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Depression in Seniors is Often Unnoticed

depression uptown dallas counseling

Family members and even primary healthcare providers often mistake an older adult’s symptoms of depression as just a natural reaction to illness or an unavoidable part of the aging process. Older adults themselves often share this belief and suffer unnecessarily because they don’t understand that they could feel better with appropriate treatment.

Statistics on Mental Health and Seniors

Recent data indicate that an estimated 20.4 percent of adults aged 65 and older met criteria for a mental disorder. (Karel, Gatz & Smyer, 2012). The CDC’s 2013 report on The State of Aging and Health in America identified “addressing mental distress among older adults” as one of its primary Calls To Action needed to improve the health and well-being of older adults.  The CDC estimates:  About 25% of adults aged 65 years or older have some type of mental health problem, such as a mood disorder not associated with normal aging. Mental distress is a problem by itself, and it has been associated with unhealthy behaviors than can interfere with self-management and inhibit recovery from an illness.  

How Can we Help Change these Statistics?

Talking to seniors about their mental health can be challenging. Family members, caregivers, and even many medical professionals are not trained to assess mental disorders.  Conversations can be awkward.  Seniors are often reluctant to talk about their symptoms.  

The most common mental disorder among older adults is depression.  Depression, once diagnosed, often responds quickly to treatment.  Most older adults with depression improve when they receive treatment with an antidepressant, psychotherapy, or a combination of both. If left untreated, however, depression may result in the onset of physical, cognitive, functional, and social impairment, as well as decreased quality of life. 

If you suspect an older adult has depression, there is an easy, direct way to talk with them about their symptoms.  The Geriatric Depression Scale (GDS) is a reliable 15-question assessment that anyone can use.  Ask the senior to answer the following questions:

Geriatric Depression Scale: Short Form
Choose the best answer for how you have felt over the past week:
1. Are you basically satisfied with your life? YES / NO
2. Have you dropped many of your activities and interests? YES / NO
3. Do you feel that your life is empty? YES / NO
4. Do you often get bored? YES / NO
5. Are you in good spirits most of the time? YES / NO
6. Are you afraid that something bad is going to happen to you? YES / NO
7. Do you feel happy most of the time? YES / NO
8. Do you often feel helpless? YES / NO
9. Do you prefer to stay at home, rather than going out and doing new things? YES / NO
10. Do you feel you have more problems with memory than most? YES / NO
11. Do you think it is wonderful to be alive now? YES / NO
12. Do you feel pretty worthless the way you are now? YES / NO
13. Do you feel full of energy? YES / NO
14. Do you feel that your situation is hopeless? YES / NO
15. Do you think that most people are better off than you are? YES / NO

Answers in bold indicate depression. Score 1 point for each bolded answer.
A score > 5 points is suggestive of depression.
A score ≥ 10 points is almost always indicative of depression.

Source: http://www.stanford.edu/~yesavage/GDS.html
This scale is in the public domain.

Any score greater than 5  warrants a follow-up assessment by a medical professional. If your senior scores higher than 5, help them schedule an appointment to discuss the results and form a treatment plan with a healthcare provider.

If you or someone you care about is in crisis, please seek help immediately using one of the following methods:

  • Call 911
  • Visit a nearby emergency department or your health care provider’s office
  • Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor

Sources: 

Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013.

Karel, M. J., Gatz, M. & Smyer, M. A. (2012). Aging and mental health in the decade ahead: What psychologists need to know. American Psychologist, 67, 184-198.

Lyness JM, Noel T, Cox C, King DA, Conwell Y, Caine ED. Screening for Depression in Elderly Primary Care Patients: A Comparison of the Center for Epidemiologic Studies—Depression Scale and the Geriatric Depression Scale. Arch Intern Med. 1997;157(4):449-454. doi:10.1001/archinte.1997.00440250107012.

U.S. Department of Health and Human Services, National
Institutes of Health, National Institute of Mental Health. (2015).
Depression (NIH Publication No. 15-3561). Bethesda, MD: U.S.
Government Printing Office.

 

 

Depression: Waiting 10 Years for Help

depression uptown dallas
One in 10 Americans are suffering from Depression at any given time. Are you worried someone you know may be more than just sad? It is often hard to know the difference between Clinical Depression and sadness. In this 4-minute Ted-Ed video, Helen M. Farrell examines the symptoms and treatments of depression, and gives some tips for how you might help a friend who is suffering.

A surprising statistic from the video:
An individual waits and average of 10 years to seek help for depression.

Uptown Dallas Counseling provides CBT: Aaron Beck’s Blueprint

CBT Uptown Dallas Counseling

Dr. Aaron Beck, founder of CBT

Uptown Dallas Counseling provides CBT or Cognitive Behavioral Therapy.  The founder of CBT, Dr. Aaron Beck, explains his view of CBT in this 6-minute audio track.

Dr. Beck founded the Beck Institute of Cognitive Therapy in 1994.  From the Beck Institute website:

Beck Institute for Cognitive Behavior Therapy is a leading international source for training, therapy, and resources in CBT. Our Center for Training delivers workshops to a worldwide audience of mental health professionals, researchers, and educators, and our Philadelphia-based Center for Psychotherapy provides state-of-the-art therapy and consultations.
Dr. Aaron T. Beck developed Cognitive Behavior Therapy (CBT) at the University of Pennsylvania in the 1960s. In 1994, Dr. Beck and his daughter, Dr. Judith Beck, established Beck Institute as a non-profit 501(c)(3). Their goal was to create a new clinical setting that would provide both state-of-the-art psychotherapy and comprehensive training opportunities for professionals worldwide.
Over the past 20 years, our organization has carried out Dr. Beck’s therapeutic model and guiding principles in training more than 3,500 professionals through our Center for Training, and providing clinical therapy services to over 2,000 individuals, couples, and families through our Center for Psychotherapy.
In addition to our professional workshops and on-site psychotherapy practice, Beck Institute remains an international authority on, and resource for, CBT information and research. Our organization continues to partner with universities, hospitals, community mental health centers, health systems, and other institutions to create and improve cognitive behavior therapy programs.

Uptown Dallas Counseling provides CBT for anxiety, depression, bipolar disorder, and other mental health problems.

Depression Therapy Treatment with Cognitive Therapy

Aaron Beck Cognitive Therapy

Dr. Judith Beck with her father, Dr. Aaron Beck

At a fundraiser on November 11, 2013, Aaron Beck talked with an audience about Depression Therapy.  While treating patients for depression in the 1960’s, he recognized a repeated pattern.  When he helped patients change their current thoughts about themselves, the patients’ moods would improve.  For example, a patient would stop thinking “I am useless” because he lost a job, to “I am talented, I will find a new job.”  Dr. Beck began to change his focus of therapy from analyzing childhood events, to challenging patients to change their negative thoughts.  Additionally, he began encouraging them to recognize and remember the many positive aspects of their lives.  He went into academia at the University of Pennsylvania where he expanded, researched, and taught his ideas to others in the field of psychology,

Dr. Beck, 92, is known as the father of Cognitive Behavioral Therapy (CBT), and is internationally respected for his views on psychotherapy.  Dr. Beck has written dozens of books detailing effective ways to treat different disorders by using his “thought changing” techniques.  The November 11 event was a fundraiser for his Beck Institute of Cognitive Therapy.  The money raised will be used to defray the costs of teaching CBT to practitioners and allow low-income clients to receive CBT treatment at the Institute.

Stacy Burling’s article published in the Inquirer on November 11, 2014 describes the details of the event:

Judith Beck, a formidable psychologist in her own right, describes her father, the psychiatrist Aaron Beck, with a mixture of amusement and veneration, as a “rock star.”

The Becks were the attractions at a fund-raising event last week for their Beck Institute in Bala Cynwyd. But it was clear that the elder Beck, known as the father of cognitive behavior therapy and one of the world’s most influential therapists, was the main draw.

Before they took the stage at WHYY in Center City to discuss their form of treatment – aimed at changing self-defeating thinking – they met with 70 “patrons” who had paid $250 a ticket for one-on-one access.

Aaron Beck, known as Tim to friends, is 92 and seriously stooped, but he was engaging and congenial as well-wishers waited in line for a chance to bend down to talk with him.

He seemed to relish the job of selling the institute, which he and Judith Beck founded 20 years ago. After the remaining 90 ticket-holders ($150 and $75) were within earshot, he joked that he and she had kept news of the center quiet until now.

“This is sort of a coming-out party for the Beck Institute,” he said.

The institute provides training in cognitive therapy as well as treatment. It recently expanded both and was raising money to help defray costs for students and patients who cannot afford the fees. This was its first fund-raiser.

“We decided the time was right to get the word out more about what we do,” Judith Beck said.

Many people think all psychotherapy is the same and equally effective, she said. “You need someone with a kind ear and the expertise to get you over what you’re suffering.”

Aaron Beck was an early advocate of measuring the effectiveness of his therapeutic approach and says cognitive therapy is now well-positioned because the Affordable Care Act encourages the use of “evidence-based” treatments.

Under the benevolent questioning of WHYY host Marty Moss-Coane, the Becks talked about their past and future with a very supportive audience.

Before Aaron Beck described how he happened on the new approach in the 1960s, he warned, “I’ve told this story before, so those who’ve heard it before can turn off their hearing aids.”

He was doing traditional psychotherapy when a patient revealed that she worried during their sessions that she was boring him. Her tales of her sexual escapades were not boring. Beck started asking other patients what they were thinking, and a theme emerged. As they went about their lives, they were telling themselves, “I am a loser.”

No wonder they were unhappy.

Beck thought it might be more fruitful to worry less about how patients felt about their mothers and work instead on changing their thinking. In each case, he’d ask them “What is the evidence?” for the negative thoughts, and challenge them to consider another explanation. He also urged them to focus more on positive things that happened, since his depressed patients seemed to selectively remember the bad.

Patients started feeling better, he said, and after 10 or 12 sessions, they told him they longer needed him.

“Until then, I was able to fill my schedule up,” Beck said drily.

This newfound efficiency, he said, led to his academic career at the University of Pennsylvania.

While new therapists get training in cognitive therapy, and many say they do it, Judith Beck said most are not doing what she recognizes as cognitive behavior therapy.

In a true CBT session, she said, the therapist assesses the patient’s mood, asks about changes since their last meeting, including positive events, and works with the patient to set an agenda for the hour. They talk about distorted automatic thoughts and how to change them.

At the end, the therapist asks the patient to summarize what happened and write down what was important. They talk about the patient’s homework for the next session, and the therapist asks for feedback and ideas on how to do better next time. That sets a “collaborative” tone.

As for the future, Aaron Beck said he thinks that evidence eventually will lead to a single approach. Cognitive therapy will be a big component of it, but it will be “fleshed out and modified in many ways.”

Aaron Beck, who uses an iPhone, iPad, and Skype, also thinks technology will bring better treatment to rural residents.

Judith Beck said her highly accomplished family – her mother is retired Superior Court Judge Phyllis Beck – gets along well.

“My father would say, ‘Problems are meant to be solved,’ ” she said.

“Have you thought about working with Congress?” Moss-Coane quipped at one point.

Aaron Beck said his publisher considered sending copies of his book, Prisoners of Hate, to lawmakers when it came out in 1999, but never did. 

http://articles.philly.com/2013-11-14/news/44033725_1_cognitive-therapy-beck-institute-aaron-beck

Is a Lack of Sleep Causing Your Depression?

uptown dallas counseling and woman sleeping

When you are not getting adequate sleep, you suffer more than just the physical effects of being tired.  You can become irritable, impatient, anxious, and depressed.  Lack of sleep undermines creativity and efficiency. Fatigue can hinder your cognitive skills of memorization, concentration, and motivation. Getting an adequate level of sleep means you are not only sleeping the number of hours your body needs, but also your sleep is high quality sleep.

Negative Effects of Not Getting Enough Sleep

  1. Lower stress threshold. Normal, everyday tasks can feel overwhelming.
  2. Impaired memory. Your brain’s ability to form memories declines.
  3. Trouble concentrating. You lose your ability to focus on a task, but also often overestimate your performace.
  4. Decreased optimism and sociability. Sleep-deprived individuals consistently score higher on Hopelessness Scales and report the desire to isolate from others.
  5. Impaired creativity and innovation. New research suggests that sleep deprivation may have a particular effect on these two areas of cognition.
  6. Increased resting blood pressure. Even a half night of sleep loss can cause increases in blood pressure.
  7. Increased food consumption and appetite. Participants in scientific research showed an increase in their desire to consume food.
  8. Increased risk of heart attack. Sleep study participants had increased levels of inflammation associated with cardiac disease.
  9. Weakened immune system.  Sleep depravation causes white blood cell counts to rise.
  10. Decreased ability to metabolize sugar.

Ten Behaviors to help you get more, higher quality sleep:

  1. Establish a nightly sleep routine that includes a set bedtime.  One of the easiest behavior changes you can make to improve sleep is going to bed and waking up the same time every day.  (Including weekends.)
  2. Create a bedtime ritual that will send signals to your body and your brain that you are getting ready for sleep.  This ritual may include changing into pajamas, washing your face, brushing your teeth, etc.
  3. Do not take naps.  Even if you are tired from a previous night of little sleep, challenge yourself to stay awake until bedtime.
  4. Do not drink caffeine or alcohol, or smoke cigarettes close to bedtime.
  5. Exercising in the morning or early afternoon can help sleep patterns.  Vigorous exercise close to bedtime may delay your ability to fall asleep.
  6. Do not go to bed with a full stomach or an empty stomach.
  7. To associate your bed with sleep, do not engage in activities other than sex and sleep in your bed.
  8. Create a quiet, dark, and comfortable sleeping space.
  9. If you are unable to fall asleep for 30-45 minutes after going to bed, get up.  Do something relaxing like drinking herbal tea or reading something calming.  After 30 minutes, try to go to bed again.
  10. Reduce any stressful thoughts by making a TO DO list on paper.  Once you write these thoughts down, your level of stress will almost always decrease significantly.  Practice relaxation techniques before bed.  Deep breathing, meditation, and some forms of yoga can be helpful.

Once you commit to changing behaviors to improve your quantity and quality of sleep, keep track of your moods.  A simple piece of paper where you write your mood level (0 to 10, with 0 extreme sadness and 10 extreme happiness) can provide valuable information and motivation.  If you still need more motivation, keep a copy of the list of the negative effects of not sleeping well with you.

We all have different limitations on our time and resources that may prevent us from fully committing to getting more and better sleep.  If you can’t commit to making all the changes listed above, try a few.  Even small improvements in sleep can have a significant impact on our levels of mental and physical functioning.

Holly Scott, MBA, MS, LPC sees clients at Uptown Dallas Counseling. Holly is trained in the specialty of Cognitive Behavioral Therapy, and holds the position of Diplomate in the Academy of Cognitive Therapy. Holly works with clients to help them overcome challenges in their daily lives that may be preventing them from achieving happiness. She helps clients with stress management, depression, parenting, marriage counseling, and other mental health concerns. If you are looking for a counselor or therapist, explore this website to see if Holly may be able to help you. 

To make an appointment for therapy or counseling with Holly at her Uptown Dallas Counseling, you have the option of using the Online Patient Portal to register and schedule. 

Decisions and Emotions

decisions and emotionsChipotle’s Scarecrow video and game app is an effort to influence your decisions and emotions.  If you haven’t seen the video, you can view it here:

The video went viral with almost 6 million views on youtube and received wide critical acclaim for the video production quality.

The Week’s Peter Weber calls it “the most beautiful, haunting infomercial you’ll ever see.”  Read Peter Weber’s Review to see the rest of his opinions on the advertisement.
On the other hand, Funny or Die has produced a scathing video parody of  Scarecrow.  You can watch that video along with commentary by Scott Meslow here:

Critics of the Scarecrow campaign believe Chipotle is misleading consumers by displaying an inaccurate view of current factory farming practices.  Others believe Chipotle is attempting to make changes to current practices by increasing awareness.  Chipotle chief marketing officer Mark Crumpacker states in a USA Today article, “We’re trying to educate people about where their food comes from.”

Human beings make decisions based on emotions.  Chipotle’s Scarecrow is a classic attempt at generating an emotional response in individuals that will lead to buying decisions that are favorable to Chipotle.  The rebuttal videos and commentaries are attempting to generate emotional responses that will lead to buying decision that are unfavorable to Chipotle.

Where do you stand?  Is Scarecrow unethical, or is it exactly the same as any other type of marketing we are exposed to everyday?

Just Discovered Alana Karsch on Upworthy.com

As I was doing my evening internet browsing, I read some posts on Upworthy.com and tweets by Alana Karsch.  Liked them so much, I wanted to share her information here:

Google+
Facebook

upworthy.com

Alana Karsch

 By day I’m a transformative photographer and art therapist. At night, I sleuth the web for outrageously important stuff. I want you to be happier, smarter, healthier, and more generous. Also, I want to paint the world with watercolors and glitter. Share all this important goodness with me on Facebook and Twitter.- Alana Karsch

I love her goals and the approach she uses to try to achieve them.  Take a look.  You may also like them.

Emotional Intelligence

Jennifer Kahn writes in The New York Times about new programs for teaching emotional intelligence to children.  The goals of the programs are to:

  • Help children learn awareness of their own emotions as well as those of others
  • Teach children methods of self-soothing when emotions are triggered
  • Help children recognize the connection between emotions and behaviors.

Scientists believe children who learn these skills have a much lower chance of turning to substance abuse, violent behaviors, bullying, and other unhealthy coping strategies.

emotional intelligence

Photo by: Holly Anders, New York Times

 

Jennifer Kahn teaches at the University of California, Berkeley, Graduate School of Journalism.

Here is her article in its entirety:

One day last spring, James Wade sat cross-legged on the carpet and called his kindergarten class to order. Lanky and soft-spoken, Wade has a gentle charisma well suited to his role as a teacher of small children: steady, rather than exuberant. When a child performs a requested task, like closing the door after recess, he will often acknowledge the moment by murmuring, “Thank you, sweet pea,” in a mild Texas drawl.

 As the children formed a circle, Wade asked the 5-year-olds to think about “anything happening at home, or at school, that’s a problem, that you want to share.” He repeated his invitation twice, in a lulling voice, until a small, round-faced boy in a white shirt and blue cardigan raised his hand. Blinking back tears, he whispered, “My mom does not like me.” The problem, he said, was that he played too much on his mother’s iPhone. “She screams me out every day,” he added, sounding wretched.

Wade let that sink in, then turned to the class and asked, “Have any of your mommies or daddies ever yelled at you?” When half the children raised their hands, Wade nodded encouragingly. “Then maybe we can help.” Turning to a tiny girl in a pink T-shirt, he asked what she felt like when she was yelled at.

“Sad,” the girl said, looking down.

“And what did you do? What words did you use?”

“I said, ‘Mommy, I don’t like to hear you scream at me.’ ”

Wade nodded slowly, then looked around the room. “What do you think? Does that sound like a good thing to say?” When the kids nodded vigorously, Wade clapped his hands once. “O.K., let’s practice. Play like I’m your mommy.” Scooting into the center of the circle, he gave the boy, Reedhom, a small toy bear to stand in for the iPhone, then began to berate him in a ridiculous booming voice. “Lalalala!” Wade hollered, looming overhead in a goofy parody of parental frustration. “Why are you doing that, Reedhom? Reedhom, why?” In the circle, the other kids rocked back and forth in delight. One or two impulsively begin to crawl in Reedhom’s direction, as if joining a game.

Still slightly teary, Reedhom began to giggle. Abruptly, Wade held up a finger. “Now, we talked about this. What can Reedhom do?” Recollecting himself, Reedhom sat up straight. “Mommy, I don’t like it when you scream at me,” he announced firmly.

“Good,” Wade said. “And maybe your mommy will say: ‘I’m sorry, Reedhom. I had to go somewhere in a hurry, and I got a little mad. I’m sorry.’ ”

Reedhom solemnly accepted the apology — then beamed as he shook Wade’s hand.

emotional intelligence
Holly Andres for The New York Times

Wade’s approach — used schoolwide at Garfield Elementary, in Oakland, Calif. — is part of a strategy known as social-emotional learning, which is based on the idea that emotional skills are crucial to academic performance.

“Something we now know, from doing dozens of studies, is that emotions can either enhance or hinder your ability to learn,” Marc Brackett, a senior research scientist in psychology at Yale University, told a crowd of educators at a conference last June. “They affect our attention and our memory. If you’re very anxious about something, or agitated, how well can you focus on what’s being taught?”

Once a small corner of education theory, S.E.L. has gained traction in recent years, driven in part by concerns over school violence, bullying and teen suicide. But while prevention programs tend to focus on a single problem, the goal of social-emotional learning is grander: to instill a deep psychological intelligence that will help children regulate their emotions.

For children, Brackett notes, school is an emotional caldron: a constant stream of academic and social challenges that can generate feelings ranging from loneliness to euphoria. Educators and parents have long assumed that a child’s ability to cope with such stresses is either innate — a matter of temperament — or else acquired “along the way,” in the rough and tumble of ordinary interaction. But in practice, Brackett says, many children never develop those crucial skills. “It’s like saying that a child doesn’t need to study English because she talks with her parents at home,” Brackett told me last spring. “Emotional skills are the same. A teacher might say, ‘Calm down!’ — but how exactly do you calm down when you’re feeling anxious? Where do you learn the skills to manage those feelings?”

A growing number of educators and psychologists now believe that the answer to that question is in school. George Lucas’s Edutopia foundation has lobbied for the teaching of social and emotional skills for the past decade; the State of Illinois passed a bill in 2003 making “social and emotional learning” a part of school curriculums. Thousands of schools now use one of the several dozen programs, including Brackett’s own, that have been approved as “evidence-based” by the Collaborative for Academic, Social and Emotional Learning, a Chicago-based nonprofit. All told, there are now tens of thousands of emotional-literacy programs running in cities nationwide.

The theory that kids need to learn to manage their emotions in order to reach their potential grew out of the research of a pair of psychology professors — John Mayer, at the University of New Hampshire, and Peter Salovey, at Yale. In the 1980s, Mayer and Salovey became curious about the ways in which emotions communicate information, and why some people seem more able to take advantage of those messages than others. While outlining the set of skills that defined this “emotional intelligence,” Salovey realized that it might be even more influential than he had originally suspected, affecting everything from problem solving to job satisfaction: “It was like, this is predictive!”

emotional intelligence
Holly Andres for The New York Times

In the years since, a number of studies have supported this view. So-called noncognitive skills — attributes like self-restraint, persistence and self-awareness — might actually be better predictors of a person’s life trajectory than standard academic measures. A 2011 study using data collected on 17,000 British infants followed over 50 years found that a child’s level of mental well-being correlated strongly with future success. Similar studies have found that kids who develop these skills are not only more likely to do well at work but also to have longer marriages and to suffer less from depression and anxiety. Some evidence even shows that they will be physically healthier.

This was startling news. “Everybody said, Oh, it’s how kids achieve academically that will predict their adult employment, and health, and everything else,” recalls Mark Greenberg, a Penn State University psychologist. “And then it turned out that for both employment and health outcomes, academic achievement actually predicted less than these other factors.”

Should social-emotional learning prove successful, in other words, it could generate a string of benefits that far exceeds a mere bump in test scores. This prospect has led to some giddiness among researchers. Maurice Elias, a psychology professor at Rutgers University and the director of the Rutgers Social-Emotional Learning Lab, has lauded emotional literacy as “the missing piece” in American education.

But finding ways to measure emotional awareness — never mind its effects — is tricky. It’s also still unclear whether S.E.L. programs create the kind of deep and lasting change they aspire to. The history of education reform is rife with failures: promising programs that succeed in studies, only to falter in the real world. The phenomenon is so common that researchers even have a name for it: the Hawthorne effect — the fact that simply focusing attention on something, like a school, is enough to cause a temporary uptick in performance.

The problem of evaluating S.E.L. is compounded both by the variety of “prosocial” programs on offer and by the ways in which they end up being used in the classroom. Some of them — including one of the most popular, Second Step — are heavily scripted: teachers receive grade-appropriate “kits” with detailed lesson plans, exercises and accompanying videos. Others, like Facing History and Ourselves — in which children debate personal ethics after reading the fictionalized letters of a Nazi colonel and a member of the French Resistance — are more free-form: closer to a college philosophy seminar than to a junior-high civics class. ” ‘Mindful eating’ is social-emotional learning, according to some people,” Brackett told me. “It’s a mess. Everybody wants to jump on the bandwagon.”

David Caruso, a psychologist who does consulting and training in emotional intelligence, has called the current boom in social-emotional programs “promising,” but he worries that the field might be getting ahead of itself. “There are people who want to write this into the Common Core right now,” Caruso told me. “But before we institutionalize this, we’d better be sure that it makes a difference in the long run.”

Leataata Floyd Elementary, a school in a low-income part of Sacramento, has few problems with gangs or guns but a long history of dysfunction. Until recently, the staff attrition rate was more than 20 percent a year, and student test scores were regularly among the lowest in the state. Before the current principal, Billy Aydlett, was hired in 2010, there were six separate principals in five years.

Not long after he arrived, Aydlett created a detailed plan to boost the school’s academic performance. He recruited a roster of highly regarded teachers and developed an aggressive new curriculum full of rich and invigorating lessons. Once the school year started, however, it became clear that the new strategy was a bust. “Literally within the first month of school, we realized that we hadn’t planned for the right thing,” Aydlett recalled when I visited the school last spring. “What we discovered was that these kids weren’t going to be able to make progress on the academics until they’d gotten help with their social and emotional issues.”

emotional intelligence
Holly Andres for The New York Times

With the district’s support, Aydlett attended social-emotional learning training. The program was an unlikely choice for Aydlett — a socially awkward man who confesses to being “awful” at ordinary human encounters. But since beginning the emotional-literacy work, Aydlett said, he had become more aware of interpersonal dynamics, and even made going on a vacation with his wife a priority — something he never bothered to do before. (“I didn’t see the point in that kind of connectedness,” he admitted. “But I’ve learned that it’s important.”) On the morning I visited, he stood greeting children at the gate with high-fives, then led me to the classroom of Jennifer Garcia, who teaches second grade.

As Aydlett and I watched, Garcia walked her class through an exercise in nonverbal cues, asking the children to imagine times when they felt sad or angry or frustrated, and then to freeze in those expressions and postures. As the kids slumped forward in exaggerated positions of woe, Garcia complimented them on small details: a bowed head or hangdog expression. Afterward, Garcia turned to the class. “This is the thinking part of your brain,” she said, holding up her thumb. She pointed to her fingers. “And this is the feeling part of your brain.” Folding her thumb into the center of her palm, she closed her fingers around it. “When we have strong emotions, the thinking part of our brain can’t always control them,” Garcia explained, waggling her fist. “What do we do in those moments?” As the kids called out answers — counting to five, “self-talk,” “dragon breaths” (a kind of deep-breathing exercise) — Garcia nodded.

Such strategies may seem simplistic, but researchers say they can have a profound effect. When I spoke with Mark Greenberg, who developed a social-emotional curriculum known as Paths (Promoting Alternative Thinking Strategies), he noted that repeatedly practicing these skills means they gradually become automatic. “The ability to stop and calm down is foundational in those moments.”

The value of such skills was evident later that day, when I sat in on a fourth-grade class meeting, in which students worked through interpersonal conflicts as a group. Sitting in a circle on the carpet, Anthony, a small boy in a red shirt, began by recounting how he cried during a class exercise and was laughed at by some of the other students. Asked whether he thought the kids were giggling to be mean, or just giggling because they were uncomfortable, Anthony paused. “I think that some people didn’t know what to do, and so they giggled,” he admitted finally — though he was also adamant that a few of the kids were actually laughing at him. “I was really sad about that,” he added.

Though Anthony was still upset, his acknowledgment that not all the kids were snickering — that some may just have been laughing nervously — felt like a surprisingly nuanced insight for a 9-year-old. In the adult world, this kind of reappraisal is known as “reframing.” It’s a valuable skill, coloring how we interpret events and handle their emotional content. Does a casual remark from an acquaintance get cataloged as a criticism and obsessed over? Or is it reconsidered and dismissed as unintentional?

Depending on our personalities, and how we’re raised, the ability to reframe may or may not come easily. Richard Davidson, a neuroscientist at the University of Wisconsin-Madison, notes that while one child may stay rattled by an event for days or weeks, another child may rebound within hours. (Neurotic people tend to recover more slowly.) In theory, at least, social-emotional training can establish neurological pathways that make a child less vulnerable to anxiety and quicker to recover from unhappy experiences. One study found that preschoolers who had even a single year of a social-emotional learning program continued to perform better two years after they left the program; they weren’t as physically aggressive, and they internalized less anxiety and stress than children who hadn’t participated in the program.

It may also make children smarter. Davidson notes that because social-emotional training develops the prefrontal cortex, it can also enhance academically important skills like impulse control, abstract reasoning, long-term planning and working memory. Though it’s not clear how significant this effect is, a 2011 meta-analysis found that K-12 students who received social-emotional instruction scored an average of 11 percentile points higher on standardized achievement tests. A similar study found a nearly 20 percent decrease in violent or delinquent behavior.

When I spoke with teachers at Leataata Floyd, they reported seeing similar results. One teacher remembered the pre-S.E.L. school as being out of control, with kids throwing food and angrily upending their desks in class. Now, she says, “they may still blow up, but they take responsibility. That’s a new thing: they always used to blame somebody else. For them to take responsibility — it’s huge.”

emotional intelligence
Holly Andres for The New York Times

Starting in the late 19th century, the philosopher John Dewey argued against the development of purely vocational elementary schools, insisting that the true purpose of schooling was not simply to teach children a trade but to train them in deeper habits of mind, including “plasticity” (the ability to take in new information and be changed by it) and interdependence (the ability to work with others).

Social-emotional learning takes Dewey’s theory further, suggesting that all emotions — not just the right ones — are adaptive if properly managed. Studies have shown that people in a slightly sad mood are better at analyzing or editing a written document (they focus better on details), while people who are slightly angry are better able to discriminate between weak and strong arguments. The purpose of a social-emotional learning program, then, isn’t to elide emotion but to channel it: to surf the rapids rather than to be swamped by them. This can be hard to do. When we feel angry, we usually act angry — even when that makes the situation worse. The nature of emotion is that it tends to run away with us. “When a feeling is unpleasant, how are you going to handle it?” asks Stephanie Jones, a Harvard psychologist who has studied a number of social-emotional learning programs. “Do you default to an angry response, a defensive response? Or do you go into a mode that’s more information-seeking?”

Social-emotional learning programs often rely on strategies from conventional therapy, like the ability to get distance on a feeling, or to unpack the deeper emotions that may be hidden within it. But fostering these skills in a child is a complex undertaking. For a child to master empathy, Jones notes, she first needs to understand her own emotions: to develop a sense of what sadness, anger or disappointment feels like — its intensity and duration, its causes. That awareness is what lays the groundwork for the next step: the ability to intuit how another person might be feeling about a situation based on how you would feel in a similar circumstance.

When it comes to making social-emotional learning effective, Jones says, determining which skills can constructively be taught at what ages is “a critically important question.” So far, however, few studies have been done on which skills are actually acquired through S.E.L., and even fewer have included the kind of rigorous, controlled trials needed to prove that acquiring a specific skill produces a specific outcome over the long term. “If skills aren’t nurtured in an ongoing way,” Jones says, “it may be that those skills are lost.”

Even a handful of poorly designed programs, Caruso notes, could cause educators who are just warming up to the idea of a social-emotional curriculum to dismiss the entire field. Critics already charge that social-emotional programs are a kind of “therapy light” and a waste of valuable classroom time. In 2010, a report from the U.S. Department of Education that evaluated seven different S.E.L. programs found no increase in academic achievement and no decline in behavioral problems. S.E.L. supporters criticized the study’s methodology and pointed out that the researchers couldn’t be sure that the comparison schools weren’t using S.E.L. techniques even if they weren’t using a formal program. Still, to show that S.E.L. is effective, Caruso says, programs will have to be tested the same way a new pharmaceutical is: through a randomized trial that could distinguish short-term placebo effects from lasting improvements. Without such evidence, social-emotional learning could go the way of the self-esteem movement, an ill-fated program from the 1980s in which schoolchildren repeated mantras like “I am special” and “I am beautiful.” At the time, it, too, was considered the height of progressive education. The program was largely abandoned after it ended up being connected to rising rates of narcissism.

“It’s a big messy field, with a lot of promises, but very little data,” Caruso says of S.E.L. “Right now I think people are just throwing stuff at the wall to see what sticks.”

One of social-emotional learning’s “stickiest” programs is Second Step, the plug-and-play curriculum that provides teachers with grade-appropriate emotional-skills lessons. Originally developed as a violence-prevention program in 1986, Second Step is currently used by approximately 25,000 schools in the U.S. and Canada, according to Joan Cole Duffell, executive director of Committee for Children, the nonprofit behind the program.

At Ella Flagg Young School in Chicago, I sat in on a sixth-grade Second Step class taught by Latasha Little-Brown, the dedicated “social-emotional learning coordinator” who has worked at the school for nine years. That day, Little-Brown began by playing a Second Step video featuring good friends, Lydia and Maria. In the story, Maria’s aunt gives her a cool new necklace, which has beads made of paper. Lydia loves it, so Maria lets her borrow it. But as Lydia is walking back from the party, it suddenly starts to rain and the necklace is ruined. Lydia doesn’t know what to do.

In the teachers’ edition of the exercise, the goal is for students to write out the steps of an apology, including reparation. (Step 1: “Maria, I was wrong for taking the necklace and not caring for it properly.” Step 2: Offer to pay for the necklace.) Little-Brown nudged the students in this direction, until one boy — a chubby kid who had kept his jacket and backpack on during the entire class — finally raised his hand in frustration. Lydia hadn’t been negligent, he pointed out: she’d just been walking home and got soaked by a thunderstorm. How was the loss of the necklace her fault?

Lawyering ensued. One girl insisted that Lydia could have put the necklace in her pocket, or balled it up in her hand — leading another student to argue that just clutching the necklace in a downpour wouldn’t have protected it. Meanwhile, Backpack Boy was still trying to parse the details of friendly obligation. If someone dumped a bucket of water on you as you walked by, he wanted to know, would that be your fault? What if someone robbed you or threatened you with a gun?

Little-Brown allowed the debate to go on for several minutes, then moved crisply to the official point of the lesson: that once a thing is in your possession, you are responsible for it. The class ended with each group writing the steps of restitution on a piece of poster board. It was a disappointing moment. Though Little-Brown was engaged and thoughtful, the class still felt more like a rote exercise in social obligation than a nuanced exploration of a complicated issue. It was hard to believe that the resolution was satisfying to someone like Backpack Boy — one of the few students who seemed eager to wrestle with the knotty issues on which justice can turn.

Later, I mentioned this incident to Marc Brackett. Like many researchers, Brackett worries about the spread of programs like Second Step, in part because they can be overly formulaic. He is also concerned that they can serve as social-emotional placebos, allowing administrators to seem as if they’re working to fix a troubled school without actually doing anything. “When the superintendent wants to show the state that they bought their anti-bully program, or whatever, they buy these kits,” he said. “But then the box just sits on the shelf.”(To be fair, Brackett’s program is one of Second Step’s competitors. Duffell says that Second Step is “dedicated to good-quality implementation” and now has an online system to monitor how teachers use the program.)

Brackett’s program, Ruler, created with David Caruso and others, is more intensive. A school interested in trying Ruler must sign a three-year commitment that involves regular training, including Brackett’s four-day “Anchors of Emotional Intelligence” workshop, which costs $1,800 per person. Though Brackett emphasized to me that Ruler is used by a variety of schools, in a range of income brackets, the program costs significantly more than Second Step, especially when teacher and staff training is factored in. (Only about 500 schools use Ruler.)

In the Ruler cosmology, social-emotional lessons aren’t restricted to one class a week, or even to one class a day. Rather, such moments of observation are expected to pervade every class, from English and math to music and P.E. “Emotional skills aren’t something that develop overnight,” Brackett emphasized. “For most people, it will take a lot of practice.”

Starting in kindergarten, students begin each day by locating themselves on the “mood meter,” a set of four colored squares — blue for moods like malaise, yellow for excitement — that represent the four quadrants of emotional experience. (The other squares are red, for anger, and green, for calm.) The goal is to develop children’s capacity for self-reflection and critical thinking. “We never say, ‘The best thing to do is to take three deep breaths,’ ” Brackett told me. “For some people, taking deep breaths works. But for me, when I take deep breaths, I just think about how I can wring your neck.”

Growing up, Brackett told me, he was bullied “horrifically” — the kind of experience he believes Ruler could help prevent. Not long after being hired at Yale, he said, he went back to his old school, hoping to persuade it to implement the program. “I said, ‘I’ll give you a gift that would normally cost $100,000’ ” — what the Ruler program can amount to, with all the training. “They said, ‘Oh, that’s O.K. — we already have a speaker on emotional intelligence.’ ”

Even now, Brackett says, many educators don’t grasp the importance of emotional awareness. For Ruler to work, he maintains, the tools need to be embraced not just by students but also by teachers and administrators. “They have to be able to walk around that school and say: ‘Hey, where are you on the mood meter? I’m in the yellow right now. I’m feeling excited, how about you?’ or ‘Man, I had a really tough morning. I had to take a meta-moment because that parent was so crazy, I really had to manage my emotions.’ ”

Brackett’s approach may strike some as overkill, but a growing number of social-emotional learning programs now offer separate training for teachers. “It’s like that old airplane maxim,” Mark Greenberg told me. “Put your own mask on before you put your child’s on. You have to help yourself first.” Greenberg notes that a great teacher can change how students learn and behave, creating a climate that is engaged, caring and respectful. In theory, S.E.L. training could help more teachers develop those skills. “The one constant in education research has been the power of these great teachers,” Greenberg said. “What has been less clear is how you bottle that.”

Located high in the hills a few miles north of Berkeley, Prospect Sierra, a private elementary school, is also a Ruler school. It’s a cheerful place filled with the subtle accessories of wealth: airy classrooms outfitted with iMacs and a sprawling sports field with an unobstructed view of the San Francisco Bay.

Walking the halls one day last spring, I spied posters for empathy (“I say what I am feeling, and listen empathetically to what the other person is saying”), with examples of various mood meters, including one made by first graders that struck me as both impressive and alarming. Alongside “energetic,” “peaceful,” and “curious,” the meter listed “frantic,” “lonely,” “depressed,” “excluded” and “joyless.”

In the afternoon, I joined a P.E. class to watch a capture-the-flag-style game, in which teams tried to retrieve colored banners without being tagged. The teacher, a lean, blond woman named Jacqueline Byrne Bressan, began by having students sit in a circle to discuss problems that came up in the last game and how they could be prevented this time around. One boy, whose silky brown hair gave him the look of a miniature British soccer star, raised his hand to note that “some people” hadn’t been willing to “roshambo” — do “rock, paper, scissors” — the school’s accepted practice for settling disputes over whether a player had been tagged or not. When Bressan asked what he did about that, the boy sat up. “I told them they weren’t playing fair,” he said solemnly. “And then I let it go.”

Not long after this discussion, I watched as a beefy blond kid in a red shirt and white Nikes was patently tagged by a small brown-haired girl, but kept running. “You’re tagged!” the girl yelled. Another boy echoed her: “You’re tagged!” The boy yelled back, “No, I’m not!” Glancing at Bressan, he slowed briefly to a walk — then moved furtively around the edge of the field and sneaked back into the game.

Watching this, Bressan smiled dryly. The beefy boy, she observed, is “one of the kids who really struggles” with basic social-emotional concepts like fairness and accountability. But she also said she felt that he was gradually improving. “It used to be, he wouldn’t roshambo at all,” she said. “Or he’d lie and say that he did. Now it may take a minute, but he usually does it.”

While it was hard to tell if roshambo was teaching deeper lessons of fairness and problem-solving, Bressan told me that it radically cut the number of arguments she had to resolve, and also made it easy to identify the kids who needed more help socially. She also said that it gave the other students the moral authority to hold another player accountable.

There seemed to be something to this. While the game had its share of elementary-school drama (at one point, a girl started to cry after a boy bragged that he was faster than her “by a million miles”), it was noticeable how quickly most kids moved on. A tiny blond girl who was in tears over being pushed — her new white jeans now had a grass stain on the knee — handled the matter by walking once around the field, then talking about it in the postgame debriefing. “We talked about not tagging too hard during the game, but it was still happening,” she said, sounding surprisingly sanguine.

When I mentioned this to Bressan, she nodded. “I think it makes a difference sometimes for them just to be able to say it,” she said. “Just to have it discussed.”

Talking later, Bressan told me that in her last job, at an inner-city school in New York, students behaved differently; when one kid was punched in the stomach during recess, she recalled, he didn’t even go to the teacher. By comparison, it was hard to know how the kids at Prospect Sierra might fare in the “real world.” But she added, “The real question is: What kind of world do we want?”

That question is one that Marc Brackett thinks about often. He envisions a generation of kids who have grown up immersed in an environment of total emotional awareness — who receive new insights at the developmentally appropriate times, and in deliberately constructive ways.

“If you have that kind of instruction, from kindergarten,” he said, “I think that in 20 years the world will be a very different place.”

Jennifer Kahn teaches at the University of California, Berkeley, Graduate School of Journalism. She last wrote for the magazine about prepsychopathic children.

Our emotions do not obstruct our logic, they create it

Have you ever been trying to make a decision and thought to yourself, “I wish I could just leave my emotions out of this, and decide on a logical basis!”  It is a widely accepted theory that humans’ feelings and emotions cloud and hinder their decision-making abilities. Scientists have been able to prove this theory wrong.

white man in black tshirt

Our emotions do not obstruct our logic, they create it.

In 1982, Antonio Damasio, a neurologist, discovered a patient named Elliot who was incapable of making decisions.  Elliot’s frontal lobe had been damaged when doctor’s removed a tumor from this area of his brain.  Tests showed his IQ and cognitive skills were not changed after the surgery.   If Elliot still had his intellect and cognitive skills, why could he not make even a small, daily decision such as what shirt to choose among two options?


Further post-surgical tests found Elliot was incapable of  possessing and expressing emotion.  His brain was no longer able to access the opinions and ideas created over his lifetime that guided his actions in the past. By studying Elliot’s and several other patient’s brains, scientists have determined that the combination of emotion and judgment creates the foundation for a decision.  Without our emotions, we have no means to decide what is logical and what is not. Humans are not irrational, we are emotional. Our emotions do not obstruct our logic, they create it.  Savannah Krantz (Greenhill, 2014) writes a more detailed accounting of Damasio’s research and findings below:

Decision Making
by Savannah Krantz, Greenhill (2014)

In 1982, Antonio Damasio, a neurologist, discovered a patient named Elliot who was incapable of making decisions. This peculiarity was acquired during the removal of a brain tumor near Elliot’s frontal lobe. The frontal lobe is the part of the brain tasked with decision making. After Elliot’s surgery, his daily routine became impossible. Simple and quick errands turned into long and difficult ordeals. However, his intelligence level and cognitive skills had not been damaged by the surgery. If his IQ was well over high enough for him to be able to make decisions, why couldn’t he? Imagine not being able to make simple decisions such as what clothes to wear, what food to order, and when to schedule an appointment. What exactly in his brain had caused this massive obstruction in his life?
Elliot was emotionless. Damasio ran a series of tests, and none of which triggered Elliot to feel any form of emotion. How could he have the ability to make a decision with no feelings to base the decision off of? Elliot’s tests did prove a common fallacy, humans are irrational, wrong. It is a widely accepted theory that humans’ feelings and emotions cloud and hinder their decision making abilities. However, Elliot, who was incapable of  possessing and expressing emotion, was unable to make decisions. The combination of emotion and judgment creates the foundation for a decision.
Many ancient philosophers believed that homo sapiens were given the frontal cortex as a gift. They believed that the frontal cortex was able to separate reason, intelligence, and morality, from the limbic region of the brain, which is responsible for emotion and impulse. The ancient philosophers thought that this magical frontal cortex gave humans an extreme amount of logic, which enabled us to ignore our feelings when making decisions. This concept is false. The ancient philosophers were unaware that the regions of the brain were not segregated from each other with distinct tasks. The frontal cortex is also associated with emotion, as is the orbitofrontal cortex.
As Antonio Damasio began to study other patients with Elliot’s symptoms, he continued to find that their cognitive abilities were untouched, yet their ability to make decisions was nonexistent.  He found a similarity within all of his patients: the orbitofrontal cortex was either damaged or missing. The orbitofrontal cortex, also known as the OFC, is a part of the frontal lobe that connects instinctive emotion to decision making. Without the orbitofrontal cortex, the brain is incapable of accessing emotion while making a simple choice, resulting in extreme indecisiveness. With a damaged OFC, the brain is no longer able to access the infinite amount of opinions that guide a human’s course of action.
Elliot, an average grown man, not only lost his ability to decide, but also lost his job and family in the process. Elements of his life that he once cared so much about no longer triggered any emotional response, whether it be positive or negative. Without our emotions, we have no means to decide what is logical and what is not. Humans are not irrational, we are emotional. Our emotions do not obstruct our logic, they create it.

Source: How We Decide, 2009, Jonah Lehrer

Your Brain Changes After "Talk Therapy"

colorful brain
As a Cognitive Behavioral Therapist, I am excited by any new research that demonstrates a biological brian change after patients undergo “talk therapy”.  A group of scientists just published a study showing:
  • biological brain changes after cognitive behavioral therapy
  • the effects of cognitive behavioral therapy can be studied empirically
The New York Times published an article by Eric R. Kandel on September 6, 2013 describing the biological basis of mental disorders.  He writes about scientists at Emory University who performed a study on depressed individuals looking for evidence of biological changes after psychotherapy and after anti-depressant medications.  They used brian scans before and after treatment to identify biological brain changes.  During this study, the scientists were able to accurately predict whether patients would respond to psychotherapy or medications for the treatment of their depression.
Dr. Kandel summarizes the significance of the study as:
First, the neural circuits disturbed by psychiatric disorders are likely to be very complex.
Second, we can identify specific, measurable markers of a mental disorder, and those biomarkers can predict the outcome of two different treatments: psychotherapy and medication.
Third, psychotherapy is a biological treatment, a brain therapy. It produces lasting, detectable physical changes in our brain, much as learning does.
And fourth, the effects of psychotherapy can be studied empirically. Aaron Beck, who pioneered the use of cognitive behavioral therapy, long insisted that psychotherapy has an empirical basis, that it is a science.
Other forms of psychotherapy have been slower to move in this direction, in part because a number of psychotherapists believed that human behavior is too difficult to study in scientific terms.  The entire article is posted on the New York Times website here.
Eric R. Kandel, a professor at the Mortimer B. Zuckerman Mind Brain Behavior Institute at Columbia, a senior investigator at the Howard Hughes Medical Institute and a recipient of the 2000 Nobel Prize in Physiology or Medicine, is the author of “The Age of Insight: The Quest to Understand the Unconscious in Art, Mind and Brain, From Vienna 1900 to the Present.”