https://www.ted.com/talks/guy_winch_why_we_all_need_to_practice_emotional_first_aid?subtitle=en

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From  greatergood.berkeley.edu

Four Reasons Why Zoom Can Be Exhausting
A new paper explains why videoconferencing exhausts the mind and body and how to protect yourself.
BY VIGNESH RAMACHANDRAN | MARCH 10, 2021

Even as more people are logging on to popular video chat platforms to connect with colleagues, family, and friends during the COVID-19 pandemic, Stanford researchers have a warning for you: Those video calls are likely tiring you out.

Prompted by the recent boom in videoconferencing, communication professor Jeremy Bailenson, founding director of the Stanford Virtual Human Interaction Lab (VHIL), examined the psychological consequences of spending hours per day on these platforms. Just as “Googling” is something akin to any web search, the term “Zooming” has become ubiquitous and a generic verb to replace videoconferencing. Virtual meetings have skyrocketed, with hundreds of millions happening daily, as social distancing protocols have kept people apart physically. In the first peer-reviewed article that systematically deconstructs Zoom fatigue from a psychological perspective, published in the journal Technology, Mind, and Behavior last month, Bailenson has taken the medium apart and assessed Zoom on its individual technical aspects. He has identified four consequences of prolonged video chats that he says contribute to the feeling commonly known as “Zoom fatigue.”
Bailenson stressed that his goal is not to vilify any particular videoconferencing platform—he appreciates and uses tools like Zoom regularly—but to highlight how current implementations of videoconferencing technologies are exhausting and to suggest interface changes, many of which are simple to implement. Moreover, he provides suggestions for consumers and organizations on how to leverage the current features on videoconferences to decrease fatigue.
“Videoconferencing is a good thing for remote communication, but just think about the medium—just because you can use video doesn’t mean you have to,” Bailenson said.
Below are four primary reasons why video chats fatigue humans, according to the study. Readers are also invited to participate in a research study aimed at developing a Zoom Exhaustion & Fatigue Scale.
Four reasons for Zoom fatigue
1. Excessive amounts of close-up eye contact is highly intense. Both the amount of eye contact we engage in on video chats, as well as the size of faces on
screens, is unnatural.

In a normal meeting, people will variously be looking at the speaker, taking notes, or looking elsewhere. But on Zoom calls, everyone is looking at everyone, all the time. A listener is treated nonverbally like a speaker, so even if you don’t speak once in a meeting, you are still looking at faces staring at you. The amount of eye contact is dramatically increased. “Social anxiety of public speaking is one of the biggest phobias that exists in our population,” Bailenson said. “When you’re standing up there and everybody’s staring at you, that’s a stressful experience.” Another source of stress is that, depending on your monitor size and whether you’re using an external monitor, faces on videoconferencing calls can appear too large for comfort. “In general, for most setups, if it’s a one-on-one conversation when you’re with coworkers or even strangers on video, you’re seeing their face at a size which simulates a personal space that you normally experience when you’re with somebody intimately,” Bailenson said.
When someone’s face is that close to ours in real life, our brains interpret it as an intense situation that is either going to lead to mating or to conflict. “What’s happening, in effect, when you’re using Zoom for many, many hours is you’re in this hyper-aroused state,” Bailenson said.
Solution: Until the platforms change their interface, Bailenson recommends taking Zoom out of the full-screen option and reducing the size of the Zoom window relative to the monitor to minimize face size, and to use an external keyboard to allow an increase in the personal space bubble between oneself and the grid.
2. Seeing yourself during video chats constantly in real time is fatiguing. Most video platforms show a square of what you look like on camera during a chat. But that’s unnatural, Bailenson said. “In the real world, if somebody was following you around with a mirror constantly—so that while you were talking to people, making decisions, giving feedback, getting feedback—you were seeing yourself in a mirror, that would just be crazy. No one would ever consider that,” he added. Bailenson cited studies showing that when you see a reflection of yourself, you are more critical of yourself. Many of us are now seeing ourselves on video chats for many hours every day. “It’s taxing on us. It’s stressful. And there’s lots of research showing that there are negative emotional consequences to seeing yourself in a mirror.”
Solution: Bailenson recommends that platforms change the default practice of beaming the video to both self and others, when it only needs to be sent to others. In the meantime, users should use the “hide self view” button, which one can access by right-clicking their own photo, once they see their face is framed properly in the video.

1. Video chats dramatically reduce our usual mobility. In-person and audio phone conversations allow humans to walk around and move. But with videoconferencing, most cameras have a set field of view, meaning a person has to generally stay in the same spot. Movement is limited in ways that are not natural. “There’s a growing research now that says when people are moving, they’re performing better cognitively,” Bailenson said.

Solution: Bailenson recommends people think more about the room they’re videoconferencing in, where the camera is positioned, and whether things like an external keyboard can help create distance or flexibility. For example, an external camera farther away from the screen will allow you to pace and doodle in virtual meetings just like we do in real ones. And, of course, turning one’s video off periodically during meetings is a good ground rule to set for groups, just to give oneself a brief nonverbal rest.

1. The cognitive load is much higher in video chats. Bailenson notes that in regular face-to-face interaction, nonverbal communication is quite natural and each of us naturally makes and interprets gestures and nonverbal cues subconsciously. But in video chats, we have to work harder to send and receive signals.

In effect, Bailenson said, humans have taken one of the most natural things in the world—an in-person conversation—and transformed it into something that involves a lot of thought: “You’ve got to make sure that your head is framed within the center of the video. If you want to show someone that you are agreeing with them, you have to do an exaggerated nod or put your thumbs up. That adds cognitive load as you’re using mental calories in order to communicate.”
Gestures could also mean different things in a video meeting context. A sidelong
glance to someone during an in-person meeting means something very different than a person on a video chat grid looking off-screen to their child who just walked into their home office.
Solution: During long stretches of meetings, give yourself an “audio only” break. “This is not simply you turning off your camera to take a break from having to be nonverbally active, but also turning your body away from the screen,” Bailenson said, “so that for a few minutes you are not smothered with gestures that are perceptually realistic but socially meaningless.”

Many organizations—including schools, large companies, and government entities
—have reached out to Stanford communication researchers to better understand how to create best practices for their particular videoconferencing setup and how to come up with institutional guidelines. Bailenson—along with Jeff Hancock, founding director of the Stanford Social Media Lab; Géraldine Fauville, former postdoctoral researcher at the VHIL; Mufan Luo, graduate student at Stanford; and Anna Queiroz, postdoc at VHIL—responded by devising the Zoom Exhaustion & Fatigue Scale, to help measure how much fatigue people are experiencing in the workplace from videoconferencing.
The scale, detailed in a recent, not-yet-peer-reviewed paper published on the preprint website SSRN, advances research on how to measure fatigue from interpersonal technology, as well as what causes the fatigue. The scale is a 15- item questionnaire, which is freely available, and has been tested now across five separate studies over the past year with over 500 participants. It asks questions about a person’s general fatigue, physical fatigue, social fatigue, emotional fatigue, and motivational fatigue. Some sample questions include:

• How exhausted do you feel after videoconferencing?
• How irritated do your eyes feel after videoconferencing?
• How much do you tend to avoid social situations after videoconferencing?
• How emotionally drained do you feel after videoconferencing?
• How often do you feel too tired to do other things after videoconferencing?

Hancock said results from the scale can help change the technology so the stressors are reduced.
He notes that humans have been here before. “When we first had elevators, we didn’t know whether we should stare at each other or not in that space. More recently, ridesharing has brought up questions about whether you talk to the driver or not, or whether to get in the back seat or the passenger seat,” Hancock explained. “We had to evolve ways to make it work for us. We’re in that era now with videoconferencing, and understanding the mechanisms will help us understand the optimal way to do things for different settings, different organizations, and different kinds of meetings.”
“Hopefully, our work will contribute to uncovering the roots of this problem and help people adapt their videoconference practices to alleviate ‘Zoom fatigue,’” added Fauville, who is now an assistant professor at the University of Gothenburg
in Sweden. “This could also inform videoconference platform designers to
challenge and rethink some of the paradigm videoconferences have been built on.”
If you are interested in measuring your own Zoom fatigue, you can take the survey here and participate in the research project.
This article was originally published on Stanford News. Read the original article.
Vignesh Ramachandran, a Stanford alumnus, is a freelance journalist and co-founder of Red, White and Brown Media.

“Me time” sounds good, but when exactly?POSTED FEBRUARY 05, 2018, 10:30 AM
Steve Calechman
Contributor,  Harvard Health Blog

​I got a new doctor last year and at my first exam, he asked the standard, “What do you like to do for fun?” I laughed at him. I said that I have a 6-year-old and 3-year-old, mumbled something about poker games, and then my answer stopped. I’m not complaining, at least not much. I like my family and they require time. I don’t mind giving it, though I also work at home, a personal choice that comes with great benefits. But I can’t completely disappear, so sometimes, it just feels like an unending amount of time. My friends with older kids try to be supportive, saying that my wife, Jenny, and I are in the deepest part of the hole and it will soon get better, but they said that last year, and maybe the year before — I don’t really remember.
I know that I should squeeze in something like listening to music, reading, or doing nothing. It just never tops the priority list. I feel guilty spending time or money on anything that isn’t family-related. Jenny feels the same. We’re not pioneers with this mindset. As Dr. Beth Frates, assistant professor of physical medicine and rehabilitation at Harvard Medical School, says, it’s almost a default. “If you’re not working or taking care of another relative, you’re giving kids 100% of your attention.”
Why taking a break is important (and why it’s so hard)The problem, she explains (and which isn’t surprising), is that parenting is a drain. It requires CEO-like thinking that happens in the prefrontal cortex, the place for self-control and rational decisions. That takes stamina, and if — check that — when you’re exhausted, you’ll shift into the amygdala, the emotional part of the brain that fights or flights, which is good against a bear attack, not so much against your child. Point is, a break every so often isn’t the worst thing.
Great. I’m still all for it. One question: when and how exactly does this magic happen?
The first step, Frates says, and it’s a big one, is acknowledging that personal time isn’t a luxury. The airplane oxygen mask analogy — put on yours first so you can better help your child — is the classic, but she prefers the idea that you can’t pour from an empty cup; with nothing there, there’s nothing to give.
The practical realities of “me time” — even a little bit can help a lotIf you can accept the concept, it becomes about identifying the daily possibilities. Ideally, she says, it’s a range, from 30 minutes to the occasional 24 hours. At minimum, it’s taking five. Even that might feel undoable, but any type of screen time is a good place to look for time that can be better spent. And if it’s just the five, Frates likes deep breathing. She did it when her kids were young. She’d be in a chair with them in the room. They eventually understood not to bother her. She got her break and they got to witness the habit.
Ultimately, there’s no list of best things to do. The main requirement is that you look forward to whatever it is to get the reward of being fully absorbed, of losing your sense of time, and forgetting that you actually have bills, deadlines, or even children. It sounds simple, and it is to a degree, but if kids are involved, few things are simple. It takes teamwork to pull off. As a supportive partner, “What can I do to help?” is never a bad opening question. Often the person knows; now there’s an opening to brainstorm and strategize. Sometimes, if you know it’s not overstepping, you can take the initiative and buy something like a prepaid yoga classes card. The free time now almost has to happen.
“Me time” done just rightMy wife took that route. I recently turned 50 on a Monday, and she woke me the morning before, holding a bottle of sports drink and telling me that this was my present. Where my head was at, I thought, “I have to get another colonoscopy?” She told me that at noon, I was playing tennis with a buddy.
I got to do something that I love — I think I stammered tennis out to the doc as well — with the person I like to hit with the most. But where Jenny crushed it was setting the whole thing up. She knew that if she gave me an open-ended coupon, it wouldn’t have happened. She just told me to go and enjoy myself.
I listened to my wife on this one. For two hours, I didn’t have to watch my language or answer the same question 10 times. My biggest responsibility was hitting a ball back over a net and breaking a sweat. It was great. I felt unburdened. I felt more energized and positive, and, at some point on the drive back, I remembered that I had two children.

When my daughter is upset, anxious, or angry, my job as a parent is to hold her in a loving presence. I don’t have to fix her emotion, give her advice, tell her not to be sad, or take the pain away. My job is simply be there for her.
The same is often true in meditation—except for myself. Many days, I have sat down to meditate and been overtaken by an emotion. Anxiety, for instance, hits me hard in my gut. It may feel quite strong—so strong that I can barely meditate. I’d rather do anything else than meditate.
And I have been known to occasionally call it a day and read a book or check email instead of face the emotion.
Yet experiencing emotions is a normal part of meditating. In fact, as you meditate more, emotions often surface more, as if they are plants longing to grow toward the light—emerging in the face of your own loving presence.
Our job is to recognize the fact that the grief or fear, pain or anger, or any other emotion, is arising and is the truth of the moment. With positive intentions as a baseline, we can trust the healing that comes as we shine the light of awareness on it. We can let these things that need to be healed surface and move through us, as we hold these processes in awareness and kindness.
This kindness doesn’t force healing to happen; it allows it to occur. When we speak to a therapist or trusted friend, finally able to get something off our chest as they fully listen to us with compassion, we experience a healing effect. Similarly in meditation, our own nonjudgmental, loving, open, and aware mind meets the strong emotion and offers it the safety to integrate and potentially resolve.
When anxiety surfaces during my meditation, I often put my hand on my chest lovingly. I
let myself sense the anxiety as it emerges organically. Sometimes I use other practices—like giving lovingkindness to myself or saying the simple, yet incredibly useful phrases “It’s okay” and “You will get through this.” I let the anxiety emerge in a field of loving awareness, trusting that it needs to come forward, trusting that I am up for the task of allowing it to do so.
If strong, difficult emotions arise in meditation, as in life, there is nothing wrong. They are a part of you that can reveal themselves in the light of awareness. Of course, if an emotion arises in meditation that feels stronger than you can handle, you should seek the appropriate therapeutic or spiritual support. But the emotion arising isn’t a sign that you’re doing something wrong; it’s a sign you’re doing something right. And wise.

Diana Winston is the Director of Mindfulness Education at UCLA’s Mindful Awareness Research Center and the author of several books including her new book, The Little Book of Being: Practices and Guidance for Uncovering your Natural Awareness.

6 Steps to Mindfully Deal With Difficult EmotionsToni Parker, Ph.D.  //  September 28, 2016
from THE GOTTMAN RELATIONSHIP BLOG 

Let’s get real here. For most of us – myself included – life is fast-paced and chock full of family, relationship, and work stressors. This reality, along with the ever-increasing pressures of technology and society at large, can really take a toll on your marriage. As a result, difficult emotions like anger, confusion, fear, loneliness, and sadness, just to name a few, can arise. Emotions like these are often the most present and powerful forces in your life.
The key to overcoming these difficult emotions is mindfulness! Practicing mindfulnessenables you to calm down and soothe yourself. In this state, you have space to reflect and thoughtfully respond, rather than react.
Following these six steps will help you to understand and deal with your difficult emotions in a mindful way:


1. Turn toward your emotions with acceptance
Once you become aware of the emotion you are feeling, notice where it is in your body. You may feel it as a stomachache, a tightening of your throat, the pounding of your heart, or tension somewhere. Sit with this anger, anxiety, depression, grief, guilt, sadness, shame, or whatever emotion you are experiencing. Become aware of it and don’t ignore it. If this is difficult, get up and walk around or get a cup of tea.
The key here is to not push the emotion away. Bottling it up inside will only cause it to bubble up and explode later, resulting in more difficult emotions or even a complete emotional shutdown. Listen to your difficult emotions. They are trying to help you wake up to what is going on before a major crisis occurs.
2. Identify and label the emotion
Instead of saying, “I am angry”, say, “This is anger” or, “This is anxiety.” In this way, you’re acknowledging its presence, while simultaneously empowering you to remain detached from it.
When my husband was in the hospital before he passed, I felt a deep sense of uncertainty, anxiety, and fear. I needed to acknowledge and identify the emotions and say to myself, “I know that I am experiencing anxiety and fear right now and I don’t know what will happen, but I am going to just ‘be’ with it.” Although it remained an extremely painful experience to the end, identifying and labeling my emotions in this way allowed me to take some of the pain out of what I was feeling. This, in turn, allowed me to stay in the present, versus catapulting me into the future, or trapping me in the past. Being thrust in either direction would have only caused me to blame myself. I can just imagine how that critical voice would have rung out, “If only you would have done something different, maybe there would have been a different outcome.”
3. Accept your emotions
When you are feeling a certain emotion, don’t deny it. Acknowledge and accept that the emotion is present, whether it is anxiety, grief, sadness, or whatever you are experiencing in that moment. Through mindful acceptance you can embrace difficult feelings with compassion, awareness, and understanding towards yourself and your partner.
Think of a friend or a loved one who might be having a hard time. What would you say to them? Bring the scenario of what you would say to them into your mind’s eye. Now, say the same thing to yourself: “I am ok. I am not to blame. I did the best I could.” Hold these images and phrases within yourself with loving kindness and compassion. Extend this act of kindness toward yourself and become aware of what is going on within you. In this way you will gain the power to not only calm and soothe yourself, but also your partner.
You will soon come to realize that you are not your anger, fear, grief, or any other difficult emotion you are feeling. Instead you will begin to experience these emotions in a more fleeting manner, like clouds that pass by in the sky. Opening yourself up to your emotions allows you to create a space of awareness, curiosity, and expansiveness that you can then apply to your relationship, as well as any other aspect of your life.
4. Realize the impermanence of your emotions
Every one of your emotions is impermanent. They arise and reside within you for a time, and then disappear. It’s easy to forget this when you’re in the midst of dealing with difficult emotions.
Allow yourself to witness and observe your emotions with kind attention and patience, giving them the latitude to morph, and in many cases, completely evaporate. To embrace this process, ask yourself: “What and where is this feeling? What do I need now? How can I nurture it? What can I do for my partner? What can my partner do for me? How can we, as a couple, turn toward one another with acts of loving-kindness?” Asking these focused questions and responding in turn will go a long way to promote empathy, compassion, and connection within your relationship.
5. Inquire and investigate
After you have calmed and soothed yourself from the impact of your emotions, take a moment to delve deeply and explore what happened.
Ask yourself: “What triggered me? What is causing me to feel this way? What is the discomfort I’m experiencing and where is it arising? Was it as result of my critical mind, or was it in reaction to something my partner said or did?”
Perhaps you had a hard day at work or difficulty dealing with your family. Maybe you feel unappreciated, lonely, or disconnected as a result of your interactions with someone. Whatever the cause or trigger, look at it closely and ask yourself, “What is happening here?”
Consider what was said or done and compare it to your values. What were your expectations surrounding the situation? What reactions or judgments caused you to become angry or anxious? Is this a pattern that keeps arising?
Asking yourself these critical questions and investigating the root of your difficult emotions will help you gain empathy and insight into what you are experiencing.
Taking yourself off autopilot and trusting your deepest, authentic self to answer these questions about your situation will create a space to see things with a different perspective. This will ultimately allow both you and your partner to be more present and connected with each other.
6. Let go of the need to control your emotions
The key to mindfully dealing with your difficult emotions is to let go of your need to control them. Instead, be open to the outcome and what unfolds. Step outside of yourself and really listen to what your partner is feeling and what he or she has to say. Only then will you truly gain an in-depth understanding of your emotions and the interactions surrounding them within your relationship.
Mindfully dealing with emotions is hard and it takes time. Be kind, compassionate, and patient with yourself and your partner. You’re in this together! As Dr. John Gottman has said, “In a good relationship people get angry, but in a very different way. The Marriage Masters see a problem a bit like a soccer ball. They kick it around. It’s ‘our’ problem.”
We are fortunate that we live in a world where you and your partner can take the time to explore, discuss, and learn about mindfulness and your emotions. Take nothing for granted, for life is fragile and fleeting!

From the VIA Institute on Character:   November 16, 2017 by Dr. Ryan Niemiec
When thinking about the concept of mindfulness, one thing is certain: the emphasis on being “purposeful” in your attention is crucial as a counterbalance to the automatic pilot default that inhabits our mind most of the time. You can purposefully bring your attention to your child’s smile, to the feeling of the steering wheel, or to the exhale of your breathing. This is mindfulness.
Mindfulness offers us the opportunity to “wake up” from sleepwalking through life. It reminds me of a clever observation by Benjamin Franklin: “Some people die at 25 and aren’t buried until 75.”
Let’s advance these insights by exploring three other definitions, culminating to the “official” definition of mindfulness used by scientists.
1.) Mindfulness is letting go of taking things for granted.
This is an emotionally pleasing way to think about mindfulness. We accept the lot we’ve been given in life. We assume and expect things will stay the same. Mindfulness challenges us to awaken from these mind-habits and appreciate the little things. But, this definition lacks a bit in specificity around what is happening when mindfulness is actually practiced.
2.) Mindfulness means to return to the present moment.
A common misconception about mindfulness is that it means to stay in the present moment. People practice meditation and get quickly frustrated by their mind’s disinterest in staying in the present moment. Many will exclaim: “I can’t be mindful. I can’t stay in the moment!” But the reality is no one’s mind stays in the present moment. And, considering the nature of what our mind needs to process and compute in each moment, we would not be able to control our mind to chronically stay. But, we have control over the return. We can always return our mind to the present moment, return it to our breath or our senses which can be found in the present moment. This definition is simplistic and clear but not specific enough.
3.) Mindfulness is the self-regulation of attention with an attitude of curiosity, openness, and acceptance.
This is the operational, scientific definition of mindfulness put forth 13 years ago. Sadly, when I’ve mentioned it to thousands of workshop participants over the years, only a handful (maybe 5 percent) have heard of it. This definition is the consensus of a group of distinguished mindfulness researchers who wanted to offer a clear way for future researchers, practitioners, and consumers to understand this ever-growing and popular practice. Otherwise, if mindfulness is referred to in 100 plus ways then everyone is on a different page. Researchers are not studying the same thing. Practitioners are teaching different things. Consumers are left confused and misled. Misconceptions and misinformation become more likely.
This last definition is less catchy and sexy than some of the others but it offers a specific, distinct, and clear way of seeing the broad nature of mindfulness and its immediate fruits. The scientists used the word “self-regulation” to refer to how you can take control of your attention, you can regulate your focus. You might deliberately shift your attention to an image on your computer screen, to the body language of your friend as she speaks, to a memory, a future goal, or to your inbreath. The second part of the definition refers to our approach of being open to whatever we place our attention on, being interested and curious of what we might discover. It might be something pleasant, unpleasant, or boring, and in any case, your openness, curiosity, and acceptance can be deployed.
Each of the definitions brings an interesting and helpful insights but it is the last one that is important for advancing the research and practice of mindfulness.


References
Bishop, S. R., Lau, M., Shapiro, S. L., Carlson, L., Anderson, N. D., Carmody, J., … Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230–241.
Niemiec, R. M. (2014). Mindfulness and character strengths: A practical guide to flourishing. Boston, MA: Hogrefe.

Is Sufficient Sleep the Key to Successful Antidepressant Response?
​Haley Otman
 September 02, 2016 Antidepressants are necessary for many with major depressive disorder, but response times and remission rates are a problem. U-M researchers find sleep might help.
Medication is an important part of treatment for many patients with major depressive disorder, but the transition to antidepressants isn’t always smooth.
SEE ALSO: 1 in 4 First-Year Residents May Meet Criteria for Clinical Depression
It can take six weeks for a person to respond to pharmacotherapy. And with remission rates at about only one-third, the majority of patients with depression could also benefit from better overall response to medication.
Researchers at the University of Michigan who specialize in both psychiatry and sleep medicine found a potential way to help. A precise sleep schedule could affect antidepressant remission rates and response time, researchers found. But not in the way they thought.

"It’s important to find practical and safe strategies that can enhance our traditional depression therapies."
J. Todd Arnedt, Ph.D.More, not less, sleepPrevious studies, mostly in inpatient settings, found that total or partial (four- to five-hour) sleep deprivation on a single night improved mood the following day for about 60 percent of patients. This extreme amount of sleep deprivation is not, however, practical or safe for patients in their own homes.
In the new U-M study published in the Journal of Clinical Psychiatry, 68 adults were assigned to spend either six or eight hours in bed each night during their first two weeks on the antidepressant fluoxetine.
It’s the first study to assess the mood effects of a modest time-in-bed restriction on outpatients. Sleep and mood were measured daily for the first two weeks, and mood measurement continued weekly for six more weeks after the patients returned to their preferred sleep schedules and continued fluoxetine.
“It’s important to find practical and safe strategies that can enhance our traditional depression therapies, so we decided to evaluate a more modest amount of sleep deprivation that could easily be implemented alongside medication treatment,” says J. Todd Arnedt, Ph.D., principal investigator and U-M associate professor in psychiatry and neurology. “Although we predicted the group with restricted time in bed would have a better response, based on previous sleep deprivation research in depression, we actually found the opposite.”
Surprisingly, the group who spent the full eight hours in bed each night showed greater improvements on all fronts. The subjects were almost twice as likely to achieve symptom remission after the full eight weeks of antidepressant treatment—63 percent compared with 33 percent in the six-hour group. They also experienced a faster response to treatment.
“This is the first study to demonstrate that adequate sleep might accelerate and augment antidepressant treatment response,” Arnedt says, “but more research is necessary.”
REM versus slow-wave sleepOf the subjects who spent six hours in bed, one group was told to stay up two hours later and the other to wake up two hours earlier. The researchers wanted to assess whether changes in deep slow-wave sleep or REM (dream) sleep affected response or remission rates. Previous studies had produced contradictory findings about whether treatment response was related to changes in particular sleep stages.
After two weeks on the six-hour schedule, overnight polysomnography verified that the subjects who woke up two hours earlier experienced a significant reduction in REM sleep while those who stayed up later experienced an increased amount of slow-wave sleep. But no differences in treatment response were found between the two six-hour groups.
“This research did not support the specific role of either slow-wave sleep or REM sleep as critical to treatment response,” Arnedt says.
Tracking complianceWearable technology allowed the researchers to know just how well their subjects were following their time-in-bed instructions.
SEE ALSO: Can a Website Keep Suicidal Thoughts Away?
The ActiGraph devices, similar to a Fitbit but able to detect sleep more accurately, use movement sensors to determine if patients spent their assigned hours in bed.
The group tasked with eight hours in bed mostly adhered to the schedule. But the six-hour group had great difficulty. The early-rise-time group spent nearly an hour more time in bed than instructed.
“These findings tell us that, even if the six-hour condition had yielded better results in terms of treatment response, patients would be unlikely to follow a clinical recommendation to spend only six hours in bed during the initial two weeks of antidepressant therapy. So, this is a strategy that is not practical for implementation in outpatient settings,” Arnedt says.
Looking aheadBecause this study was designed to primarily evaluate the effects of restricting time in bed on antidepressant treatment response, the next step, Arnedt says, is to directly assess whether optimizing or extending sleep time while initiating antidepressant therapy improves response. Optimization of the sleep schedule would involve considering not only how much people are sleeping but also individual factors such as a subject’s preferred sleep and wake times and sleep quality.
The team is also interested in more sophisticated measurement techniques, such as brain imaging and high density EEG, to further examine the impact of directly manipulating REM, slow-wave sleep and other aspects of sleep as well as factors implicated in treatment response.
In the meantime, Arnedt recommends paying closer attention to how, and how much, patients are sleeping when they begin antidepressants. Patients beginning a new antidepressant should be cautioned against restricting their time in bed because it could influence how quickly and effectively they respond to the medication.

“Eventually, we’d like to identify combinations of sleep and circadian treatments that are independently effective for depression and that can be used practically and safely in inpatient and outpatient settings,” he says.

What to say (and not say) to someone who is depressed  Nov. 4, 2015 
Joan Raymond
TODAY.com

Depression doesn't play favorites. Men and women, the young and the old, and even those people who seemingly have everything can suffer from the complex disorder that makes all facets of life just so hard.
Many people do feel more anxiety or sadness during the holidays.While most mental illnesses are quite rare, major depression is exceedingly common. Nearly 7 percent of American adults —an estimated 16 million people in 2013 — had at least one major depressive episode, according to the National Institute of Mental Health.
As common as it is, the stigma around depression persists, which is why it matters when celebrities and other well-known people reveal their own struggles. In a recent interview with Billboard magazine, Lady Gaga said she has suffered with depression and anxiety her whole life, "every single day." "Nashville" actress Hayden Panettiere revealed she sought treatment for postpartum depression. And Sarah Silverman opened up about her battles with depression in a piece in Glamour magazine.
The chances are good that you know someone with depression. And chances are also good that you've often wondered what to say — and what not to say — to your friend, your colleague, or your family member who is battling the illness. People who suffer depression say the feelings of despair and hopelessness may never be truly understood by those who have never experienced it. But there are we can help our friends and loved ones.

Do say:
I'm Here For You"Don't just say it, mean it," says psychologist Dr. John Grohol, founder and chief executive of PsychCentral.com.
That means once you say those words, check in regularly with your friend or family member who is struggling. And offer to help them with tasks like finding a therapist, keeping appointments, or any support they may need. "For a depressed individual to learn that someone is there for them is huge," he adds.
Let's Do SomethingPeople with depression can get into a state of ruminative thinking, basically replaying negative events or agonizing over how particular situations could have played out differently.
Unfortunately, rumination can lead to worsening depression. "Rumination isn't just worrying, it's more of a fixation on a past event or even a fixation on what someone said and what that may mean," says psychologist Dr. Avie Rainwater of LifeCare Psychology Group in Florence, South Carolina.

While therapists help people deal with this type of negative thinking, you can help, too, if a person is willing. Doing an activity together that is both mentally and physically challenging can help potentially distract someone who is the midst of ruminative thought patterns, says psychologist Dr. Carl Tishler, adjunct associate professor of psychiatry and psychology at The Ohio State University.
"Say, let's go for a walk, let's go kickboxing, let's go to a yoga class, let's do something together," says Tishler. "A person could be very surprised at how good they feel after doing something with someone."
I Don't Know Exactly What You're Feeling, But It Has To Be HardDepression is a complex condition with genetic, biological and psychological components.
Reaffirming that you may not understand the disease, but you do recognize that it is real and often difficult to control can be beneficial for both you and your loved one.
"Acknowledging that depression sucks," can be the start of a good conversation," says Grohol, allowing the depressed individual to talk without fear of judgement.
Sometimes, Say NothingYou can't put a price on the power of being a good listener. "It really is okay to say nothing, to not offer advice, and to simply sit and to listen," says Tishler. Since feelings of loneliness and isolation can often overwhelm someone with depression, your mere presence can help. "Don't underestimate the power of shared humanity," says New York City-based psychologist Dr. Alison Ross.
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Don't Say:
All You Need Is A Little Retail Therapy. There is nothing less helpful and potentially damaging than minimizing someone's pain.
"People with depression don't choose to be sad or pessimistic and saying something trite that doesn't acknowledge the difficulty of depression is not helpful at all," says Ross.
Remember: clinical depression is a mood disorder best treated with a combination of medication and psychotherapy, along with lifestyle changes like exercise and stress reduction.
Don't You Want To Get Better? This kind of statement implies that a depressed individual is at fault.
"Depression can be tough to treat, and no medication or treatment is one hundred percent effective all the time," says Ross. Among many depressed patients there are already feelings they aren't strong enough or "good enough" to fight the illness, and "piling on" with negative comments that imply they are in complete control of their well-being is destructive, adding to stigma, she says.
Oh, Hey I Was Depressed Once. Everyone likes to talk about themselves, but occasional feelings of sadness are not the same as clinical depression.
"People want to be empathetic and immediately want to explain how they handled their own experience with something sad that happened to them, but unless that person is struggling with clinical depression they have no clue what their friend is feeling," says Dr. Rainwater. Instead of talking about yourself, let your friend or family member talk about their own feelings.
Suck it Up, There Are People Worse Off Than YouClinical depression can lead to problems with jobs, education, and relationships.
Some research shows the persistent change in mood, behavior, and feelings — all hallmarks of depression — may also up an individual's risk for heart disease and diabetes, among other ailments, according to the World Health Organization.
Know it can be difficult for a person in the throes of a depressive episode to "look outside" of their own situation.
Your best bet in trying to talk to someone you care about who has depression is to remember that you alone can't "fix" them, but you may be able to lessen their feelings of loneliness and isolation, says psychologist Dr. Arthur Nezu, Distinguished University Professor of Psychology at Drexel University, Philadelphia.

From Psych Congress 2015:

SAN DIEGO—Richard Shelton, MD, explained the science behind the obesity/depression connection and offered practical tips for changing patients' diets. After his presentation, he took the time to answer a few questions.

If you could have everyone in the audience do one thing differently when they get back to their clinical practice, what would that be? 

It would be to go to their patients and ask them to reduce one high-glycemic-index food. You can build progressively from there, but you’ve got to start somewhere. Trying to get rid of all the carbohydrates at once just doesn’t work that well for people, but progressively doing it over time really helps. 

I create a hierarchy with patients from the most problematic to the least problematic high-glycemic-index food and start focusing on the highest one on that list and start working up. 

Do clinicians have any misconceptions about the relationship between obesity and depression that you’d want to correct? 

I think the most common misconception is that the treatments are causing most of the problem. For example, people have the idea that antidepressant medications are causing the majority of weight gain over time. 

I think the evidence indicates that depression itself is driving most of the weight gain as time goes by, and it’s one of the reasons you can see a wide range of antidepressant medications being used and progressively over time you’ll still get the weight gain issue. Even bupropion, which itself seems to be weight neutral, unfortunately does not cause weight loss. Therefore, you will eventually have patients catching up and continuing to gain weight.

Is a low carbohydrate diet a better strategy than exercise?

Adherence to the low-carb diet is much higher. We go from not dramatically decreasing the total calories that people have but simply converting them from higher- to lower-glycemic-index food, and hopefully eliminating carbs progressively over time. 

Adherence rates tend to be quite high, even in populations that we know are otherwise resistant to lifestyle intervention effects, including people who don’t have easy access to whole, intact foods. 

I think the reason why the low-carb diet works better is that people will simply do it, whereas with most other sorts of interventions—very low calorie diets, dramatic reduction in fat, exercise interventions—people just don’t adhere over time. 

Does the gluten-free or paleo diet work through mechanisms that are independent of the effect of low-carbohydrate diets?

Probably no. If people want to go to one of those diets, as long as they’re reducing carbs and as long as they’ll do the diet, then it doesn’t make any difference. I certainly don’t think that there are any strong data that suggest there are anything different or special about those diets. They work by converting the patient from higher carbs to lower carbs. 

If patients come in and say “I want to do the paleo diet,” I say “Fine. As long as you adhere to the diet it doesn’t make any difference. At the end of the day, I want you to have something that’s going to reduce total carbohydrates.” 

Do those diets have any harmful effects?

As far as I’m aware, no. People are often confused about the health benefits of reducing gluten though. A lot of folks will attempt to explain the health benefits by focusing on the gluten itself, but the problem is that gluten is tied to wheat and comes along with a lot of carbohydrates. By eliminating gluten, you eliminate carbohydrate intake. 

Any tips for negotiating with patients in terms of reducing carbs?

It’s really about doing exchanges. It’s getting people to set up a hierarchy with me and figure out one thing they’re able to do, similar to the approach we take with phobias. You have a behavioral hierarchy and you start from the least and go to the greatest. 

I try to get an agreement from the patient to eliminate anything, because that makes a difference. As soon as we get a toehold, we start getting benefits, and patients more willing to take the next step. 

Sugared soft drinks seem to be the easiest thing for patients to tackle first. People can go from sugared soft drinks to artificially sweetened soft drinks, which I don’t prefer them to have. Nonetheless, at the end of the day if I can get them to drop that down they’re going to start feeling better and we’ll tend to get improvements after that. Everyone has their thing they’re not willing to give up, but that doesn’t matter. We’ll just choose something else on the list.