, but this person is doing the best they can right now.’ If you can exude that, you will help regulate them. It’s incredibly contagious — the same way a parent who stays calm can soothe a crying baby, or a kindergarten teacher with supreme calmness can regulate a whole class.”
  • Be curious, not furious. Ablon recommends asking questions without jumping to conclusions, so you can find out where people are coming from. What are their circumstances? What’s driven them to this moment? What do they need?
  • Practice active listening. “One of the most powerful things you can do to regulate someone is to repeat back to them what you’re hearing from them in your own words. It makes them feel heard,” Ablon says. “So ask questions, and when you get information, reflect back what you’ve heard. It’s called active listening.”
  • Offer reassurance. Remind the person you’re talking to that you’re trying to help. “Say, ‘I’m just trying to understand. I know you must have an important reason and I want to hear more. I’m not trying to get you upset. I want to work things out.’ That’s very calming and regulating,” Ablon says.

It may not be easy to remain empathetic in these challenging times. But the more you practice this skill, the more empathetic you’ll become. That can deliver significant results. “If you can stay calm and approach someone kindly and with understanding,” Ablon says, “it will head things off at the pass for both of you.”

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Treatment with abiraterone significantly improves survival in advanced prostate cancer

illustration outline of a hand against a blue background with a blue ribbon on the palm symbolizing prostate cancer research

In December, researchers reported findings from a study showing that the drug abiraterone halves the risk of prostate cancer death among a specific group of patients who previously would not have been treated with it. Currently, abiraterone is approved only for men with prostate cancer that is spreading (metastasizing) in the body. But men enrolled in the study were treated at earlier stages, before their tumors had a chance to spread. Based on the findings, the investigators concluded that abiraterone should considered for treating aggressive prostate cancer that has not yet begun to spread to other sites, but likely will in the future.

Abiraterone was first approved in 2011, specifically for metastatic prostate cancer that no longer responds to chemotherapy or drugs that block testosterone (a hormone that fuels prostate tumor growth). Treatments that block testosterone production in the testicles and other glands are called androgen deprivation therapies, or ADT. Some tumors get around ADT by making their own testosterone, however, and that’s where abiraterone comes into the picture: it prevents cancer cells from making the hormone. Doctors give abiraterone together with prednisolone, a steroid that lessens treatment side effects. More recently, abiraterone’s approval was extended to men who still respond to ADT or have not yet been treated with chemotherapy.

During the newly published study, which is called STAMPEDE, researchers in the UK and Switzerland enrolled 1,974 men with high-risk cancer that was still confined to the prostate and nearby lymph nodes. The STAMPEDE clinical trial is testing multiple treatments for advanced prostate cancer, and this particular study was one of several conducted as part of that broader effort. The men in this case were 68 years old on average, and each of them was assigned to one of three different groups:

  • ADT by itself (the control group, which included 988 men) 
  • ADT in combination with abiraterone and prednisolone (459 men)
  • ADT in combination with abiraterone, prednisolone, and another drug called enzalutamide that is similar to abiraterone (527 men).

ADT in the control group lasted three years, while most of the men receiving combined therapies underwent two years of treatment.

The results

After six years of follow-up, 7% of the 986 men who received abiraterone as part of their treatment had died from prostate cancer. By contrast, 15% of the 988 men given ADT by itself had a prostate cancer death. Moreover, abiraterone significantly lengthened the time it took for metastases to appear.

Based on these findings, the investigators concluded that “patients treated with the combination therapy [that includes abiraterone] are more likely to live longer and die from another cause.” Side effects were more common among abiraterone-treated men, and included hypertension and increased liver enzymes. Adding enzalutamide had no added treatment benefits, making that drug’s use among nonmetastatic cancer patients “unjustified due to additional toxicity and cost,” the investigators wrote.

“This important study adds to the extraordinarily encouraging news regarding treatment advances in advanced and metastatic forms of prostate cancer,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org. “Giving abiraterone together with prednisolone is now a mainstay in the management of men with prostate cancer that has spread beyond the confines of the prostate gland and lymph nodes. This new study shows that the addition of abiraterone plus prednisolone to traditional ADT can benefit men who have not yet developed metastatic disease but would be likely to do so in the future. The investigators of the STAMPEDE program continue to make practice-changing discoveries that are meaningful and improve survival in this population, and we welcome these results.”

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Waiting for motivation to strike? Try rethinking that

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All of us know that motivation is a key ingredient to accomplishing goals in our personal and professional lives. But if you wait for motivation to strike like a sudden lightning storm, you’re a lot less likely to take a single step toward any goal. Even if you have a much-desired goal in mind, it’s all too easy to deplete motivation through feeling overwhelmed, procrastination, or impatience. The steps below can help you increase your motivation to accomplish the goals that matter to you.

The meaning of your goal

Before setting a goal, it is critical to clearly identify meaning — that is, why is successfully reaching this goal important to you? What will this achievement mean to you? For example, telling yourself “I want to lose 10 pounds so I have more energy to play with my grandchildren” conveys far more meaning than “I want to lose weight.” Or maybe your goal is to paint a room a different color because you feel that color will bring more joy into your life. That’s very different than setting a goal of “paint room.”

If you set a goal and find yourself procrastinating or not achieving it, revisit the meaning of the goal you have set. Is this a goal that continues to matter to you? If so, consider the meaning behind the procrastination or the difficulties that you are experiencing.

Operationalize your goal

Write out a detailed plan to achieve the goal. Use the SMART acronym to guide this plan:

  • Specific (What exactly do you want to accomplish?)
  • Measurable (How will you know when you have succeeded?)
  • Achievable (Is the goal you have set possible?)
  • Realistic (Does setting this goal make sense for you right now?)
  • Time-bound (What is the specific time frame to accomplish this goal?)

For example, a goal of “exercise more” is too vague, and will not set you up for success. Instead, set a goal of walking 50 steps in the next hour, or taking a 15-minute walk Wednesday morning. This goal is specific, measurable, achievable, realistic, and time-bound.

Set up a to-do list — and tick it off

Once you identify a specific goal, make a to-do list to accomplish it.

  • What resources do you need?
  • What are the steps you’ll take toward your goal? Break down tasks into manageable mini-tasks and write each one down.
  • Set deadlines for each task. Make a schedule to accomplish these tasks, being sure to include regular breaks and realistic time frames.
  • Cross off each mini-task as you complete it. Step by step, you’ll see you’re making progress toward your goals.

If you are having difficulty breaking down your goal into smaller tasks, just begin working toward it. For example, if you set a goal of increasing the number of steps you walk each day, but have difficulty identifying the ideal number of steps as a goal, just start walking. You can figure out that ideal number later.

Include others

Invite a team to help you with your goal. You could join a running club, or ask family and friends to check on your progress in achieving tasks related to your overall goal. Perhaps friends can send email or text message reminders to keep you accountable. Finally, surround yourself by other people who are actively working on their own goals. Their efforts may inspire you, too.

Visualize success

Create an image of yourself achieving this goal. This image could be in your mind, or perhaps you could draw a picture of yourself achieving your goal. Imagine what achieving this goal will mean for you. How will you experience the success? How will it feel for you? Remember these positive emotions as you are completing the tasks on your to-do list to help fuel motivation.

Avoid distractions

Try to choose a space that is organized, free of clutter, and with minimal distractions. Focus on one task at a time, not multitasking. Close email and place your phone on silent. Avoid social media sites that make goals seem very easy to attain.

Track progress and time spent

Decide how often you’ll track progress toward your overall goal through your to-do list. Are you meeting the timeline you initially established? If not, identify stumbling blocks. Revisit the importance and meaning of this goal and how you initially set up your SMART model. If necessary, reconsider challenging aspects of your goal and make changes in your plan.

Think creatively about how to expand available time to work on your goal. Can you make certain tasks more routine in your life? Can you link unenjoyable tasks with more pleasurable activities? For example, if you dread your goal of taking 100 additional steps each day, could you listen to music or a podcast that you enjoy while you are taking these steps?

Embrace empathy

Be kind to yourself when tracking progress toward achieving your goal. Practice self-compassion on occasions when you fall short. Build small rewards into the process, and consider how to celebrate all your accomplishments.

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Are certain fruits healthier than others?

close up image of a colorful variety of assorted fruits

In the US, we are fortunate to have a dizzying array of fruits that fill our grocery stores year-round. They come in all sizes, shapes, and colors, and we have all heard about the recommended five servings of fruits and vegetables a day. So, what are we eating them for? And how does the nutritional value vary between fruits? Is there any difference between whole fruits versus juice, fresh versus dried? Let’s take a look.

Differences between fruits

Just like other foods, different fruits have different nutrient values. Generally, whole fruits are good sources of fiber while fruit juices are not. And one cup of fruit juice, even 100% fruit juice, has a lot more sugar than one piece or one serving of whole fruit. In addition, whole fruits are more satiating than juices. When meeting the recommended fruit and vegetable intake, it is better to eat them (whole) than drink them (juice). However, one should not completely avoid drinking juice — if it is 100% juice — but you should limit consumption to no more than 4 to 8 ounces a day.

The freezer section of the grocery store is often stocked with quite a variety of frozen fruits. These are often peeled and cut already (like mango), which is convenient and often less expensive than fresh fruits. Frozen fruits are usually picked and quick-frozen near the point of harvest, therefore the nutrients are well preserved. Moreover, some seasonal fruits such as blueberries are readily available in frozen form. The key to selection is to choose plain frozen fruits without added sugar.

There are a number of fruits that are available in dried form, such as raisins, apricots, and pineapple — just to name a few. They also have good nutrient values, keep for a long time, are convenient to carry around, and are high in calories, making them a favorite for hikers and campers. However, some often have sugar added in the drying process, particularly mango and pineapple. Dried cranberries almost always have sugar added, as they are naturally very tart. Even for those without added sugar, the compact volume and sweetness make it quite easy to eat a lot in one sitting, and the calories can add up quickly.

Some dried fruits like raisins and apricots are also treated with sulfur dioxide to preserve freshness and color. For most people that is not a concern; however, some individuals are sensitive, especially those with asthma. Sulfur dioxide treatment is labeled on the package, so it is not difficult to avoid if necessary.

What about buying organic?

We have much choice when it comes to organic and conventionally grown fruits, be they fresh, frozen, or dried. Nutritionally, there is not enough difference to choose one over the other, though consumers might choose one over another based on farming practices and environmental impact. The US has regulations on pesticide use, but some fruits tend to have more residual pesticides than others, and it is always recommended that you wash fruits thoroughly before eating.

Differences in nutritional value

Different fruits are good sources of different nutrients. Citrus fruits are high in vitamin C, and other fruits are good sources of nutrients too. A few examples below:

Nutrient

Major functions

Good fruit sources

potassium

fluid and electrolyte balance, maintaining healthy blood pressure

oranges, raspberries, bananas, cherries, pomegranates, honeydew melons, avocados

iron

formation of red blood cells, brain growth in children

dried apricots, raisins

vitamin C

maintaining healthy immune system, wound healing, antioxidant

citrus fruits, strawberries, kiwi

folate

DNA synthesis, formation of red blood cells, early neural tube development in the fetus

oranges, mangos, avocados

vitamin A

night vision, cell growth, immune function

cantaloupe

Besides the above nutrients, certain fruits are also high in flavonoids. This is a diverse group of compounds, some of which are potent antioxidants that protect against oxidative damage, and may reduce the risk of certain diseases such as cardiovascular disease and diabetes. In particular, citrus fruits are high in the flavanones class of flavonoids, and blackberries, blueberries, cranberries, and cherries are high in the anthocyanidins class of flavonoids.

So, what fruits should we eat?

As you can see, there isn’t one fruit that has all the nutrients, so eating a variety is the key to good health. Try something new! Most adults should eat a variety of colors for about 2 cups a day. Prioritize whole fruits over juice. Eat what is in season, as it will be cheaper. And enjoy your fruits: eat mindfully to fully appreciate the smell, texture, and flavor. Bon appetit!

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Exercise, metabolism, and weight: New research from The Biggest Loser

woman running outdoors in sunlight

The Biggest Loser was a popular reality television show that ran on NBC for over a decade starting in 2004. In it, participants with obesity competed with each other through intense physical challenges and ate a reduced-calorie diet to see who could lose the highest percentage of body weight.

Prior findings from studies of The Biggest Loser contestants showed not only that metabolism slows drastically following significant weight loss, but also that regaining the lost weight does not restore metabolism back to its pre-weight loss levels. This means people who have lost large amounts of weight must adhere to an extremely low-calorie intake in order to maintain that weight loss. One show contestant lost 239 pounds and achieved a weight of 191 pounds, yet six years later, after regaining 100 pounds of that lost weight, had to consume an 800-calorie-per-day diet to maintain his weight.

New research about physical activity and metabolic rate

A more recent study by the same researcher aims to explain and interpret the findings from The Biggest Loser in light of an energy conservation model. In what he calls the "constrained model of human energy expenditure," Dr. Kevin Hall theorizes that because the contestants engaged in large, sustained periods of intense physical activity, their metabolisms slowed substantially in order to reduce their metabolic rates and thereby minimize changes in total energy expenditure. In other words, their bodies made automatic compensatory changes to maintain energy balance.

Of particular interest is the fact that at the end of The Biggest Loser competition, the degree of metabolism reduction was not related to contestants’ subsequent weight regain, and in fact, the contestants that maintained the greatest weight loss six years after the competition actually had the greatest amount of metabolism adaptation. This suggests that metabolic adaptation is a response to the change in lifestyle, namely the dramatic increase in physical activity observed in those who maintained the most weight loss. Fortunately for those trying to maintain significant weight loss, the compensatory mechanisms do not completely counteract lifestyle changes, so it is possible to keep off substantial amounts of weight.

What have we learned about weight loss from studying The Biggest Loser contestants?

Taken together, what we’ve learned from these studies on The Biggest Loser contestants is that while short-term reductions in resting metabolic rate are related to the extreme calorie restriction at the time of active weight loss, the larger, persistent metabolic adaptation that takes place later is related to substantial sustained increases in physical activity.

Results from the National Weight Control Registry (established in 1993 to determine characteristics of individuals successful at keeping weight off) have long demonstrated that physical activity is a key component of successful weight maintenance. What we don’t yet know is how sustained increases in physical activity lead to improved maintenance of lost weight, despite the compensatory long-term reduction in resting metabolic rate. Dr. Hall theorizes this could potentially be because of the effect of physical activity on lowering appetite.

But as is always the case, additional studies are needed to fully clarify the relationship between body composition, physical activity, energy regulation, and weight maintenance. In the meantime, we should continue to follow the well-founded advice to eat healthy whole foods in moderation, avoid processed foods, and engage in regular physical activity to maintain a healthy body weight.

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Pandemic challenges may affect babies — possibly in long-lasting ways

The COVID-19 pandemic has been hard on so many people in so many ways. For babies born during this pandemic, a study published in JAMA Pediatrics suggests that the damage has potential to be lifelong.

The first three years of life are crucial for brain development. And it’s not just the health of babies that matters, but the interactions between babies and their caregivers. Babies need to be touched, held, spoken to, smiled at, played with. As they receive and respond to those interactions, in a “serve and return” kind of way, neural connections are built in the brain. When babies don’t have those interactions, or enough of them, their brains don’t develop as they should — and can even be literally smaller.

When you are a stressed or depressed parent or caregiver, it can be hard to find the time, let alone the energy or interest, to talk to and play with your infant. There are multiple studies showing that maternal depression, poverty, and other family stressors can change the development of a child forever.

How was the study done?

In this study, part of an ongoing study of mothers and babies, researchers from Columbia University looked at the development of three groups of 6-month-old babies. Two of the groups were born during the COVID-19 pandemic; the mothers of one group had COVID-19, while the mothers of the other did not. The third group was a historical cohort (a group of babies who were born before the pandemic).

Mothers participating in the study used an Ages and Stages Questionnaire (ASQ-3) to record their babies’ development. The researchers noted no difference in the development of the two groups of babies born during the pandemic, suggesting that prenatal exposure to COVID-19 doesn’t affect development, which is great news. But the babies born during the pandemic scored lower in gross motor, fine motor, and social-emotional development than the babies born before the pandemic. Examples of developmental tasks for infants this age are rolling from back to tummy (gross motor), reaching for or grasping a toy with both hands (fine motor), and acting differently to strangers than to parents or familiar people (social-emotional development).

What does it suggest about infant development during the pandemic?

It’s just one study, and we need to do more research to better understand this, but the findings are not really surprising given what we know about infant development. The COVID-19 pandemic has caused a lot of stress — emotional, financial, and otherwise — for so many families. It has also markedly affected the number and kind of interactions we have with other people. Babies are on average interacting with fewer people (and seeing fewer faces because of masking) than they did before the pandemic.

Even though we need to do more research, this study should serve as an alarm bell for us as a society. The children of this pandemic may carry some scars forever if we don’t act now. We’ve been seeing the emotional and educational effects on children; we need to be aware of the developmental effects on babies, too. All of these could permanently change their lives.

What can we do to address these challenges?

We need to find ways to support families with young children, financially and emotionally. We need to be energetic and creative, and work every angle we can. While our government should play a role, communities and individuals can help too.

We need to refer families to and fund early intervention programs around the country that support the development of children from birth to 3 years of age. Because of the pandemic, many of these programs have moved to virtual visits, which can make them less effective. So we need to get creative here, too. We can’t just wait for the pandemic to be over.

And parents and caregivers of infants and toddlers need to know about this research — and ask for help. It’s understandable and natural for parents to think that babies are too small and unaware to be affected by the pandemic. But they are affected, in ways that could be long-lasting. Talk to your doctor about what you can do to help yourself, your family, and your baby’s future.

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