The Promise of Self-Compassion for Stressed-Out Teens

Psychologists have now turned their attention to self-compassion in adolescents. Their initial findings reveal an unusually powerful intervention for stressed out young adults, a potential crown jewel of resilience interventions.

Late last year, Imogen Marsh, Stella Chan and Angus Macbeth at the University of Edinburgh published a meta-analysis of research on self-compassion in young people in the journal Mindfulness. They synthesized studies on more than 7,000 adolescents from six countries, ranging in age from 10 to 19. They found that teens with high levels of the trait were most likely to report lower levels of distress caused by anxiety and depression — especially when facing chronic academic stress.

Adolescence is a developmental moment of peak stress, and a teen’s heightened self-consciousness (“Do I look weird? Did I just sound stupid in class?”) cranks up the volume of the inner critic. Self-compassion encourages mindfulness, or noticing your feelings without judgment; self-kindness, or talking to yourself in a soothing way; and common humanity, or thinking about how others might be suffering similarly.

This last step is particularly salubrious for adolescents: Many believe that “I’m the only one going through this,” which exacerbates feelings of isolation and shame.

The teens I work with are prone to catastrophizing when facing a problem (“I’ll never get into college,” “I’ll never get a good job”). For them, the mindfulness step of self-compassion — which asks them to zero in on a feeling instead of an imagined, exaggerated outcome — is especially grounding. My students find self-kindness most challenging, so I ask them to imagine how they would comfort a close friend struggling with the same challenge. “There’s almost no one whom we treat as badly as ourselves,” Dr. Neff told me.

Skeptics like the Princeton athlete in my workshop worry that self-compassion is indolence in disguise: an excuse to lower your standards or give up instead of “sucking it up” and dealing. As an educator from a mostly immigrant, bootstrapping family, I once might have agreed with her. Self-compassion is precisely the kind of New-Agey trend some of my crustier relatives might have called piffle, a way to brush off mistakes instead of owning them.

But research shows that self-compassion does not diminish integrity or standards of accountability. Instead, it lets you own up to a tough moment without paying for it with your self-worth. This new logic teaches students that they don’t have to be perfect to be worthy.

I have been stunned by the reaction of students of all ages to the practice. In a public high school auditorium in Hopewell Valley, N.J., in November, I led more than 600 juniors and seniors through a self-compassion meditation. I asked them to place their hands on their hearts, and to feel the pressure and warmth of a kind hand. Their silence was respectful and profound. Many students were crying. They had never thought to approach their own setbacks with gentleness.

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At a local elementary school in Northampton, Mass., I volunteer teaching self-compassion to children as young as 5. Kindergartners share embarrassing moments (“I fell off the monkey bars in front of my friends”) and practice hugging themselves as a form of self-soothing. First graders sit in a circle holding hands, reminding each other they are not alone.

But self-compassion may be most critical in adolescence, when researchers say it is at its lowest levels. This is especially true for teen girls, who show the lowest levels of self-compassion of any group of youth, and who experience a sudden drop in the trait between middle and high school.

Late last year the first self-compassion curriculum for teens, “Making Friends With Yourself: A Mindful Self-Compassion Program for Teens and Young Adults,” was published by Karen Bluth, assistant professor at the University of North Carolina’s School of Medicine.

Inspired by Dr. Neff’s similar curriculum for adults, the program’s evaluations revealed lowered stress in middle and high school participants, compared with those in a control group. Participants also had lower anxiety and depression, and elevated resilience and healthy risk taking.

To teach their children how to show themselves grace in the face of a challenge, I coach parents to model self-compassion in the face of everyday setbacks. Instead of cursing at yourself when you lose your keys, verbalize mindfulness: “I am feeling so frustrated right now.” When describing a disappointment at work, demonstrate what self-kindness sounds like: “I did my best, and I’ll make sure not to make that mistake next time.” When you burn dinner, recognize common humanity: “Well, I’m pretty sure I’m not the only bummed out parent feeding their kids pizza tonight.”

Among college students, the need for such thinking is high. A 2016 report from the Center for Collegiate Mental Health, using data from 139 college and university counseling centers, found a surge in demand for mental health services, with anxiety and depression the most common concerns. As schools scramble to handle it, they might consider training peer educators and professional staff members in self-compassion.

If more students use self-compassion to reframe their failures, they may discover more nourishing sources of motivation and healthier strategies to pursue their goals.

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[1] https://www.nytimes.com/2018/02/20/well/family/self-compassion-stressed-out-teens.html?partner=rss&emc=rss

Contraception for Teenagers – The New York Times

“Teens today get much more information about sexually transmitted diseases in school health ed classes than they do about pregnancy prevention,” according to Dr. Philippa Gordon, a pediatrician in Brooklyn, N.Y., who treats many adolescent girls and boys. “They don’t realize how very easy it is for a teenager to become pregnant. Just five to eight acts of unprotected sex would result in pregnancy. A girl can get pregnant even without having intercourse. Our biology is set up to foster it.”

Talking with adults about sex is often embarrassing for teenagers and challenging for their parents, who may leave it up to teachers and doctors to provide the necessary details. Indeed, some may be getting their information surreptitiously from watching pornography. Although schools may recognize the importance of preventing teenage pregnancy, they are often hampered by the mistaken belief that informing youngsters about contraception can encourage them to become sexually active.

However, Dr. David L. Hill tells parents, “Talking to kids about sex and even giving them condoms does not make them have sex any sooner. It does, however, lower the chances you’ll become a grandfather before you’re ready.”

The fact is, with or without sex ed, about half of high school seniors have already become sexually active and need accurate, up-to-date information and access to effective contraception. Furthermore, teenagers who are not adequately informed about pregnancy prevention, or are told only about abstinence, are more likely to become pregnant than those told about birth control options, including emergency contraception, and how to get them. Cost may be a factor.

Many adolescents planning on abstinence do not remain abstinent. As Dr. Hill wrote on the website healthychildren.org, “The best studies of adolescents who take a ‘virginity pledge’ suggest that these kids have sex just as early as those who don’t pledge, but that they are less likely to use birth control when they do have sex.”

Recognizing this, both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (ACOG) have urged their members to have “comprehensive” conversations with adolescent patients about their reproductive health and their contraceptive needs, knowledge and concerns.

Dr. Karen Gerancher, author of a recent ACOG opinion article on counseling adolescents about contraception, said, “When we’re able to reach patients before they become sexually active, or early in their sexually active life, we empower them to take control of their reproductive health, and prevent sexually transmitted infections and unintended pregnancies that could permanently impact the future they’ve envisioned for themselves.”

Although many adolescent girls choose birth control pills, as typically used they are not most effective in preventing pregnancy. Here’s what teens should know about contraceptive options, in order of effectiveness.

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The implant. This long-acting reversible contraceptive is a matchstick-size flexible plastic rod that a doctor inserts under the skin, usually in the upper arm, where it can prevent pregnancy for at least three years, at which time it should be replaced. It contains a progestin hormone that blocks the release of an egg from the ovary. It is the most effective means of birth control, with a one-year failure rate significantly less than one in 100 (0.05 percent). Fertility typically returns quickly once the implant is removed.

An IUD. This other long-acting reversible contraceptive has a slightly higher failure rate of 0.2 to 0.8 percent. A doctor inserts the small T-shaped device into the uterus, where it prevents sperm from fertilizing an egg. There are two types: the Copper T IUD that has no hormone and needs to be replaced only once in 10 years, and a progestin-containing IUD that is replaced every three to five years.

Progestin injection. This shot of a progestin prevents the release of an egg from the ovaries for three months. Its failure rate is six in 100 within the first year.

Vaginal ring. This hormone-containing ring is placed once a month by the user into her vagina, where it prevents release of an egg for three weeks. It is then removed for one week to permit menstruation. During one year of use, about nine women in 100 will get pregnant with this method.

The patch. The patch contains a hormone that is absorbed through the skin to block release of an egg. It is replaced weekly for three weeks, followed by a week off to allow for menstruation. Like the ring, it has a 9 percent failure rate.

The pill. This too has a 9 percent failure rate within the first year of use. The pill must be taken daily, and inconsistent use is the usual reason it fails. There are two types, but only the one containing two hormones, an estrogen and a progestin, is usually prescribed for teens.

Condom. This is the only method that can prevent sexually transmitted infections and should always be used with any of the other methods. The male condom, a thin sheath that slips over the penis, has a pregnancy rate of 18 percent. The female condom, or vaginal pouch, has a failure rate of 21 percent, comparable to that of withdrawal, which has a 22 percent failure rate.

Emergency contraception. These progestin-containing pills, to be taken within five days (the sooner the better) when contraception is not used or a condom breaks, are available over-the-counter, even for teens.

ACOG recommends that teens keep emergency contraception on hand “just in case” to maximize its effectiveness.

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[1] https://www.nytimes.com/2018/02/19/well/live/contraception-for-teenagers.html?partner=rss&emc=rss

Talk to Your Doctor About Your Bucket List

A bucket list is an itemized list of goals people want to accomplish before they “kick the bucket” — or die. Making a bucket list allows us to reflect on our values and goals and identify important milestones and experiences that we want to have in our lifetime.

In my experience as an internist, geriatrics and palliative care doctor, most patients have a bucket list. Some give it a lot of thought, while others have a nebulous mental checklist of items.

I routinely ask my patients about their bucket lists; I started doing this to forge a personal connection and get a quick glimpse into what matters most to each of them. The responses were fascinating and revealed hidden dimensions of their personalities. For example, one patient wanted to sky-dive on her 80th birthday. When I pointed out that it might be a tad risky given her hypertension, diabetes and osteoarthritis, she shrugged.

“Don’t worry, Doc,” she said. “If I die sky diving, I’ll be sure to take my diseases with me. Besides, the instructors are very handsome, so not a bad way to go at all.”

Other patients were less venturesome and talked about the desire to travel or organize an extended family reunion. A recovered alcoholic, who had been sober for decades, grinned wickedly saying that he wanted to “down a jumbo martini in a long gulp one last time.”

I understood two things in eliciting bucket lists. First, knowing patients’ bucket lists is a great way to get them to adopt healthy behaviors. For example, I found that saying, “I don’t think your half marathon is happening anytime soon if you don’t quit smoking” got my patient’s attention much faster than making obvious and boring statements like, “Smoking is bad for you.” Second — and most important — knowing my patients’ bucket list goals has prevented me from implementing medical interventions that subvert them.

That was the case with a patient of mine who had gallbladder cancer. As cancers go, this is a pretty nasty one. It is often silent until late in the game, when people develop itching and jaundice (yellow pigmentation of skin), as did my patient. We ran numerous tests in the next few days and determined that his cancer was inoperable, and that he might find some benefit from radiation treatments and chemotherapy.

I met with him and went over what his treatments would entail: daily radiation appointments for several weeks and chemotherapy. Did he have things he wanted to accomplish in the time he had left? He was quite resigned to being tethered to the hospital for the weeks to come.

“Always wanted to take my family to Maui — could never afford to go before,” he said. “They already made my radiation appointments. I can go next year, right?” I took one good look at him, and it was clear that he was going to be fading fast. He had no idea how little time he had left or how the radiation and chemotherapy would deplete his meager energy reserves. He would be lucky to get up from bed, let alone get on a flight bound to Hawaii following the treatments. So I told him the unvarnished truth as gently as I could.

As is often the case, he was unsurprised. “What are my options?” he asked.

“You could go to Maui, while you still can,” I told him. “Start the cancer treatments as soon as you return.”

He returned two weeks later beaming like a jack-o’-lantern and brought back the largest tin of macadamia nuts that I had ever seen. If I had not asked about his bucket list, he would have stoically undergone the radiation and chemotherapy, and the Maui trip would have remained a sunny fantasy.

Write your bucket list today: It is free, easy and extremely important.CreditVideo by StanfordPalliative

What goes on a bucket list?

In a study published today in the Journal of Palliative Medicine, we asked 3,056 people across the United States and found that nine out of 10 had a bucket list. Participants who said that faith, religion or spirituality were unimportant to them were the least likely to have a bucket list. We also discovered six common themes.

The desire to travel, within the nation or internationally, was the most common bucket list item, followed by the desire to accomplish a personal goal (“drive a Porsche”; “run a marathon”).

One patient wanted to design and build a formal dining room as a gift for his wife, despite his multiple medical problems and chronic pain. He accomplished his goal and built the 12-by-12-foot room by himself in time for their annual family Christmas dinner.

Achieving specific life milestones (“I want to reach our 60th wedding anniversary”), spending quality time with friends and family, and achieving financial stability (“pay off bills”; “be debt-free by age 45”) were next on the list.

The desire to do a daring activity (“Run with the bulls”) was the sixth theme, with young people (26 years of age or less) exponentially more likely to report this desire than older people.

Many — especially those who are not in perfect health — may underestimate the extensive coordination required to make their bucket list wishes possible.

One in four Americans will live with chronic illness like heart disease, cancer or dementia in the last decade of life. Most will undergo numerous medical treatments and procedures in the many years before death.

Your doctor, unaware of your life goals and bucket-list desires, will recommend treatments to you in a vacuum. Some of these treatments could get in the way of your life goals, and you may unknowingly embark upon them without realizing the major impact on your life.

Next time you see your primary care provider, be sure to discuss your current bucket list and ask about the potential impact of proposed treatments on your life goals. Your doctor may even be willing to record your list wishes in your medical record.

Your list is likely to change over the years. As you review and update your bucket list annually (perhaps on your birthday), be sure to inform your doctors and your family.

If you clearly voice your wishes, your doctors should do everything in their power to make sure their treatments do not prevent you from living your life. But if they don’t know what your goals are they cannot help you reach them.

And if you are reading this while you are in good health, you might consider checking some items off your bucket list before it’s too late. That trip to Alaska you’ve always dreamed of will be much more manageable if you can go when you don’t need a wheelchair and an oxygen tank.

[1] https://www.nytimes.com/2018/02/08/well/live/talk-to-your-doctor-about-your-bucket-list.html?partner=rss&emc=rss