The terms lesbian, gay, bisexual, and transgender (LGBT) describe distinct groups within the gay culture.

The terms lesbian, gay, bisexual, and transgender (LGBT) describe distinct groups within the gay culture. The early initiatives for people who were gay focused mostly on men. So, in an attempt to draw attention to issues specific to gay women, "lesbian" is often listed first. People who are bisexual or transgender have been traditionally left out of, or underrepresented in, research studies and health initiatives. It is now considered standard to include these two groups along with gay men and lesbians.

What is the Meaning of LGBT?

According to researchers Susan Cochran and Vickie Mays, sexual orientation includes the following dimensions: 

- sexual attraction
- sexual behavior
- sexual fantasies
- emotional, social, and lifestyle preferences
- self-identification

What is Sexual Orientation?

The term "gay" has traditionally been used to represent a diverse group of people who are attracted to people of the same gender or are in a relationship with someone of the same gender. It is important to recognize, however, that different groups within the gay community exist, and that the term "gay" is not all-inclusive.

For example, transsexuals and some people who are bisexual do not consider themselves to be gay. Also, research has found that men who have had relationships with other men do not always identify themselves as gay. There is also a tremendous ethnic diversity among our lesbian, gay, and bisexual communities, and this contributes to the different perceptions of the term "gay." 

Heterosexual, or straight, refers to people whose sexual and romantic feelings are mostly for the opposite gender: Men who are attracted to women, and women who are attracted to men.

Homosexual, or gay, refers to people whose sexual and romantic feelings are mostly for the same gender: Men who are attracted to men, and women who are attracted to women.

Lesbian refers to women who are homosexual.

Bisexual or "bi" refers to people whose sexual and romantic feelings are for both genders.

Transgender is an umbrella term that encompasses a diversity of gender expressions including drag queens and kings, bi-genders, crossdressers, transgenderists, and transsexuals.

Transvestites are people who like to dress like members of the opposite sex.

Transsexuals are people who feel that their anatomical sex does not match the gender with which they identify.

Bigender refers to people who define themselves as having the behavioral, cultural, or psychological characteristics associated with both the male and female genders.

Transgenderist describes someone who is gender variant or transgresses gender norms as part of their lifestyle or identity.

Definition of Terms

Introduction

LGBT individuals encompass all races and ethnicities, religions, and social classes. Sexual orientation and gender identity questions are not asked on most national or State surveys, making it difficult to estimate the number of LGBT individuals and their health needs. Research suggests that LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights.

Discrimination against LGBT persons has been associated with high rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for LGBT individuals and have long-lasting effects on the individual and the community. Personal, family and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBT individuals

Why Is LGBT Health Important?
Eliminating LGBT health disparities and enhancing efforts to improve LGBT health are necessary to ensure that LGBT individuals can lead long healthy lives. The many benefits of addressing health concerns and reducing disparities include reductions in disease transmission and progression, increased mental and physical well-being, reduced health care costs, and increased longevity.

Lesbian, Gay, Bisexual, and Transgender Health

In order to effectively address LGBT health issues, we need to securely and consistently collect SOGI information in national surveys and health records. This will allow researchers and policymakers to accurately characterize LGBT health and disparities. Understanding LGBT health starts with understanding the history of oppression and discrimination that these communities have faced. For example, in part, because bars and clubs were often the only safe places where LGBT individuals could gather, alcohol abuse has been an ongoing problem.

Social determinants affecting the health of LGBT individuals largely relate to oppression and discrimination. Examples include:

- Legal discrimination in access to health insurance, employment, housing, marriage, adoption, and retirement benefits
- Lack of laws protecting against bullying in schools
- Lack of social programs targeted to and/or appropriate for LGBT youth, adults, and elders
- Shortage of health care providers who are knowledgeable and culturally competent in LGBT health

The physical environment that contributes to healthy LGBT individuals includes:
- Safe schools, neighborhoods, and housing
- Access to recreational facilities and activities
- Availability of safe meeting places
- Access to health services

Understanding LGBT Health

A number of issues will need to continue to be evaluated and addressed over the coming decade, including:

- Nationally representative data on LGBT Americans
- Prevention of violence and homicide toward the LGB community, and especially the transgender population
- Resiliency in LGBT communities
- LGBT parenting issues throughout the life course
- Elder health and well-being
- Exploration of sexual/gender identity among youth
- Need for an LGBT wellness model
- Recognition of transgender health needs as medically necessary

Continuing Issues in LGBT Health

LGBT Health

LGBT Community

Volunteering is a win-win situation - it improves your mood and helps other people out!


Learn about volunteering benefits and opportunities.

Dummy Title: Part 1 - video

Part of being a great volunteer is loving what you're doing. Find something that you're passionate about or something that inspires you, and then find a need in your community. There are dozens of reasons why you should volunteer - you just need to find the one that feels right.

20 GREAT REASONS TO VOLUNTEER:
- Help others
- Make a difference
- Find purpose
- Enjoy a meaningful conversation
- Connect with your community
- Feel involved
- Contribute to a cause that you care about
- Use your skills in a productive way
- Develop new skills
- Meet new people
- Explore new areas of interest
- Meet good people
- Impress your mom
- Impress yourself
- Expand your horizons
- Get out of the house
- Make new friends
- Strengthen your resume
- Feel better about yourself

Why Volunteer?

VolunteerMatch
Idealist.org
Network for Good
Points of Light Volunteer Opportunities
Points of Light’s HandsOn Network
Peace Corps
AmeriCorps
Senior Corps

Places to Find Volunteering Opportunities

Volunteering 101

Volunteering

The better you eat, the better you'll feel!

When it comes to eating, we have strong habits. Some are good ("I always eat breakfast"), and some are not so good ("I always clean my plate"). Although many of our eating habits were established during childhood, it doesn't mean it's too late to change them. Making sudden, radical changes to eating habits such as eating nothing but cabbage soup, can lead to short-term weight loss. However, such radical changes are neither healthy nor a good idea, and won't be successful in the long run. Permanently improving your eating habits requires a thoughtful approach in which you Reflect, Replace, and Reinforce.

- REFLECT on all of your specific eating habits, both bad and good; and, your common triggers for unhealthy eating.
- REPLACE your unhealthy eating habits with healthier ones.
- REINFORCE your new, healthier eating habits.

Strong Habits

Reflect on your eating habits and determine if you need change.

Create a list of your eating habits. Keeping a food diary for a few days, in which you write down everything you eat and the time of day you ate it, will help you uncover your habits. For example, you might discover that you always seek a sweet snack to get you through the mid-afternoon energy slump. Use a diary to help. It's good to note how you were feeling when you decided to eat, especially if you were eating when not hungry. Were you tired? Stressed out? Highlight the habits on your list that may be leading you to overeat. Common eating habits that can lead to weight gain are:

- Eating too fast
- Always cleaning your plate
- Eating when not hungry
- Eating while standing up (may lead to eating mindlessly or too quickly)
- Always eating dessert
- Skipping meals (or maybe just breakfast)

Look at the unhealthy eating habits you've highlighted. Be sure you've identified all the triggers that cause you to engage in those habits. Identify a few you'd like to work on improving first. Don't forget to pat yourself on the back for the things you're doing right. Maybe you almost always eat fruit for dessert, or you drink low-fat or fat-free milk. These are good habits! Recognizing your successes will help encourage you to make more changes.

Create a List

Create a list of "cues" by reviewing your food diary to become more aware of when and where you're "triggered" to eat for reasons other than hunger. Note how you are typically feeling at those times. Often an environmental "cue", or a particular emotional state, is what encourages eating for non-hunger reasons. Common triggers for eating when not hungry are:

- Opening up the cabinet and seeing your favorite snack food.
- Sitting at home watching television.
- Before or after a stressful meeting or situation at work.
- Coming home after work and having no idea what's for dinner.
- Having someone offer you a dish they made "just for you!"
- Walking past a candy dish on the counter.
- Sitting in the break room beside the vending machine.
- Seeing a plate of doughnuts at the morning staff meeting.
- Swinging through your favorite drive-through every morning.
- Feeling bored or tired and thinking food might offer a pick-me-up.

Circle the "cues" on your list that you face on a daily or weekly basis. Going home for the Thanksgiving holiday may be a trigger for you to overeat, and eventually, you want to have a plan for as many eating cues as you can. But for now, focus on the ones you face more often. Ask yourself these questions for each "cue" you've circled, Is there anything I can do to avoid the cue or situation? This option works best for cues that don't involve others. For example, could you choose a different route to work to avoid stopping at a fast-food restaurant on the way? Is there another place in the break room where you can sit so you're not next to the vending machine? For things I can't avoid, can I do something differently that would be healthier? Obviously, you can't avoid all situations that trigger your unhealthy eating habits, like staff meetings at work. In these situations, evaluate your options. Could you suggest or bring healthier snacks or beverages?

Understanding Cues and Triggers

For example, in reflecting upon your eating habits, you may realize that you eat too fast when you eat alone. So, make a commitment to share a lunch each week with a colleague, or have a neighbor over for dinner one night a week. Other strategies might include putting your fork down between bites or minimizing other distractions (i.e. watching the news during dinner) that might keep you from paying attention to how quickly — and how much — you're eating. Here are more ideas to help you replace unhealthy habits:

- Eat more slowly. If you eat too quickly, you may "clean your plate" instead of paying attention to whether your hunger is satisfied.
- Eat only when you're truly hungry instead of when you are tired, anxious, or feeling an emotion besides hunger. If you find yourself eating when you are experiencing an emotion besides hunger, such as boredom or anxiety, try to find a non-eating activity to do instead. You may find a quick walk or phone call with a friend helps you feel better. 
- Plan meals ahead of time to ensure that you eat a healthy well-balanced meal.

Replace Unhealthy Habits With New, Healthy Habits

Habits take time to develop. It doesn't happen overnight. When you do find yourself engaging in an unhealthy habit, stop as quickly as possible and ask yourself: Why do I do this? When did I start doing this? What changes do I need to make? Be careful not to berate yourself or think that one mistake "blows" a whole day's worth of healthy habits. 

You can do it! It just takes one day at a time!

Reinforce Your New, Healthy Habits (Be Patient With Yourself)

Reflect On Your Eating Habits

Healthy Eating Habits

Learn about digital fasting and how digital fasting can improve your well-being.

See what a digital fast is, who likes to digital fast, and how to do a digital fast.

Also known by various other terms like “digital detox,” “digital Sabbath,” and “unplugging”, the idea behind a digital fast is to voluntarily and deliberately stop using all connected devices – smartphones, computers, tablets, and so on – that plug you to the internet for a pre-specified amount of time. The abstention could be for as little as a few hours (say, from 7 pm until the next morning). However, most digital fasts are at least a day-long event, and many span an entire weekend or even longer. 

Like food fasts, longer digital fasts are thought to be more effective (up to a point) in weaning oneself away from digital connectivity, and in regaining self-control. Some versions of the digital fast recommend off-line activities you should perform instead (with all the spare time freed up from not texting and Facebooking): going on a walk or a hike, or organizing a pot-luck meal with friends who are also digitally fasting. 

In theory, the idea of a digital fast has generated a lot of interest, with organizations such as Adbusters and the Huffington Post each promoting their respective versions of digital fasts. It is especially popular among Silicon Valley employees of tech companies like Facebook and Google. But in practice, digital fasting really hasn’t moved beyond the fringes of our culture. One reason is that there is a raging debate about whether a digital fast is desirable. Advocates take the digital stance that digital technology has addictive properties that cause harm in various ways, and we need to regain control over its use. Its opponents counter with the argument that digital technology satisfies our fundamental needs today and is irreplaceable. So, they say, there is no need for anyone to fast or unplug.

What is a digital fast?

Discover the different perspectives of how technology affects us.

They point to the fact that when using smartphones, or playing online games, or using social media, many people exhibit features that are very similar to those displayed by drug addicts. These features include the following: excessive use of the digital technology without discretion, experiencing symptoms of withdrawal including feelings of anger, tension, or depression without negative repercussions from using technology such as lowered ability to focus and insomnia. 

One study from 2014 led by psychologist Julia Hormes concluded: “The use of online social networking sites is potentially addictive…Disordered online social networking use seems to arise as part of a cluster of symptoms of poor emotion regulation skills and heightened susceptibility to both substance and non-substance addiction."

Under this perspective, unchecked use of digital technology is a potential problem that could have serious consequences. One avenue to gain control over the problem is to disconnect from the source of the addiction in a deliberate and systematic way by means of a digital fast.

The Addiction Perspective

Technology enthusiasts take an entirely different view. They see nothing problematic or dangerous with our incessant digital connectivity. They believe that there is no need for anyone to unplug at all, even momentarily. Rather, they argue that digital technologies now satisfy many of our most basic needs and we no longer have other, old-fashioned ways of meeting these needs.

For instance, (at least in the United States) people no longer stroll to the town square every evening or call each other to talk for hours on a landline phone. Our online and offline lives have now blended together so completely that one is not possible without the other. Thus, fasting digitally will lead to nothing more than depriving ourselves of basic need fulfillment and constitutes a case of unnecessary technological asceticism.

This view is expressed nicely by business consultant Alexandra Samuel: “When we’re online — not just online, but participating in social media — we’re meeting some of our most basic human needs. Needs like creative expression. The need to connect with other people. The need to be part of a community. Most of all, the need to be seen: not in a surface, aren’t-you-cute way, but in a deep, so-that’s-what’s-going-on-inside-your-head way.”

Under this perspective of technology and digital connectivity, it is clear that a digital fast is an anathema. Instead, it would see each of us as electric appliances. Unless it is plugged into a power source, it is useless. In the same way, we are only functioning when we are digitally connected.

The Tech Enthusiast Perspective

It is worth thinking deeply about which perspective of technology relationship – addiction or empowerment – resonates with you. When I thought about this question, it was clear even though using digital technology and being connected is empowering, I am also addicted to its use. Some experts suggest that people like me should approach digital connectivity like a diet instead of a fast. In other words, use technology in a restrained way rather than not at all. Nevertheless, I choose to unplug from all digital devices from time to time, usually for a few hours, or sometimes for a weekend. If nothing else, digital fasting is a way to prove to myself that I have the strength to act willfully in my relationship with technology.


Which Perspective Makes Sense?

Perspectives

Digital Fasting

Learn about the most important muscle in the body and how to take care of it!

Learn about the heart and how it changes over time.

Your heart is a strong muscle that pumps blood to your body. A normal, healthy adult heart is about the size of your clenched fist. Just like an engine makes a car move, the heart keeps your body running. The heart has two sides, each with a top chamber (atrium) and a bottom chamber (ventricle).
 
The right side pumps blood to the lungs to pick up oxygen. The left side receives blood rich with oxygen from the lungs and pumps it through arteries throughout the body. An electrical system in the heart controls the heart rate (heartbeat or pulse) and coordinates the contraction of the heart\'s top and bottom chambers.

How Does the Heart Work?

People age 65 and older are much more likely than younger people to suffer a heart attack, to have a stroke, or to develop coronary heart disease (commonly called heart disease) and heart failure. Heart disease is also a major cause of disability, limiting activity, and eroding the quality of life of millions of older people. Aging can cause changes in the heart and blood vessels. For example, as you get older, your heart can't beat as fast during physical activity or times of stress as it did when you were younger. However, the number of heartbeats per minute (heart rate) at rest does not change significantly with normal aging.
Changes that happen with age may increase a person's risk of heart disease. A major cause of heart disease is the buildup of fatty deposits in the walls of arteries over many years. The good news is there are things you can do to delay, lower, or possibly avoid or reverse your risk.

The most common aging change is increased stiffness of the large arteries, called arteriosclerosis (ahr-teer-ee-o-skluh-roh-sis), or hardening of the arteries. This causes high blood pressure, or hypertension, which becomes more common as we age. High blood pressure and other risk factors, including advancing age, increase the risk of developing atherosclerosis (ath-uh-roh-skluh-roh-sis). Because there are several modifiable risk factors for atherosclerosis, it is not necessarily a normal part of aging. Plaque builds up inside the walls of your arteries and, over time, hardens and narrows your arteries, which limits the flow of oxygen-rich blood to your organs and other parts of your body.

Oxygen and blood nutrients are supplied to the heart muscle through the coronary arteries. Heart disease develops when plaque builds up in the coronary arteries, reducing blood flow to your heart muscle. Over time, the heart muscle can become weakened and/or damaged, resulting in heart failure. Heart damage can be caused by heart attacks, long-standing hypertension and diabetes, and chronic heavy alcohol use. Age can cause other changes to the heart. For example:

- There are age-related changes in the electrical system that can lead to arrhythmias—a rapid, slowed, or irregular heartbeat—and/or the need for a pacemaker. Valves—the one-way, door-like parts that open and close to control blood flow between the chambers of your heart—may become thicker and stiffer.

- Stiffer valves can limit the flow of blood out of the heart and become leaky, both of which can cause fluid to build up in the lungs or in the body (legs, feet, and abdomen).
The chambers of your heart may increase in size. The heart wall thickens, so the amount of blood that a chamber can hold may decrease despite the increased overall heart size. The heart may fill more slowly.

- Long-standing hypertension is the main cause of increased thickness of the heart wall, which can increase the risk of atrial fibrillation, a common heart rhythm problem in older people.

With increasing age, people become more sensitive to salt, which may cause an increase in blood pressure and/or ankle or foot swelling (edema). Other factors, such as thyroid disease or chemotherapy, may also weaken the heart muscle. Things you can't control, like your family history, might increase your risk of heart disease. But, leading a heart-healthy lifestyle might help you avoid or delay serious illness.

How Your Heart Changes with Age

The Heart

Learn about Heart Disease, signs of Heart Disease, and how to prevent Heart Disease.

Heart disease is caused by atherosclerosis (ath-uh-roh-skluh-roh-sis), which is the buildup of fatty deposits, or plaques, in the walls of the coronary arteries over many years. The coronary arteries surround the outside of the heart and supply blood nutrients and oxygen to the heart muscle. When plaque builds up inside the arteries, there is less space for blood to flow normally and deliver oxygen to the heart. If the flow of blood to your heart is reduced by plaque buildup or is blocked if a plaque suddenly ruptures, it can cause angina (chest pain or discomfort) or a heart attack. When the heart muscle does not get enough oxygen and blood nutrients, the heart muscle cells will die (heart attack) and weaken the heart, diminishing its ability to pump blood to the rest of the body.

What Is Heart Disease?

Early heart disease often doesn't have symptoms or the symptoms may be barely noticeable. That's why regular checkups with your doctor are important. Contact your doctor right away if you feel any chest pain, pressure, or discomfort. However, chest pain is a less common sign of heart disease as it progresses, so be aware of other symptoms. Tell your doctor if you have:

- Pain, numbness, and/or tingling in the shoulders, arms, neck, jaw, or back
- Shortness of breath when active, at rest, or while lying flat
- Chest pain during physical activity that gets better when you rest
- Lightheadedness
- Dizziness
- Confusion
- Headaches
- Cold sweats
- Nausea/vomiting
- Tiredness or fatigue
- Swelling in the ankles, feet, legs, stomach, and/or neck
- Reduced ability to exercise or be physically active
- Problems doing your normal activities

Problems with arrhythmia are much more common in older adults than younger people. Arrhythmia needs to be treated. See a doctor if you feel a fluttering in your chest or have the feeling that your heart is skipping a beat or beating too hard, especially if you are weaker than usual, dizzy, tired, or get short of breath when active.

Signs of Heart Disease

Try to be more physically active. Talk with your doctor about the type of activities that would be best for you. If possible, aim to get at least 150 minutes of physical activity each week. Every day is best. It doesn't have to be done all at once—10-minute periods will do. 

If you smoke, quit. Smoking is the leading cause of preventable death. Smoking adds to the damage to artery walls. It's never too late to get some benefit from quitting smoking. Quitting, even in later life, can lower your risk of heart disease, stroke, and cancer over time.

Follow a heart-healthy diet. Choose foods that are low in trans and saturated fats, added sugars, and salt. As we get older, we become more sensitive to salt, which can cause swelling in the legs and feet. Eat plenty of fruits, vegetables, and foods high in fiber, like those made from whole grains.

Keep a healthy weight. Balancing the calories you eat and drink with the calories burned by being physically active helps to maintain a healthy weight.
Keep your diabetes, high blood pressure, and/or high cholesterol under control. Follow your doctor's advice to manage these conditions, and take medications as directed.

Don't drink a lot of alcohol.

Manage stress. Learn how to manage stress, relax, and cope with problems to improve physical and emotional health. Consider activities such as a stress management program, meditation, physical activity, and talking things out with friends or family.

How To Prevent Heart Disease?

Heart Disease

Heart Health

Discover the types of clubs you can join and interact with!

There are four main club categories: fundraising, community service, career interest, and interpersonal dynamics. Many clubs offer a combination of each element.

Fundraising
Many people polarize toward fundraising for a major organization or movement. Fundraising appeals to people as high school students make a direct impact on international affairs, such as funding cancer research or environmental preservation.

Community Service
Many schools require that students perform a certain community service quota. To obtain such a threshold, many people turn to community service organizations such as Exchange Clubs, Key Club, Interact Club, Lion's Club, Red Cross, FCCLA, and local clubs.
In doing so, many teenagers experience more camaraderie while performing community service. Other individuals just enjoy helping the local community around them.

Career Interest
Many teenagers join clubs that revolve around their career interests. Many clubs, such as Future Scientist and Engineers of America focus on specific career fields and help students understand them better. Many competitions, awards, and conventions are held to give club members advantages in these fields by exposing them to new opportunities. In addition, members of career interest clubs network with other students who will enter similar fields.

Interpersonal Dynamics
Many teenagers join clubs that offer no academic, organizational, or community benefits. These clubs tend to focus on culture, social dynamics, and self-interest. These clubs look to satisfy the needs and demands of teenagers in each school, based on environment, tradition, and culture. Clubs such as Anime Club can bring students to socialize.

Types of clubs

- TSA - Technology Student Association
- JSA - Junior State of America
- DECA
- Future Business Leaders of America
- French Club
- UNICEF High School Clubs
- Key Club
- Interact Club
- High Schools Society, Ghana
- Lion's Club
- Red Cross
- Thespian Society
- Model United Nations
- The National FFA Organization
- SkillsUSA (formerly known as VICA)
- HOSA- Health Occupation Students of America
- Amnesty International
- Student Council
- Anime Club
- Korean Culture Club
- Chess Club
- BHHS Real Estate Club
- BHHS Feed the Families Club
- Gay/Straight Alliance
- Speech and Debate club
- Academic Decathlon
- First Robotics
- Quiz bowl
- Science Bowl
- Scholar Bowl
- Math Team
- VEX Robotics Competition
- Book club
- Science club
- Science Olympiad
- Yearbook club
- National Honor Society
- Music Honor Society

List of Social Clubs

Join the Club!

Social Clubs

Learn about conquering recurring nightmares.

Discover how to reduce the frequency and severity of recurring nightmares.

Practice relaxation techniques each night before you go to bed.

Step 1

Choose a recurring nightmare you would like to work on. This will be your target nightmare.

Step 2

Choose a changed ending for the nightmare. The change should occur BEFORE anything traumatic or bad happens to you or others in the nightmare. Essentially, you want to come up with a change that will prevent the bad outcome of the usual nightmare from occurring. The more unusual and out-of-the-ordinary the change is, the more effective this protocol may be. For example, you might become a person with superhuman powers (e.g., invisibility, ability to fly) who is able to escape to safety or fight off attackers.

Step 3

Write down the full nightmare with the change.

Step 4

REHEARSAL + RELAXATIONS: Practice rehearsal of the nightmare by visualizing the entire dream with the change each night before practicing relaxation techniques.

Step 5

Visualize the entire dream with the change, and practice relaxation, as often as possible during the day.

Step 6

The Protocol

Instructions for Nightmare Protocol

Negative thought patterns are repetitive, unhelpful thoughts. They directly cause what we could describe as ‘negative’ (unwanted or unpleasant) emotions like anxiety, depression, stress, fear, unworthiness, or shame.


People often try many different ways to get rid of their negative thoughts, including distractions, diversions, or ‘drowning their sorrows’ only to later mentally beat themselves up for being still stuck in their negativity. It can feel like a real internal battle. These are common strategies that attempt to stop the thoughts and numb the pain in the short term but they only make things worse in the long term. It doesn’t fix the problem at its core. The research shows that struggling with, arguing with, trying to drown out, or push away unhelpful thoughts only amplifies them and makes things worse. If you are struggling with negative thinking, it is possible to turn things around, cultivate inner peace, and live a rich, meaningful, and fulfilling life. Read on to find out how.

Ineffective Ways People Try to Stop Negative Thinking

Negative thought patterns are repetitive, unhelpful thoughts. They directly cause what we could describe as ‘negative’ (unwanted or unpleasant) emotions like anxiety, depression, stress, fear, unworthiness, shame, etc. Once we learn to recognize and identify negative thought patterns as they occur, we can start to step back from them. This process of stepping back from thoughts is called ‘cognitive defusion.’ In cognitive defusion, we learn to see the thoughts in our head as simply that—just thoughts. Not reality. You see, when we are fused with our thoughts (cognitive fusion) we tend to take our thoughts very, very seriously. We believe them. We buy into them and we obey them. We play them out. When we are not fused with our thoughts—when we can step back into cognitive defusion, then we do not take our thoughts too seriously. We hold them lightly. We only listen to them if we find them valuable or helpful.  We certainly don’t take our thoughts to be ‘the truth’ and we don’t automatically obey them or play them out. We see our thoughts as simply bits of language that pass through the mind. Mental events if you will, that move through the mind all the time just like the weather passes through the sky. We have a choice in how we choose to respond to them. An example to illustrate the difference between cognitive fusion and cognitive defusion is this...imagine waking up one day and looking out the window and seeing rain. It’s possible that a thought might come into your head that says “what a dreadful day”. Now is it true that the day is dreadful? No, of course not, it is simply raining. However, if you believe the thought “what a dreadful day”, in other words, if you are stuck in cognitive fusion (literally fused with the thought) then guess what you will probably have? That’s right, you will probably have a dreadful day! In other words, if you believe a thought like that, it can generate what we might call negativity. It’s completely normal to have negative thoughts! It’s part of our evolutionary history. There is nothing wrong with you. We all have minds that have evolved to be constantly on the lookout for problems and dangers, so most of us have minds prone to have many negative thoughts. The problem is not that we have negative thoughts. The problem comes when we believe our thoughts are true. When you are no longer entangled in thoughts they lose their grip on you and lose their power to generate unpleasant emotions. Imagine you’re laying in bed in the morning, you look out the window and you see that it’s raining and once again the thought arises “what a dreadful day”. If you are not fused with the thought (you don’t buy into it) then your experience would be like this. You’re watching the rain falling, then you also watch the thought (as simply a mental event) “what a dreadful day” arise and fall away just like the rain is falling and since you don’t take it seriously or believe it, it generates no negativity, passes by easily and you’re free to lay there relaxed and at ease, enjoying the pitter-patter of the rain on the roof. As you can see, the ability to recognize unhelpful thinking and step back from it is incredibly liberating! It can change the quality of your whole day and indeed your whole life.

Recognize and Take a Step Back

“My life has been full of terrible misfortunes, most of which never happened”. ~ Michel de Montaigne

Worry is when the mind projects into an imagined future and conjures up scenes and thoughts about what could go wrong. Here it often creates ‘what if’ scenarios. Sometimes it takes the form of imagining or expecting that bad things will happen or that nothing good will ever happen for you. You might fret about your health deteriorating, your relationship going downhill, your car breaking down or your career being ruined—even though nothing has actually happened yet. You might focus on the lack in your life and believe that nothing will ever get better for you. Stress-related to your financial future, the welfare of your children or your partner leaving you fit into this category.

Anxious Thoughts and Worry

Do you have a harsh inner critic? Are you always trying to whip yourself into shape, mentally beating yourself up for not being good enough yet? Are you on a mission for perfection?
Another pattern of negative thought is to constantly criticize and self-improve because you’re not good enough yet. You may be very harsh on yourself, focusing on all of your weaknesses and perceived flaws. Likewise, you may extend this habit of criticism to others in your life. This can be the cause of tremendous strain on relationships. Negative self-talk and self-criticism often result in low self-esteem and a lack of confidence. One way some people cope with low self-esteem is to compensate for these feelings by attaining status, achievements, and recognition. Others may feel completely debilitated by feelings of unworthiness, becoming depressed, or even suicidal. There is nothing wrong with having goals and aiming to get fitter or healthier and the like—we can simply choose to do those because they are good for us or we want to stretch and grow. It’s a very different headspace to be doing those things because we don’t feel like we’re enough yet. When the mind continuously hones in on what is wrong with yourself (and your life) and disassociates from what is going well and is good, we can become stuck in negativity.

Criticism and Self-Beating

Ruminating on mistakes made in the past often creates feelings of shame, guilt, and negativity. Feelings of worthlessness may arise when you play over and over in your mind, ‘bad’ choices or ‘wrong’ actions you feel you have made. There is nothing ‘negative’ about simply reflecting on past experiences. This is how we can learn, grow and mature as people. Negativity arises when you dwell on a situation repeatedly with no real intention to learn and grow–but instead, you are self-beating or wishing things were different instead of being accepting of things as they are.

Regret and Guilt

The Patterns

Learn how to break free from negative thought patterns.

People trapped in negative thinking often say they feel hopeless because they often wrestle or argue with the thoughts or push them away, but the research shows that trying to struggle with thoughts in these ways just amplifies them as you may have noticed in your own life. What you resist persists. So how do you move through life in a way that is practical, peaceful, and authentic without getting stuck in negative thought patterns? Here is the first step. It’s a very powerful, simple, tried, and tested technique for untangling from thoughts without struggling with them. It’s called the ‘name it to tame it’ technique. "Name it to tame it" is a phrase coined by author and psychiatrist Dr. Daniel Siegel. Here are the basics of how ‘name it to tame it’ works: 

When an unhelpful thought pattern (and the associated emotion) arises you simply mentally ‘label’ the story. You’ve probably noticed many of our thoughts are repetitive and involve the same storylines. A story you could be telling yourself is, “Who am I to be putting myself out there teaching mindfulness. Aren’t you supposed to be perfect first!? Have it all totally together?!” This story is unhelpful so when thoughts come up along that storyline, you should simply take the mental note, “Ahhhh the ‘who do you think you are’ story is here again” and then let it go. By ‘let it go’ we simply mean, stop giving it all your attention and stop taking it so seriously. Realize it’s just a thought, not reality, then open your awareness to the world around you again—the birds in the trees, the sounds, the breeze. Get out of your head and into your life. As soon as you name the mental story or pattern, you have now stepped back from being caught up in it. In other words, you have initiated cognitive defusion. 

From a neuroscience perspective, when you name the thoughts you stop being hijacked by them from the negativity they create because you bring the smartest part of your brain online (the frontal cortex). The frontal cortex is reflective and helps you step back and get a greater perspective. You can do the same thing with emotions, naming them to tame them like “ahhh anxiety is here” or “oh shame has arrived”. When naming or labeling your thoughts or emotions, one important tip. Make sure when you mentally label, to do it in a soothing, kind tone of voice. This is important as it helps you to settle and invite compassion and soothing into that moment instead of aggression or struggle. We’re not going to battle with the mind here. We are gently training it into new neural pathways of peace and ease. At a biological level, when you ‘name it to tame it’ in a soothing voice you even get a squirt of soothing neurotransmitters in the brain! This brings feelings of calm and ease and comfort.

Getting Unstuck: The "Name It To Tame It" Technique

“Let us not look back in anger or forward in fear, but around in awareness.” ~ James Thurber

Notice that many negative thoughts mostly flow from two directions. The first is dwelling on the past—maybe you ruminate over mistakes, problems, guilt, and anything in your life that’s did not go the way you believe it should have gone. The second is worrying about the future—fear of what may or may not happen for yourself, others, or the planet.
This may take the form of stress over whether or not you will achieve certain goals or anxiety about the security of your finances or relationships. Or perhaps you may worry about getting old. Whatever your particular negative thoughts are, notice that in order to engage in negative thought patterns the mind needs to cast its focus mostly on the past or future. Either that or we judge and mentally label things in the present moment to be ‘bad’. When lost in negative thinking we tend to be so engrossed in thoughts that we completely lose touch with what is actually happening in the present moments of our lives. We miss the little pleasures of living each day. The sunlight on your skin, the taste of the food we’re eating, a real connection with someone we love while they are talking. When we’re lost on our heads we lose touch with the world around us... and we lose touch with ourselves. To become more present, and able to step out of negative thinking, one powerful method is to ‘come to your senses. To do this simply redirect your attention out of the thoughts in your head and bring your focus to your sense perceptions. Whether you’re in your home, at the office, in the park, or on a subway, notice everything around you. Use your senses to their fullest. Don’t get into a mental dialogue about the things you see, just be aware of what you’re experiencing at this moment. Be aware of the sounds, the scents, the sensation of the air on your skin, or the contact points with the seat beneath you. Be there fully in the moment. This is a form of mindfulness practice.

Research from Prof. Mark Williams from Oxford University showed that when difficulties arise in life many of us tend to get caught up in excessive unhelpful thinking.
Sometimes people try to stop constant unhelpful thinking but we don’t have to try to stop our thoughts. A more effective way to ease all that internal noise, Prof. Williams teaches, is to pay attention to our direct sensory experience. In this way, there’s simply little to no room left in our attention for all that excessive thinking. Coming to our senses calms the mind and grounds us in the present moment. Now, it’s not that we’re aiming to live completely immersed in our senses all the time. It’s appropriate to think when it’s useful of course. But we can use this awareness of our senses to the ground and center us in a greater awareness when we find ourselves caught up in negative thinking. It is actually almost impossible to be both deeply present in the moment in our senses and keep the negativity going! Try it out as an experiment and find out for yourself to see whether this is true.

Coming To Your Senses

Breaking Free

Breaking Negative Thought Patterns

We've all been in a situation where we know we need to work out, but one of a number of excuses has got the better of us and we've skipped the gym. Learn about the benefits of having a training partner!

Perhaps the best aspect of training with someone is that your partner provides instant accountability. We’ve all been in a situation where we know we need to work out, but one of a number of excuses has got the better of us and we've skipped the gym. Making plans with a training partner makes it much harder to cancel a workout as you know you’ll be messing up their plans too.

Accountability

It’s not uncommon to be overly critical when looking at workout progression. You may just be your own worst critic. A good training partner will always be able to look at your concerns through fresh eyes and give a healthy second opinion.

Outside Perspective

We humans (especially men, it seems) tend to work harder and perform better in competitive situations. Training with a partner can unlock your competitive drive no matter how chilled out you usually are. There’s nothing like a training partner looking great or making serious progress in the gym to fire up your desire to do better. One word of caution though: if your partner is considerably stronger or fitter than you, don’t be sucked into trying to perform the same workouts. Your partner won't progress, and you'll likely get injured. Instead, try to compete on degrees of improvement relative to your own current ability.

Healthy Competition

Those incorporating weightlifting into their training regime will benefit greatly from having a training partner who can act as a spotter on those big lifts. Depending on the type of training program you are using, reaching or approaching concentric failure on a set may be necessary to make progress. Having someone there to help control the weight means that you can push further than you could alone and have a safer workout. It’s common to hear people ask for a spot on the bench press, but it shouldn’t stop there: you can get more out of almost all free weight exercises with the help of a spotter.

You'll Be Able to Spot Each Other

One of the greatest parts of having a good training partner is the ability to share each other's successes. Setting training goals and edging closer and closer to their attainment alongside someone else is very motivating. It’s also a great idea to plan rewards together. A previous training partner and I used to book a weekend trip away to let our hair down each time we finished a 6-8 week training phase. It helps to balance all the hard work with a worthy reward.

Celebrate Successes Together

Benefits

OK, you want a training partner. How do you find one?

Finding the right training partner isn’t easy. If you don’t already have a training partner or have someone in mind to ask, here are some ways you could go about finding one:

Public goals / social media: 
Why not set a public goal on one of your social media profiles, post some of your workouts, and just add the odd "anyone fancy joining me?" tag to some of your posts. You never know, one or more of your acquaintances might be in exactly the same position as you. Make it easy for people to select themselves.

Meet-up groups: 
You could use meetup.com or other online meeting websites to directly seek out like-minded individuals in your area that are also actively seeking out a training partner. This one works really well as you already have a motivated audience.

The gym: 
You may need not look further than your own gym. Get to know the other members and keep a lookout for other users doing similar training to yourself. Be on hand and ready to lend a spot and just be an all-around positive character on the gym floor. You may be surprised how quickly people begin to present themselves as potential training partners.

Finding a Training Partner

How to Find a Training Partner

Benefits of Training With a Partner

These suggestions are meant as alternatives to Self-Injury in times of dire crisis and overwhelming urges. They are what I call "Intermediate coping strategies" designed to help you move into a less emotionally volatile state. They are NOT DBT skills!

Learn about various tools you can use to respond to a high distress situation.

The source of this material is from many people with BPD sharing what has worked for them. This is a compilation of their answers, These suggestions for dealing with panic are not a replacement for the Distress Tolerance skills. They are about being effective in the moment - which means doing what it takes to be safe. Believe it or not, even the ones that sound stupid usually, help a little, and the best skill of all is to wait 15 min, and then ask yourself if you can wait for 15 more, and so on. If 15 min is a long time for you, try 5. The point is, self-injury urges usually hit and you want to do it "right now". If you can wait, then maybe you don't have to do it at all. Emotions come to us in waves. The longer you wait, the more likely the urgent need will dissipate. As you go along in life without self-injuring, one day you will think about doing it and a little voice says, "Ouch! That would hurt! That's not going to make me feel better." Self-injury can be addictive but over time, with practice, you'll find other ways to tolerate distress and it will become more manageable.

Note About These Distress Skills

Distress Skills

Discover some options for immediate distress options

- Try something physical and violent, something not directed at a living thing:
- Slash an empty plastic soda bottle or a piece of heavy cardboard or an old shirt or sock.
- Make a soft cloth doll things you are angry at instead of yourself
-Flatten aluminum cans for recycling, seeing how fast you can go.
- Hit a punching bag.
- Use a pillow to hit a wall, pillow-fight style.
- Rip up an old newspaper or phone book,
- On a sketch or photo of yourself, mark in red ink what you want to do. Cut and tear the picture.
- Make Play-Doh or Sculpey or other clay models and cut or smash them.
- Throw ice into the bathtub or against a brick wall hard enough to shatter it.
- Break sticks.

Sometimes these things work even better if you rant at the thing you are cutting/tearing/hitting. You could start out slowly, explaining why you are hurt and angry, but you might end up swearing and crying and yelling. It helps a lot to vent like that.
- Crank up the music and dance.
- Clean your room (or your whole house).
- Go for a walk/jog/run.
- Stomp around in heavy shoes.
- Play handball or tennis.
- Play an intense computer game.

Distress Options For When You Feel Angry, Frustrated, Restless

- Do something slow and soothing, like taking a hot bath with bath oil or bubbles.
- Curl up under a comforter with hot cocoa and a good book.
- Baby yourself somehow. Do whatever makes you feel taken care of and comforted.
- Light sweet-smelling incense.
- Listen to soothing music.
- Smooth nice body lotion onto the parts of yourself you want to hurt.
- Call a friend and just talk about things that you like.
- Make a tray of special treats and tuck yourself into bed with it and watch TV or read.
- Visit a friend.
- Play a friendly, easy computer game.
- Make a list of the things you are grateful for, start with the easy things.

Distress options for when you feel sad, unhappy, depressed

- Watch a funny movie.
- Watch a cartoon movie.
- Watch children's programs.
- Watch educational programs.
- Watch programs about nature.
- Avoid watching violent television.

Distress Options For When You Feel Overwhelmed or Obsessed

Distress Options

Panic List For Distress Skills

Co-dependency, also known as “relationship addiction” because people with codependency often form or maintain relationships that are one-sided, emotionally destructive and/or abusive. 

Source: https://www.mhanational.org/co-dependency

Co-dependency is a learned behavior that can be passed down from one generation to another. It is an emotional and behavioral condition that affects an individual’s ability to have a healthy, mutually satisfying relationship.

Co-dependency often affects a spouse, a parent, sibling, friend, or co-worker of a person afflicted with alcohol or drug dependence. Originally, co-dependent was a term used to describe partners in chemical dependency, persons living with, or in a relationship with an addicted person. Similar patterns have been seen in people in relationships with chronically or mentally ill individuals. Today, however, the term has broadened to describe any co-dependent person from any dysfunctional family.

Who Does Co-Dependency Affect?

A dysfunctional family is one in which members suffer from fear, anger, pain, or shame that is ignored or denied. Underlying problems may include any of the following:

- An addiction by a family member to drugs, alcohol, relationships, work, food, sex, or gambling.
- The existence of physical, emotional, or sexual abuse.
- The presence of a family member suffering from a chronic mental or physical illness.

Dysfunctional families do not acknowledge that problems exist. They don’t talk about them or confront them. As a result, family members learn to repress emotions and disregard their own needs. They become “survivors.” They develop behaviors that help them deny, ignore, or avoid difficult emotions. They detach themselves. They don’t talk. They don’t touch. They don’t confront. They don’t feel. They don’t trust. The identity and emotional development of the members of a dysfunctional family are often inhibited.

Attention and energy focus on the family member who is ill or addicted. The co-dependent person typically sacrifices his or her needs to take care of a person who is sick. When co-dependents place other people’s health, welfare and safety before their own, they can lose contact with their own needs, desires, and sense of self.

What Is A Dysfunctional Family?

Co-dependents have low self-esteem and look for anything outside of themselves to make them feel better. They find it hard to “be themselves.” Some try to feel better through alcohol, drugs or nicotine - and become addicted. Others may develop compulsive behaviors like workaholism, gambling, or indiscriminate sexual activity.

They have good intentions. They try to take care of a person who is experiencing difficulty, but the caretaking becomes compulsive and defeating. Co-dependents often take on a martyr’s role and become “benefactors” to an individual in need. A wife may cover for her alcoholic husband; a mother may make excuses for a truant child; or a father may “pull some strings” to keep his child from suffering the consequences of delinquent behavior.

The problem is that these repeated rescue attempts allow the needy individual to continue on a destructive course and to become even more dependent on the unhealthy caretaking of the “benefactor.” As this reliance increases, the co-dependent develops a sense of reward and satisfaction from “being needed.” When the caretaking becomes compulsive, the co-dependent feels choice-less and helpless in the relationship, but is unable to break away from the cycle of behavior that causes it. Co-dependents view themselves as victims and are attracted to that same weakness in the love and friendship relationships.

How Do Co-Dependent People Behave?

Characteristics Of Co-Dependent People Are:

- An exaggerated sense of responsibility for the actions of others
- A tendency to confuse love and pity, with the tendency to “love” people they can pity and rescue
- A tendency to do more than their share, all of the time
- A tendency to become hurt when people don’t recognize their efforts
- An unhealthy dependence on relationships. The co-dependent will do anything to hold on to a relationship; to avoid the feeling of abandonment
- An extreme need for approval and recognition
- A sense of guilt when asserting themselves
- A compelling need to control others
- Lack of trust in self and/or others
- Fear of being abandoned or alone
- Difficulty identifying feelings
- Rigidity/difficulty adjusting to change
- Problems with intimacy/boundaries
- Chronic anger
- Lying/dishonesty
- Poor communications
- Difficulty making decisions

Characteristics Of Co-Dependent People

The first step in changing unhealthy behavior is to understand it. It is important for co-dependents and their family members to educate themselves about the course and cycle of addiction and how it extends into their relationships. Libraries, drug and alcohol abuse treatment centers and mental health centers often offer educational materials and programs to the public.

A lot of change and growth is necessary for the co-dependent and his or her family. Any caretaking behavior that allows or enables abuse to continue in the family needs to be recognized and stopped. The co-dependent must identify and embrace his or her feelings and needs. This may include learning to say “no,” to be loving yet tough, and learning to be self-reliant. People find freedom, love, and serenity in their recovery.

Hope lies in learning more. The more you understand co-dependency the better you can cope with its effects. Reaching out for information and assistance can help someone live a healthier, more fulfilling life.

When Co-Dependency Hits Home

Learn about how to identify signs of co-dependency and how someone is treated for co-dependency

This condition appears to run in different degrees, whereby the intensity of symptoms are on a spectrum of severity, as opposed to an all or nothing scale. Please note that only a qualified professional can make a diagnosis of co-dependency; not everyone experiencing these symptoms suffers from co-dependency.

1. Do you keep quiet to avoid arguments?
2. Are you always worried about others’ opinions of you?
3. Have you ever lived with someone with an alcohol or drug problem?
4. Have you ever lived with someone who hits or belittles you?
5. Are the opinions of others more important than your own?
6. Do you have difficulty adjusting to changes at work or home?
7. Do you feel rejected when significant others spend time with friends?
8. Do you doubt your ability to be who you want to be?
9. Are you uncomfortable expressing your true feelings to others?
10. Have you ever felt inadequate?
11. Do you feel like a “bad person” when you make a mistake?
12. Do you have difficulty taking compliments or gifts?
13. Do you feel humiliation when your child or spouse makes a mistake?
14. Do you think people in your life would go downhill without your constant efforts?
15. Do you frequently wish someone could help you get things done?
16. Do you have difficulty talking to people in authority, such as the police or your boss?
17. Are you confused about who you are or where you are going with your life?
18. Do you have trouble saying “no” when asked for help?
19. Do you have trouble asking for help?
20. Do you have so many things going at once that you can’t do justice to any of them?

If you identify with several of these symptoms; are dissatisfied with yourself or your relationships; you should consider seeking professional help. Arrange for a diagnostic evaluation with a licensed physician or psychologist experienced in treating co-dependency.

Questionnaire To Identify Signs Of Co-Dependency

Because co-dependency is usually rooted in a person’s childhood, treatment often involves exploration into early childhood issues and their relationship to current destructive behavior patterns. Treatment includes education, experiential groups, and individual and group therapy through which co-dependents rediscover themselves and identify self-defeating behavior patterns. Treatment also focuses on helping patients getting in touch with feelings that have been buried during childhood and on reconstructing family dynamics. The goal is to allow them to experience their full range of feelings again.

How Is Co-Dependency Treated?

Identification and Treatment

Co-dependency

Spending time in nature can have many benefits - including stress relief and improved mood.

Learn about the benefits of getting out into nature and the effects it has on your mental health and mind.

It’s clear that hiking—and any physical activity—can reduce stress and anxiety. But, there’s something about being in nature that may augment those impacts. In one recent experiment conducted in Japan, participants were assigned to walk either in a forest or in an urban center (taking walks of equal length and difficulty) while having their heart rate variability, heart rate, and blood pressure measured. The participants also filled out questionnaires about their moods, stress levels, and other psychological measures.

Results showed that those who walked in forests had significantly lower heart rates and higher heart rate variability (indicating more relaxation and less stress), and reported better moods and less anxiety, than those who walked in urban settings. The researchers concluded that there’s something about being in nature that had a beneficial effect on stress reduction, above and beyond what exercise alone might have produced. In another study, researchers in Finland found that urban dwellers who strolled for as little as 20 minutes through an urban park or woodland reported significantly more stress relief than those who strolled in a city center.

The reasons for this effect are unclear, but scientists believe that we evolved to be more relaxed in natural spaces. In a now-classic laboratory experiment by Roger Ulrich of Texas A&M University and colleagues, participants who first viewed a stress-inducing movie, and were then exposed to color/sound videotapes depicting natural scenes, showed much quicker, more complete recovery from stress than those who’d been exposed to videos of urban settings. These studies and others provide evidence that being in natural spaces— or even just looking out of a window onto a natural scene—somehow soothes us and relieves stress.

Being in Nature Decreases Stress

Gregory Bratman, of Stanford University, has found evidence that nature may impact our mood in other ways, too. In one 2015 study, he and his colleagues randomly assigned 60 participants to a 50-minute walk in either a natural setting (oak woodlands) or an urban setting (along a four-lane road). Before and after the walk, the participants were assessed on their emotional state and on cognitive measures, such as how well they could perform tasks requiring short-term memory. Results showed that those who walked in nature experienced less anxiety, rumination (focused attention on negative aspects of oneself), and negative affect, as well as more positive emotions, in comparison to the urban walkers. They also improved their performance on the memory tasks.

In another study, he and his colleagues extended these findings by zeroing in on how walking in nature affects rumination—which has been associated with the onset of depression and anxiety—while also using fMRI technology to look at brain activity. Participants who took a 90-minute walk in either a natural setting or an urban setting had their brains scanned before and after their walks and were surveyed on self-reported rumination levels (as well as other psychological markers). The researchers controlled for many potential factors that might influence rumination or brain activity—for example, physical exertion levels as measured by heart rates and pulmonary functions.

Even so, participants who walked in a natural setting versus an urban setting reported decreased rumination after the walk, and they showed increased activity in the subgenual prefrontal cortex, an area of the brain whose deactivation is affiliated with depression and anxiety—a finding that suggests nature may have important impacts on mood. Bratman believes results like these need to reach city planners and others whose policies impact our natural spaces. “Ecosystem services are being incorporated into decision making at all levels of public policy, land use planning, and urban design, and it’s very important to be sure to incorporate empirical findings from psychology into these decisions,” he says.

Nature Makes You Happier and Less Brooding

“People have been discussing their profound experiences in nature for the last several 100 years—from Thoreau to John Muir to many other writers,” says researcher David Strayer, of the University of Utah. “Now we are seeing changes in the brain and changes in the body that suggest we are physically and mentally more healthy when we are interacting with nature.” Today, we live with ubiquitous technology designed to constantly pull our attention. But many scientists believe our brains were not made for this kind of information bombardment, and that it can lead to mental fatigue, overwhelm, and burnout, requiring “attention restoration” to get back to a normal, healthy state. Strayer is one of those researchers. He believes that being in nature restores depleted attention circuits, which can then help us be more open to creativity and problem-solving. “When you use your cell phone to talk, text, shoot photos, or whatever else you can do with your cell phone, you’re tapping the prefrontal cortex and causing reductions in cognitive resources,” he says. 

In a 2012 study, he and his colleagues showed that hikers on a four-day backpacking trip could solve significantly more puzzles requiring creativity when compared to a control group of people waiting to take the same hike—in fact, 47 percent more. Although other factors may account for his results—for example, the exercise or the camaraderie of being out together—prior studies have suggested that nature itself may play an important role. One in Psychological Science found that the impact of nature on attention restoration is what accounted for improved scores on cognitive tests for the study participants. This phenomenon may be due to differences in brain activation when viewing natural scenes versus more built-up scenes—even for those who normally live in an urban environment.

In a recent study conducted by Peter Aspinall at Heriot-Watt University, Edinburgh, and colleagues, participants who had their brains monitored continuously using mobile electroencephalogram (EEG) while they walked through an urban green space had brain EEG readings indicating lower frustration, engagement, and arousal, and higher meditation levels while in the green area, and higher engagement levels when moving out of the green area. This lower engagement and arousal may be what allows for attention restoration, encouraging a more open, meditative mindset. It’s this kind of brain activity—sometimes referred to as “the brain default network”—that is tied to creative thinking, says Strayer. He is currently repeating his earlier 2012 study with a new group of hikers and recording their EEG activity and salivary cortisol levels before, during, and after a three-day hike.

Early analyses of EEG readings support the theory that hiking in nature seems to rest people’s attention networks and engage their default networks. Strayer and colleagues are also specifically looking at the effects of technology by monitoring people’s EEG readings while they walk in an arboretum, either while talking on their cell phone or not. So far, they’ve found that participants with cell phones appear to have EEG readings consistent with attention overload, and can recall only half as many details of the arboretum they just passed through, compared to those who were not on a cell phone. Though Strayer’s findings are preliminary, they are consistent with other people’s findings on the importance of nature to attention restoration and creativity. “If you’ve been using your brain to multitask—as most of us do most of the day—and then you set that aside and go on a walk, without all of the gadgets, you’ve let the prefrontal cortex recover,” says Strayer. “And that’s when we see these bursts in creativity, problem-solving, and feelings of well-being.”

Nature Increases Creativity

In a series of experiments published in 2014, Juyoung Lee, GGSC director Dacher Keltner, and other researchers at the University of California, Berkeley, studied the potential impact of nature on the willingness to be generous, trusting, and helpful toward others, while considering what factors might influence that relationship. As part of their study, the researchers exposed participants to more or less subjectively beautiful nature scenes (whose beauty levels were rated independently) and then observed how participants behaved playing two economics games—the Dictator Game and the Trust Game—that measure generosity and trust, respectively. After being exposed to the more beautiful nature scenes, participants acted more generously and more trusting in the games than those who saw less beautiful scenes, and the effects appeared to be due to corresponding increases in positive emotion.

In another part of the study, the researchers asked people to fill out a survey about their emotions while sitting at a table where more or less beautiful plants were placed. Afterward, the participants were told that the experiment was over and they could leave, but that if they wanted to they could volunteer to make paper cranes for a relief effort program in Japan. The number of cranes they made (or didn’t make) was used as a measure of their “prosociality” or willingness to help. Results showed that the presence of more beautiful plants significantly increased the number of cranes made by participants and that this increase was, again, mediated by positive emotion elicited by natural beauty.

The researchers concluded that experiencing the beauty of nature increases positive emotion—perhaps by inspiring awe, a feeling akin to wonder, with the sense of being part of something bigger than oneself—which then leads to prosocial behaviors. Support for this theory comes from an experiment conducted by Paul Piff of the University of California, Irvine, and colleagues, in which participants staring up a grove of very tall trees for as little as one minute experienced measurable increases in awe, and demonstrated more helpful behavior and approached moral dilemmas more ethically, than participants who spent the same amount of time looking up at a high building.

Nature May Help You to be Kind and Generous

With all of these benefits to being out in nature, it’s probably no surprise that something about nature makes us feel more alive and vital. Being outdoors gives us energy, makes us happier, helps us to relieve the everyday stresses of our overscheduled lives, opens the door to creativity, and helps us to be kind to others. No one knows if there is an ideal amount of nature exposure, though Strayer says that longtime backpackers suggest a minimum of three days to really unplug from our everyday lives. Nor can anyone say for sure how nature compares to other forms of stress relief or attention restoration, such as sleep or meditation. Both Strayer and Bratman say we need a lot more careful research to tease out these effects before we come to any definitive conclusions. Still, the research does suggest there’s something about nature that keeps us psychologically healthy, and that’s good to know…especially since nature is a resource that’s free and that many of us can access by just walking outside our door.

Results like these should encourage us as a society to consider more carefully how we preserve our wilderness spaces and our urban parks. And while the research may not be conclusive, Strayer is optimistic that science will eventually catch up to what people like me have intuited all along—that there’s something about nature that renews us, allowing us to feel better, to think better, and to deepen our understanding of ourselves and others. “You can’t have centuries of people writing about this and not have something going on,” says Strayer. “If you are constantly on a device or in front of a screen, you’re missing out on something that’s pretty spectacular: the real world.”

Nature Makes You “Feel More Alive”

Benefits of Being in Nature

Time in Nature

Health starts in our homes, schools, workplaces, neighborhoods, and communities. Taking care of ourselves by eating well, staying active, and seeing a doctor when we are sick all influence our health.

Introduction to Social Determinants of Health

Health starts in our homes, schools, workplaces, neighborhoods, and communities. We know that taking care of ourselves by eating well and staying active, not smoking, getting the recommended immunizations and screening tests, and seeing a doctor when we are sick all influence our health. Our health is also determined in part by access to social and economic opportunities; the resources and supports available in our homes, neighborhoods, and communities; the quality of our schooling; the safety of our workplaces; and the nature of our social interactions and relationships.

Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Conditions (e.g., social, economic, and physical) in these various environments and settings (e.g., school, church, workplace, and neighborhood) have been referred to as “place.” In addition to the more material attributes of “place,” the patterns of social engagement and sense of security and well-being are also affected by where people live. Resources that enhance the quality of life can have a significant influence on population health outcomes. 

Examples of these resources include safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services, and environments free of life-threatening toxins. Understanding the relationship between how population groups experience “place” and the impact of “place” on health is fundamental to the social determinants of health—including both social and physical determinants. By working to establish policies that positively influence social and economic conditions and those that support changes in individual behavior, we can improve health for large numbers of people in ways that can be sustained over time. Improving the conditions in which we live, learn, work, and play will create a healthier population, society, and workforce.

Understanding Social Determinants of Health

- Availability of resources to meet daily needs (e.g., safe housing and local food markets)
- Access to educational, economic, and job opportunities
- Access to health care services
- Quality of education and job training
- Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities
- Transportation options
- Public safety
- Social support
- Social norms and attitudes (e.g., discrimination, racism, and distrust of government)
-Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community)
- Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it)
- Residential segregation
- Language/Literacy
- Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media)
Culture

Examples of Social Determinants

- Natural environment, such as green space (e.g., trees and grass) or weather (e.g., climate change)
- Built environment, such as buildings, sidewalks, bike lanes, and roads
- Worksites, schools, and recreational settings
- Housing and community design
- Exposure to toxic substances and other physical hazards
- Physical barriers, especially for people with disabilities
- Aesthetic elements (e.g., good lighting, trees, and benches)

Examples of Physical Determinants

Social Determinants of Health

Learn about improving social areas, which in turn improves health.

A “place-based” organizing framework, reflecting five (5) key areas of social determinants of health (SDOH), was developed by Healthy People 2020.

These five key areas (determinants) include:
- Economic Stability
- Education
- Social and Community Context
- Health and Health Care
- Neighborhood and Built Environment

Each of these five determinant areas reflects a number of key issues that make up the underlying factors in the arena of SDOH. 

- Economic Stability: Employment, Food Insecurity, Housing Instability, and Poverty
- Education: Early Childhood Education and Development, Enrollment in Higher Education, High School Graduation, and Language and Literacy
- Social and Community Context: Civic Participation, Discrimination, Incarceration, and Social Cohesion
- Health and Health Care: Access to Health Care, Access to Primary Care, and Health Literacy
- Neighborhood and Built Environment: Access to Foods that Support Healthy Eating Patterns, Crime and - Violence, Environmental Conditions, and Quality of Housing

This organizing framework has been used to establish an initial set of objectives for the topic area as well as to identify existing Healthy People objectives (i.e., in other topic areas) that are complementary and highly relevant to social determinants. It is anticipated that additional objectives will continue to be developed throughout the decade. In addition, the organizing framework has been used to identify an initial set of evidence-based resources and other examples of how a social determinants approach is or may be implemented at a state and local level.

Healthy People 2020 Approach to Social Determinants of Health

Improving Social Determinants of Health

Learn about how Serotonin and Dopamine affect the body.

Learn about how Dopamine and Serotonin combined with other factors affect the body, and the role Dopamine and Serotonin play in digestion, sleep, and depression.

Like other mental health conditions, depression is a complex condition that’s caused by a number of factors. Both dopamine and serotonin play a role in depression, though experts are still trying to figure out the details. Dopamine plays a big role in motivation and reward. If you’ve ever worked hard to reach a goal, the satisfaction your feel when you achieve it is partly due to a rush of dopamine. Some of the main symptoms of depression include:

- low motivation
- feeling helpless
- a loss of interest in things that used to interest you

Experts believe these symptoms are linked to a dysfunction within your dopamine system. They also believe this dysfunction might be triggered by short- or long-term stress, pain, or trauma. Researchers have been studying the link between serotonin and depression for more than five decades. While they initially believed that low serotonin levels caused depression, they now know that isn’t the case.

The reality is more complicated. While low serotonin doesn’t necessarily cause depression, increasing serotonin through the use of selective serotonin reuptake inhibitors (SSRIs) is one of the most effective treatments for depression. However, they do take some time to work. Among people with moderate to severe depression, 40 to 60 percent of people only report an improvement in their symptoms after they’ve taken SSRIs for six to eight weeks. This suggests that simply increasing serotonin isn’t what treats depression. Instead, research has suggested that SSRIs increase positive emotional processing over time, resulting in an overall shift in mood. Another factor is that researchers have found that depression is associated with inflammation in the body. SSRIs have an anti-inflammatory effect.

The Main Difference: Dopamine system dysfunction is linked to certain symptoms of depression, such as low motivation. Serotonin is involved in how you process your emotions, which can affect your overall mood.

Dopamine, Serotonin, and Depression

It’s not just your brain — you also have dopamine and serotonin in your gut, where they play a role in digestion.
Dopamine’s role in digestion is complex and poorly understood. However, experts do know that it helps to regulate the release of insulin from your pancreas.
It also affects movement in your small intestine and colon to help move food through your system.
In addition, dopamine has a protective effect on the mucosal lining of your gastrointestinal tract, which may help to prevent peptic ulcers.
More research is still needed to fully understand how else dopamine may affect our guts.
Your gut contains around 95 percent of your body’s serotonin. It’s released when food enters the small intestine, where it helps to stimulate contractions that push food through your intestines. Your gut releases extra serotonin when you eat something containing harmful bacteria or an allergen. The extra serotonin makes the contractions in your gut move faster in order to get rid of the harmful food, usually through vomiting or diarrhea. Low serotonin in your gut, on the other hand, is associated with constipation. Based on this knowledge, research has found that serotonin-based medications can help treat several gastrointestinal conditions, such as irritable bowel syndrome. They’ve also been used to treat nausea and vomiting caused by chemotherapy. 

The Main Difference: While both dopamine and serotonin are found in your gut, serotonin plays a much larger role in indigestion. It helps to stimulate contractions in your gut that move food through your intestines.

Dopamine, Serotonin, and Digestion

Your sleep-wake cycle is regulated by a small gland in the brain called the pineal gland. The pineal gland receives and interprets light and darkness signals from the eyes. Chemical messengers translate these signals into the production of melatonin, a hormone that makes you feel sleepy. The pineal gland has receptors for both dopamine and serotonin.

Dopamine is associated with wakefulness. Drugs that increase dopamine levels, such as cocaine and amphetamines, typically increase alertness. In addition, diseases that decrease dopamine production, such as Parkinson’s disease, often cause drowsiness. In the pineal gland, dopamine can stop the effects of norepinephrine, a neurotransmitter involved in producing and releasing melatonin. When dopamine appears, your pineal gland makes and releases less melatonin, causing you to perk up. 

A 2012 study also found that sleep deprivation decreases the availability of certain types of dopamine receptors. With fewer receptors, dopamine doesn’t have anywhere to attach to, making it hard to stay awake. Serotonin’s role in regulating the sleep-wake cycle is complex. While it plays a role in maintaining sleep, it can also prevent you from falling asleep. How serotonin affects sleep depends on the part of the brain it comes from, the type of serotonin receptor it binds to, and several other factors. In a part of your brain called the dorsal raphe nucleus, high serotonin is associated with wakefulness. However, an accumulation of serotonin in the area over time may put you to sleep.

Serotonin is also involved in preventing rapid eye movement (REM) sleep. Studies have shown that increasing serotonin through the use of SSRIs reduces REM sleep. While serotonin seems to both induce sleep and keep you up, it’s a chemical precursor to melatonin, the main hormone involved in sleep. Your body needs serotonin from your pineal gland in order to produce melatonin. 

The Main Difference: Both dopamine and serotonin play a role in your sleep-wake cycle. Dopamine can inhibit norepinephrine, causing you to feel more alert. Serotonin is involved in wakefulness, sleep onset, and preventing REM sleep. It’s also required to produce melatonin.

Dopamine, Serotonin, and Sleep

Dopamine, Serotonin, and ________

Dopamine and serotonin also both play roles in psychological conditions other than depression. Nearly all pleasurable experiences — from eating a good meal to having sex — involve the release of dopamine. That release is part of what makes some things addicting, such as:

- drugs
- shopping
- gambling
- sex/pornography

Experts evaluate something’s potential to cause addition by looking at the speed, intensity, and reliability of the dopamine release it causes in your brain. It doesn’t take long for your brain to associate certain behaviors or substances with a rush of dopamine. Over time, your dopamine system may be less reactive to the substance or activity that used to cause a big rush. For example, someone might need to consume more of a drug to achieve the same effects that a smaller amount used to provide. Besides Parkinson’s disease, experts also believe that a dysfunction of the dopamine system plays a role in bipolar disorder, schizophrenia, and attention deficit hyperactivity disorder (ADHD).

In a 2014 review, serotonin was also linked to several other conditions, including anxiety disorders, autism, and bipolar disorder. More specifically, the researchers found low serotonin binding among people with obsessive-compulsive disorder (OCD) and social anxiety disorder. This results in less available serotonin in the brain. In addition, they found that people with autism are more likely to have lower levels of serotonin in certain areas of the brain. Bipolar disorder was also associated with altered serotonin activity, which may influence the severity of someone’s symptoms.

The Main Difference: There’s a close link between dopamine and how you experience a pleasure. Dysfunction of the dopamine system might also contribute to bipolar disorder and schizophrenia. Serotonin affects emotional processing, which can have significant effects on mood.

What About Other Mental Health Conditions?

Dopamine and serotonin are two neurotransmitters that play important roles in your brain and gut. An imbalance in your levels of either one can have effects on your mental health, digestion, and sleep cycle. There are no clear ways to measure serotonin and dopamine levels. While they both affect a lot of the same parts of your health, they do so in distinct ways the experts are still trying to understand.

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