With Age Comes Happiness

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February 19th, 2013

Wisdom may come with age, but does happiness follow suit?

Some studies show that the elderly may be more prone to depression and loneliness, which can lead to higher rates of unhappiness, not a surprise given the health and emotional challenges that tend to accompany aging. But increasing, more and more studies suggest that happiness may actually rise after middle age — at least when scientists take into account some of the non-biological factors that can influence reports of contentment.

In a new study, which was published in Psychological Science, researchers led by Angelina Sutin of Florida State University College of Medicine examined data from two large samples of people; one included nearly 2,300 primarily white and highly educated people with an average age of 69 living in a Baltimore community between 1979 and 2010. The second group included reports of well-being collected in the 1970s from a representative sample of some 3,000 adults from the U.S. population who were in their late 40s and 50s at the time of the study.

Sutin and her colleagues were particularly interested in exploring whether differences in happiness reported by different generations — the middle-aged vs. the elderly, for example — were related to factors that have nothing to do with aging itself, but rather reflect life situations reflecting when they were born.

For instance, growing up in tough economic times might reduce the sense of well-being of an entire generation— and if this group is compared to younger folks who got their start in better times, being older might seem to cause a decline in happiness, when instead, the older people were actually less happy because they were unable to overcome the effects of early adversity.

When the researchers adjusted for the influence of such generation-wide life experiences, says Sutin, “Well-being may increase with age and also across generations. Those born during the early part of the 20th century had lower levels of well-being than those born more recently. Once we accounted for the fact that people grew up in different eras, it turns out, on average, people maintain or increase their sense of well-being as they get older.”

This suggests that previous studies that compared people across generations measured a decline in well-being that was mis-attributed to aging, and was actually due to initial differences in happiness, related to events such as the Great Depression and ongoing improvements in longevity and health.

People born in 1940, for example, scored nearly 3 times higher on measures of well-being related to the time period immediately preceding the survey (responses to items like “I enjoyed life” and “I was happy”), compared to those born in 1900.

What does that mean for the current generation, which is facing another difficult recession with high unemployment and wage stagnation? “The … [r]ecession was certainly devastating for many people. Too many people lost their jobs and their homes and the repercussions are still being felt,” Sutin says.

And those consequences may leave a lasting legacy. “The extent to which this recession will have a long-lasting effect on well-being is an open question at this point. A number of longitudinal studies have shown that after periods of unemployment, well-being does not quite recover to pre-unemployment levels. When unemployment is widespread, as was the case during the Great Depression, the well-being of a whole generation may not recover.”

Fortunately, however, even those born in tough times will see some rise in happiness with age — or at least they won’t become unhappier. Although the change is not as large as the difference in happiness that comes from being born in a better time, it is measurable and occurs consistently. “[R]elative to their starting point, all of the cohorts increased rather than decreased in well-being with age,” the authors write.

So why do we tend to think of older people as primarily depressed and unhappy, a perception that seems to be supported by the fact that the elderly have the highest suicide rates, when they themselves often report being happier now than when they were younger — and when studies show well-being rises after mid-life?

One reason for the happiness and suicide rates being at-odds could be related to the fact that happiness ratings often rely on general population figures, not measures of particular individuals, which can be much more varied. As data from several Scandinavian countries shows, it’s possible for a country to lead the world in both population happiness and suicide rates. While the reasons aren’t clear — perhaps the cold, dark winters are difficult to take for some, or perhaps being depressed when everyone around you is happy is even harder to take — the conflicting trends do occur simultaneously.

“It does seem like a paradox, but both happiness and depression can increase with age,” says Sutin. It is possible to swing between the two states and it is also possible that age pushes people to one extreme or another. “With age, people tend to become more emotional and experience both sadness and happiness,” she says. That could account in part for why we tend to see the elderly as sad: the sadness is both more visible and more congruent with our expectations about this stage of life.

“Especially when we’re young, it’s really easy to look at older adults and see the loss: loss of youth, loss of mobility, loss of loved ones,” Sutin says. “We assume that all of that loss would make older adults unhappy. It’s harder to see the benefits of aging: feelings of pride for children and grandchildren, a meaningful career, more confidence, wisdom. There are a lot of reasons to be happy in older adulthood, but they may not be as visible as the losses.” When they are, however, it turns out that happiness is one of the benefits that come with age.

Read more: http://healthland.time.com/2013/02/18/with-age-comes-happiness/#ixzz2LKsgTWqe

Anxiety, you’re not the boss of me

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February 12th, 2013

By Richard Lucas, Special to CNN

Editor’s note: Richard Lucas was diagnosed with panic disorder, a type of anxiety disorder, about five years ago. He now lives in Virginia and manages his condition with drugs and therapy. He first shared his story on CNN iReport.

It was a morning like any other. I woke up and went through my daily routine, slopped on some hair gel and a few sprays of cologne, and made my way to work. I picked up breakfast, then headed outside for my traditional post-meal smoke.

There I was, sitting outside on a cool San Francisco Tuesday, when, suddenly and inexplicably, pain covered my chest. Squeezing pain, as if someone had picked me up from behind and given me a bear hug of massive proportions. I stood up, stretched and rubbed my chest, hoping for the pain to disperse. But it got worse.

I went back inside and sat down. My boss noticed my visible discomfort and asked if I was all right, so I described my symptoms. Then he asked a question that changed the course of my life forever: “Do you need to go to the hospital?”

I was a 25-year-old healthy man who’d never broken a bone or had anything more serious than an ingrown toenail. But that morning when I heard the word “hospital,” I was certain that I was about to die.

“Yes” I mumbled. “I need you to get me to the ER; I think I’m having a heart attack.”
I arrived at the emergency room and flew through the doors as a person in a life-threatening emergency would. “I’m having a heart attack,” I dramatically proclaimed. The nurse rushed me to the back as I heard the call go out over the radio: “Possible MI, male, room two.” (MI stands for myocardial infarction, i.e., a heart attack.)

The doctors entered and looked puzzled. I was pretty young to be experiencing chest pain. They confirmed I was the correct patient, then diligently ran a battery of tests. After several hours of being prodded and poked, they determined that there was nothing wrong with me, but that this was the product of stress.

When does anxiety need treatment?

I was utterly dumbfounded by the idea that I, always fearless and never really worried about anything, could have been reduced to a blubbering victim of stress. It made no sense. But hey, I thought. I wasn’t dying. I had that going for me, and to hear I was medically sound made me feel pretty good about myself. I’d been checked out and now it was over, right?

Wrong. On a business trip a few weeks later, it hit me again, so bad this time that I was racing down the shoulder of the interstate trying to get to the ER. Once again, the doctors said it was stress.

At their recommendation, I sought a regular primary care physician. I assume that he had never felt the feelings that I was having. He referred me for a full cardio workup, just to ease my concern, scratched off a prescription for Xanax and sent me on my way.

By this point, my occasional outbursts of despair — panic attacks — had forged a constant fear that another one was on its way. I checked my pulse constantly to make sure my heart was still beating, I lay in bed with my hand on my chest to feel my heart, and I went into panic mode daily.

Five years, 25 emergency room visits and upwards of 30 doctors’ appointments later, I have finally found some resolution in my battle with anxiety. For those of you who also suffer, or have someone in their life who suffers, I wanted to share what I’ve learned.

To those with a friend or loved one who has anxiety disorder:

I know that you don’t understand this apparent madness, and I hope for your sake that you never do, but please be supportive.

Do not, under any circumstances, disregard or downplay the victim’s feelings. For someone who has never suffered from anxiety, the idea of such an absurd and irrational thought process is difficult, if not impossible, to understand. But for those of us who have felt this way, it is very real and extremely scary.

We’re a fragile bunch, and telling us mid-panic attack there’s nothing wrong with us is the equivalent of kicking someone in the shin and then telling them the pain is all in their head. You may know for a fact that there is nothing wrong — and rationally, we often know it too — but the anxiety is very real and disregarding it just intensifies it.

Do remind us that we are going to be OK. That validates our feelings, helps us focus on how the situation will end and takes us out of the panicked moment.

To my fellow jittery friends:

My biggest piece of advice is to find a compassionate doctor who will give you the support and attention that you need. I finally found one after going through half a dozen or so, and she is amazing. So amazing that she even came to therapy with me, twice! Talk with your doctor and agree upon a medication or other course of therapy that will help you.

Find someone that you can talk to, someone who understands. You may find comfort in a support group, either online or in person. They’re full of people just like us who are there to vent and be supportive of one another. No matter what kind of anxiety you experience, there is someone else who knows exactly how you feel.

Here’s one for the moment when you decide that you are actually dying and are in need of immediate emergency care: Think about how it ends. Think about how it ends with you walking out of the hospital, carrying your discharge papers. This time, it will end the same.

Can anxiety kill your ability to love?

Am I completely cured? No, and I never will be. But I have learned to manage much better. I’m proud to say that I haven’t visited an emergency room in about nine months, a huge feat for a guy who was getting to know the staff by name. I have a network of very supportive people in my life, including my doctor, without whom I’d probably be doing my routine of pulling into a gas station and yelling for an ambulance, rather than writing this article.

I used to be a SCUBA diving instructor, fearlessly navigating the deep, coming face to face with sharks while keeping my students safe and alive. The last two times I dove, I was struck with panic and had to abort, but in a few months I will return to the depths of the ocean and I will conquer my fear.

I will conquer because I will not allow anxiety and panic to kill another day of my life. It’s my life, and anxiety can’t have it anymore.

You can find more information on panic disorder and other anxiety disorders at the National Institute of Mental Health.

The Most Stressed Out Generation? Young Adults

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February 11th, 2013

By Alexandra Sifferlin

The latest survey shows stress is on the decline overall, but still hover above healthy levels, especially for young adults.

In the national Stress in America survey, an annual analysis by Harris Interactive for the American Psychological Association, 35% of adults polled since 2007 reported feeling more stress this year compared to last year, and 53% said they received little or no support from their health care providers in coping with that heightened stress. The survey involved more than 2,000 U.S. adults ages 18 and older who answered an online survey in August 2012.

The participants ranked their overall stress level on a scale from one to 10, with 1 being ”little or no stress” and 10 being ”a great deal of stress.” Overall, stress in America has been declining since 2010, when 24% of Americans reported experiencing extreme stress compared to 20% in 2012. And on average, the participants reported a stress level of 4.9, compared to the 5.2 they reported in 2011.

But that trend masks some concerning hints that those declines aren’t deep enough. Most adults said that they considered a stress level of 3.6 to be healthy, or manageable, and current levels remain stubbornly above this mark. The common source of stress involved money, with 69% of participants citing financial problems and conflicts as the primary cause of their anxiety, while 65% fingered work, 61% noted the economy, and 56% pointed to relationship angst.

The most concerning trend emerging from the data, however, is the fact that most Americans don’t feel they are managing their stress well, and that the healthcare system isn’t there to help them cope. A little over half of the participants said they received little or no support for stress management from their health care providers and while 32% felt it was important to discuss their concerns about stress with their health care providers, only 17% said they actually did.

Despite the fact that stress increasingly touches the life of almost every American, and that there are lifestyle changes that can help to relieve some of the worst aspects of stress, once the doctor’s office, it’s not a common topic of discussion. About 20% report never talking to their health provider about lifestyle changes to improve their health, 27% don’t discuss their progress in making behavior changes to curb stress, 33% never talk about how to manage stress and 38% never discuss their mental health.

These potential consequences are especially worrisome since the survey showed that young adults, between the ages of 18 to 33, reported the highest average level of stress at 5.4, meaning they may have to bear the brunt of the long term effects of stress throughout their lives. Thirty nine percent of this younger generation reported that their stress level had increased in the past year, compared to 29% of those aged 67 or or older. These young adults also admitted to feeling the least equipped to manage their stress well.

What is triggering all this worry? Among those aged 18 to 47, work, money and job stability contributed the most anxiety, while those aged 48 and older were more likely to be concerned with either their own health or that of their families.

“Millennials [those aged 18 to 33] are growing up at a tough time,” Mike Hais a market researcher and co-author of two books on that generation, including Millennial Momentum, told USA Today. “They were sheltered in many ways, with a lot of high expectations for what they should achieve. Individual failure is difficult to accept when confronted with a sense you’re an important person and expected to achieve. Even though, in most instances, it’s not their fault — the economy collapsed just as many of them were getting out of college and coming of age — that does lead to a greater sense of stress.”

Women reported feeling more stress than men, with an average rating of 5.3 vs. 4.6, and women were also more likely to feel that their stress levels increased over the past five years. Men, however, are making more strides in managing their stress, primarily through exercise or listening to music; 39% of men reported being able to cope with anxiety in the most recent survey, compared to 30% in 2010, while 34% of women felt they were able to manage their stress successfully.

Despite the encouraging signs that overall stress levels appear to be dropping, the researcher say that the lack of adequate stress management could end up reversing that trend. More discussions about stress in the doctor’s office, as well as support for lifestyle and behavior changes to cope with people’s major worries, could significantly improve the anxiety that inevitably comes with living in difficult economic times. As the authors write in the report, “If left unaddressed, this disconnect between untreated stress and chronic illness could contribute to a continued and unnecessary increase in the number of chronically ill Americans, along with a further escalation in health care costs.” Stress may be unavoidable, but managing it shouldn’t be so out of reach.

Should Mentally Ill Patients Be Allowed to Smoke?

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February 11th, 2013

By Maia Szalavitz

Quitting smoking is hard enough on its own, but studies show the challenge is even greater if you suffer from a mental illness — which is why many treatment facilities still allow patients to smoke, even encouraging the habit by using cigarettes as a reward for complying with tests or therapies.

According to the Centers for Disease Control and Prevention (CDC), around 31% of cigarettes in the U.S. are smoked by people with mental illness. And the New York Times details the long-standing tradition of smoking in mental health facilities, along with the growing controversy triggered by administrators’ attempts to now change course and ban cigarettes.

People with mental illness are 70% more likely to smoke than those who are not mentally ill— and at least 50% less likely to quit successfully. This includes people with depression and anxiety disorders as well as those with schizophrenia and bipolar disorder. The more disabling the mental illness is, the higher the smoking rates are, with about 88% of people with schizophrenia being regular smokers.

Those who run psychiatric hospitals and other facilities for the mentally ill are familiar with the high rate of lighting up among their patients, and there is even evidence explaining why smoking is so appealing to those with mental illness. Research shows that nicotine can have antidepressant and antipsychotic effects— and advocates for the mentally ill also maintained that it would be cruel to deprive patients of one of the few pleasures they enjoyed while hospitalized.

So despite the known health hazards of smoking, including the risk of heart disease, stroke and lung cancer, administrators accepted the habit as a necessary evil, often turning a blind eye to health risks in favor of the more immediate benefit of having patients comply with treatments.

The lenient smoking policies are taking a toll, however, and the article notes that a recent report from the National Association of State Mental Health Program Directors showed patients in these facilities are dying on average 25 years sooner than the general population, many from smoking-related diseases. That trend is prompting administrators to re-evaluate their smoking policies, with many hospitals trying to ban or at least rein in smoking.

But the bans may be only marginally effective in protecting patients from tobacco-related health problems; the trend toward shorter stays in mental health facilities means patients stop only temporarily, and start lighting up again once they leave.

Supporting patients with smoking-cessation therapies, however, has had mixed results. Patches and gum can help in some cases by providing the therapeutic benefit of nicotine with far less risk. And a small preliminary study in Italy suggests that e-cigarettes, which deliver nicotine without the accompanying tar and smoke of tobacco, can cut cigarette consumption by 50% in about half of people with schizophrenia, even if they weren’t trying to quit.

Chantix (varenicline) and Xyban (bupropion) can be used for most patients, but these medications present additional problems for the mentally ill. Xyban, for example, can’t be mixed with certain antidepressants and Chantix, which is roughly twice as effective as other methods, carries the risk of intensifying or even causing psychiatric symptoms.

So facilities are left with few good options. “I am ambivalent about this,” says Harold Pollack, professor of social service administration at the University of Chicago and an expert on substance use disorders. “I am a strong proponent of aggressive tobacco control policies,” noting that both of his in-laws died early and suffered from lung cancer and that cigarettes take a disproportionate toll on the mentally ill. “Given this reality, I certainly would oppose all-too-common behavioral control strategies that use cigarettes as incentives or rewards within psychiatric settings. Yet there is another side. I am uncomfortable with the level of coercive paternalism exemplified by that policy. People have a legal and moral right to smoke, even though this is often a foolish and self-destructive choice. To completely ban smoking strikes me, on balance, as an unduly severe infringement of patient autonomy. We wouldn’t physically prevent heart failure patients from smoking. We shouldn’t do this to mentally ill patients, either.”

Dr. Mark Willenbring, former director of the treatment and recovery division of the National Institute on Alcoholism and Alcohol Abuse and current head of Alltyr, a treatment program in Minnesota, agrees that the question is complex and that we don’t have good research about how to help the mentally ill quit. Because nicotine can affect the way some antipsychotic medications are metabolized, even suppressing their effectiveness, he says there’s a good argument that it should permitted during short stays among those who plan to continue smoking, to ensure that doctors reach the accurate dose of the drugs that their patients need.

However, he says, “On balance, I favor anything that discourages smoking since it is the single most destructive thing you can do to your body. So I would tend to say no, residential facilities should not allow smoking. At the same time, there needs to be a lot more research on how to help people with severe mental illness stop smoking and remain abstinent.” As some mental health hospitals start to implement no smoking policies, some of that research may just be getting started.

Let’s talk about sex … and cancer

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February 7th, 2013

By Jacque Wilson, CNN

Michelle was prepared for chemotherapy. She was prepared to lose her hair and deal with extreme nausea and be hospitalized for months at a time.

She was even prepared to die — knowing, with her aggressive form of leukemia, that death was a very real possibility.

But when death didn’t come, Michelle was officially labeled a cancer survivor. And she wasn’t at all prepared for what came next.

Treatment forced the mother of two through menopause, leaving her hormones reeling. Stress and self-doubt created problems with her husband of 24 years.

She also suffered from vaginal stenosis, a narrowing of the vaginal passage so severe that intercourse was impossible. As her primary care physician explained, she was basically a BAV: born again virgin.

“I was 49 when I was diagnosed, 50 when I received my (bone marrow) transplant,” said Michelle, who asked not to be identified by her full name due to the personal details she’s revealing. “I wasn’t ready to give up on a very important part of my well-being — that being my sexuality.”

There are 13.7 million cancer survivors living in the United States; the American Cancer Society estimates there will be 18 million by 2022. Survivors face many long-term effects of treatment, from secondary cancers to cardiovascular problems to cognitive defects. But the debilitating effects on a patient’s sexuality are often ignored, said Sharon Bober, director of the sexual health program at the Dana-Farber Cancer Institute in Boston.

Bober’s program is one of a handful of sexuality-focused survivorship programs that have popped up at cancer centers around the country. Bober was inspired to start the program when she realized many of her patients — adult survivors of pediatric cancers — were struggling with sexual issues and had no idea where to go for help.

Radiation, chemotherapy, hormone therapy and surgery all have the capacity to affect sexual function significantly, Bober said.

In one study, young breast cancer survivors reported skin sensitivity, vaginal dryness, genital pain, premature menopause, fertility issues and extreme fatigue. Their scores on a sexual health test were also lower than the general population’s, indicating problems with sexual desire, arousal, attaining orgasm and relationship satisfaction.
I wasn’t ready to give up on a very important part of my well-being.
Michelle, cancer survivor

These symptoms are common for cancer patients, Bober said. Men face many of the same issues in addition to erectile dysfunction.

The side effects don’t stop when treatment stops. Bober and her colleagues recently completed a study of 200 young adult cancer survivors; a significant number of them talked about long-term sexual problems years after their therapies were complete.

Imagine dealing with all the normal teenage development changes on top of dealing with cancer. Many pediatric cancer survivors feel uncomfortable even dating, Bober said.

Adult cancer survivors can also be apprehensive about the bedroom: Hormonal changes from chemotherapy and radiation often lower a patient’s sex drive. And many face self-confidence issues post-treatment.

Right next to the wigs and prosthetics in Dana-Farber’s patient store are vibrators and lubricants, which Bober said helps normalize the “personal products” she advocates using. Bober works with a team of doctors to provide whatever services her patients need, whether it’s couples therapy or education on vaginal health after early menopause.

Bober’s program helped Michelle understand what had happened to her sexuality — both physically and mentally. “She not only provided us with the emotional tools to overcome the changes we experienced, she also encouraged me to use ‘tools’ to help my body get its groove back,” Michelle said.

“I will often joke that I never expected vibrators to be prescribed. But they were absolutely necessary.”

Behind closed doors

Most of Bober’s patients are simply grateful to learn that there’s nothing wrong with them or their relationships. Although studies have shown sexuality plays an important role in happiness and quality of life, it’s not something doctors discuss often, Bober said.

We live in a culture that does not support or facilitate honest and frank conversations about sex anyway,” she said. “Lots of people assume that because no one says anything about it, this is just the price that they have to pay.”

No one knows about America’s behind-closed-doors policy on sex better than Patty Brisben, co-author of “Sexy Ever After: Intimacy Post-Cancer,” and founder of Pure Romance, the world’s largest in-home party company specializing in bedroom accessories.

As an advocate for sexual health awareness, Brisben often does group presentations. Usually she conducts a 20-minute question-and-answer session at the end of her talk. Several years ago, a group of young cancer survivors held her captive with questions for more than two hours.
We live in a culture that does not support or facilitate honest and frank conversations about sex.
Sharon Bober, sexual health program director at Dana-Farber Cancer Institute

“Women that are 19 and 20 years old, who never had that first sexual experience — doctors telling them (to buy) bedroom toys to stimulate so atrophy wouldn’t set in,” Brisben remembers. They asked, “Patty, what does that mean?”

That was the start of Pure Romance’s Sensuality, Sexuality, Survival program. Consultants from the company meet with cancer survivors to talk about combating dryness with lubricants and using other toys to enhance sexual pleasure.

“It has a lot to do with education,” Brisben said. “It’s so important to provide a safe platform where women can ask questions.”

Brisben teaches her employees not to sugarcoat anything. It’s a long journey, she said, and each cancer survivor needs to learn to stand up for herself; sexuality can’t be a dirty word.

“You truly have to be your own disciple,” she said. “Women will demand when it comes to our children or our significant others, but we don’t demand for our bodies.”

A return to intimacy

Michelle’s husband was a “trouper” through her cancer treatment, she said, but the couple had difficulty reconnecting in the bedroom. With her symptoms, her husband had trouble keeping an erection out of fear of hurting her.

She remembers thinking, “He must be so traumatized. … He only sees me now as a frail being and not as the woman I used to be.”

Cancer can test any relationship, said CNN’s sex expert Ian Kerner. It’s not uncommon for cancer patients to become depressed and question their life path, he said, which a partner can find hard to relate to.

“Ultimately, of course, when you’re in the midst of a battle of cancer, you really are focused on survival,” he said. “But as you resume your life, you want to resume all aspects of your life. And sexuality becomes a key factor.”

Kerner recommends couples start slow: Act like two people in love again, instead of patient and caregiver, by going out on date nights and cuddling in front of the fire.

Make your sexuality an ongoing conversation, he said. Your newfound intimacy might not necessarily be sex in the way it once was — you have to find a new version of sex that works for you.

“Recovering from cancer, you’re often not talking about weeks or months,” Kerner said. “You’re talking about years.”

Michelle has been in remission since March 2009. She’s adjusting to life as a survivor, volunteering at Dana-Farber to help others who are dealing with similar emotional scars.

“I’m striving to get back on track with normalcy,” she said, “in every facet of my life.”