Attention-grabbing articles, backed by research.

Across the country and indeed the globe, the coronavirus pandemic has upended people’s lives. Over 150 million Americans have been ordered to stay home, and the vast majority of them are not physically ill right now. This news still feels like a shock to the system, but as these radical changes shift from days to weeks and even months, the combination of widespread anxiety and social isolation will be a major strain on our mental health. Here’s what I’m doing (and what you can do) to maintain sanity during this insane time.

Coronavirus news is everywhere, and it is true that the facts are changing by the day. Naturally, I want to know about the latest number of cases, emerging science about the virus itself, and government plans to address the illness as well as the effects on the economy. However, being trapped at home makes the world feel small, and constantly reading about the coronavirus adds worry with little solace. A supervisor once told me that reading fiction is the best training for a psychiatrist. As we move from our own mind to another person’s point of view, we literally practice empathy. I have also come to realize that reading fiction transports me to another time and space (without exposing me to any viruses). This week, I finally read Tara Westover’s Educated. Reading about the Idaho mountains added a breath of fresh air to my small New York City apartment. 

Remember the mind and body are connected. Just because you can’t go to the gym doesn’t mean you can’t work out. I strongly prefer gyms or playing a sport, but these are not options right now. I’m focusing on what I can do from home: 5-minute yoga sequences in the morning to stay limber, and bodyweight workouts that do not require much space. The American Heart Association guidelines suggest we aim for at least 30 minutes of moderate activity 5 times per week or 75 minutes of intense physical activity per week. If you need people to help motivate you, many fitness studios and yoga classes are offering online streaming so that you can continue your group fitness class from the comfort and safety of your home. 

Do that project you’ve been putting off

Let’s face it: with the lack of commute to work and social events, most of us have more time on our hands than we’re used to. Especially for people who are feeling well and suffering from “cabin fever,” try to think of this time as an opportunity. We all have things we’ve been meaning to do when we get more time: clean out our closet, make a scrapbook, learn a language. Now is the time to work on these items. 2020 will be forever remembered as the year of coronavirus in history, but in your personal story it can also be the year you began something new. In my case, I’m working on improving my Gujarati skills to pass on the language of my parents to my newborn child.

Language and communication are the essence of what makes us different from every other animal species. While social distancing is the best public health strategy right now, social isolation runs counter to human nature. Perhaps that is why isolation is a risk factor for depression, anxiety, poor cognition, physical illness, and even premature death. I have family in 4 different states, and we’ve implemented a FamilyFaceTime on Saturdays at 12pm. It really is different (and better) to get dressed and look at one another in real-time. For many younger people reading this, a video-chat may feel intrusive in today’s text message-oriented culture, but remember, if they are a human on this planet, your friends and family are likely at home with more time on their hands too. While you’re at it, consider reaching out to people you care for but have lost touch with. Reconsider strained and estranged relationships in favor of burying the hatchet. Calamities like this one risk isolation and despair, but they are also an opportunity for mutual understanding and coming together.  

Extra time can make anyone stir crazy, but it is also an opportunity to consider what you want out of life. Introspection requires us to pause and think about who we are, what we believe in, and what we want out of life. Mindfulness and meditation using apps like Headspace and Calm can help with focusing our minds in the present moment. For people who find such exercises challenging, this reflection could take the form of journaling about where you are in your life and where you want to go. Finally, for people who have been considering it, now is an excellent time to start therapy - just be sure to find a provider using telehealth. 

College is a time of exploration, growth, and development. It has its own ups and downs. In that context, freshmen who were just getting their feet wet and seniors wrapping up their final semester (and everyone in between) have all been asked to halt everything, return home, and try to take their courses online. Naturally, much of the magic of college occurs in conversations, group meetings, clubs and extracurriculars, and class discussion. Feeling sad, disappointed, and even angry are all normal emotions to have during this time. If you are feeling particularly out of sorts, reach out to your college counseling center. They are likely still functioning (albeit online), and they can help you figure out the best way to get through this situation. 

Wherever you are, I hope these tips help you as we prepare for weeks and maybe even months of social distancing, lockdowns, and more time at home. Take care of yourself. Look after others. And above all, stay safe. 

Ravi N. Shah (@RaviShahMD) is assistant professor of psychiatry at Columbia University Irving Medical Center and Co-Founder of Mantra Health. 

Tips from a Psychiatrist on Coping at Home During Coronavirus

An old adage of psychotherapy is that as therapists, we must “meet the patient where they are at.” Right now, because of the coronavirus pandemic, students are no longer on campus, but they are online. As college counseling professionals, our delivery of behavioral health services has changed drastically as a result of social distancing requirements. In order to continue to provide care to students, providers now meet with student clients through telehealth platforms, such as videoconferencing or phone.

While our times are challenging, this is also a unique opportunity for those who have had little exposure to using telehealth in higher education counseling to begin their journey. In this article, I am excited to share what I have learned in my time providing telehealth services through HIPAA-compliant platforms for Penn State College of Medicine (PSU-COM). I hope this post will be useful in helping those who are ready to take the next steps in providing care to students using telehealth. 

Here are some suggestions as you contemplate a move to telemental health at your university counseling center.

Select your platform & keep it simple. All universities are in the same boat. Consult with your director or other higher education counseling professionals who are using various software platforms to understand your options related to costs and different features. From my own experience, Doxy.me was a great place to get my feet wet. It is free, HIPAA-compliant, and it has a virtual waiting room. Clients can sign up for an account easily and it allows you to send out a message through your email to alert the client to join the session. The Department of Health and Human Services have suspended requirements for HIPAA-compliant platforms. As long as the service is private, it is acceptable during the national emergency. Fortunately, most platforms for telemental health have been built to be very user friendly and applicable to a wide range of populations. From a practical standpoint, you only need a laptop or desktop computer with a video camera, internet, and limited computer skills. The companies who make these platforms also have customer service links and contact numbers for technical support.  

Have a back-up plan. One of the most important things I’ve learned during my telehealth practice at PSU COM is to have multiple back-up plans in the case of a technology failure, which I review explicitly with the client via email or text. Common technology failures are due to the strength of the internet connection or a problem with the computer itself, both of which are not related to the telehealth platform itself. I notice the connection issue is often related to capacity (I have too many tabs open and programs running at once, or the student is not connected to a strong wifi network). If the issue cannot be resolved, I often move to a phone session or reschedule if that is the student’s preference. 

Know your state laws & protect privacy. It is essential to know your state’s laws regarding telehealth. Given the national emergency, federal and state laws have been dramatically changed to support the use of telehealth. As a general best practice, you should have at least two security barriers to protect student PHI and visit information. I use multiple passwords and encrypt all notes in the case my laptop is misplaced or stolen. I have also found it helpful to reach out to my state board with additional questions related to telehealth practice laws or ethics. They often have helpful answers, point me to a board related document, or tell me that they have “not thought of that specific issue related to telehealth” and that guidance will be coming. 

Know the research that supports your telehealth practice. Sharing that there is sound research to support treatment via telehealth may help both new and existing student clients feel comfortable starting or making the transition to a virtual environment. For example, a recent study showed that online group counseling which employed CBT is just as effective as F2F (Weinberg & Rolnick, 2020). Additionally, a current study by a colleague of mine at Oregon State University found that online counseling through a video application was just as effective as F2F counseling in treating mild to moderate anxiety as assessed by the Beck Anxiety Inventory. Finally, the same online clients were able to achieve an equal level of connection with their counselor as their F2F counterparts, as assessed by the Therapeutic Bond Scale (Novella, 2019). 


There are recommended best practices when utilizing technology with your student clients. One seminal textbook that I would recommend is the Theory and Practice of Online Therapy by Weinber & Rolnick. It has been very helpful in my learning and growth as a telehealth practitioner. I will summarize a few best practices here:

Pay attention to the practical concerns and details of online counseling, as they make a difference. Find a video camera that you are comfortable operating, keeping video placement with the student client in mind. I do this overtly in session, so the student feels I am maintaining good eye contact. Furthermore, I let the student know that I take notes in session and elicit any concern they may have with my breaking eye contact with them. As mentioned above, itis also very important to discuss a back-up plan for what happens if the technology fails, the call is dropped, and is then resumed. Lastly and most importantly, because of a potential lack in proximity tothe student client, discuss your crisis response protocols during the intake session with the student and have your emergency policy and procedure explicitly written in your counseling center’s disclosure statement. Providers should also be sure to confirm the student’s current physical location in the case of an emergency.

Have fun with the technology and play with the features. Most of my student clients at PSU COM have also seamlessly made the transition to virtual sessions. Telehealth vendors build their product to easily fit into a provider's workflow without compromising quality of care, and taking advantage of the features related to the video applications has potentiated the effectiveness of my sessions. For example, I often share links to evidence-based educational websites through my platform’s chat feature to increase my student’s resources and health knowledge. I also share my screen with my client during a session and present avideo clip that highlights a concept of our work.

Be intentional in increasing your understanding and awareness of empirically validated differences between online and face to face counseling (F2F), and how it may impact your clinical practice. Interestingly, research has shown that online counseling environments increase the sense of anonymity and decrease self-control in client populations, leading individuals to be more honest, spontaneous, and open in virtual environments (Weinber & Rolnick, 2020). It may take some time to understand how the delivery of your clinical interventions translates in a virtual medium with college students.  

You may need to adjust some of your theoretical orientation to allow for the psychology of the internet. For example, if you are a dynamically oriented therapist, the concepts of transference or resistance may present differently with student clients when you are providing telehealth in a virtual environment (Weinber & Rolnick, 2020). In addition, the use of long silences as an intervention may come off as a glitch in the technology rather than the pregnant pause of an in-person session. 

I hope this short introduction to telehealth has been helpful. My aim was to provide an accurate representation of my own experience using telehealth, and further reduce perceived barriers for those who are new to using technology in their university counseling center practice. I also believe there will be continued demand for face to face counseling, but because of the current health crisis and the pace of technological innovation, the present moment is a great time to add to your clinical offerings at your institution, and give telehealth a try.  

Novella, J. K. (2019). A Comparison of Online and In-Person Counseling Using Solution-Focused Brief Therapy for College Students with Mild to Moderate Anxiety. 

Weinberg, H., & Rolnick, A. (2020). Theory and practice of online therapy.

Telehealth 101: Getting up to speed on telehealth for college counseling centers

by Kristel Carrington, Medical Director at Mantra Health

Treating depression involves a holistic approach that addresses its biological, environmental and psychological causes. Medications, when needed, are just one tool I recommend in the treatment of my depressed patients. However I also prescribe non-medication interventions that focus on building positive experiences and reducing symptoms of depression. These natural antidepressants can help to reduce risks of depression, improve current symptoms of depression, and help to prevent recurring episodes of depression. They are readily available and I enjoy helping clients think of ways to incorporate them into their lives. The supplements and lifestyle goals mentioned below have strong evidence for improving symptoms of depression.  

There are dietary supplements that have been shown to improve mood due to their ability to boost the building blocks of hormones that can be depleted in those suffering with depression. [1] Three of these supplements with the most evidence are:

5-HTP (5-hydroxytryptophan) is an important ingredient for making serotonin, a major hormone associated with depression symptoms. 

SAMe (S-adenosyl-L-methionine) is a naturally occurring compound in the body which is involved in the creation of other brain hormones hypothesized to play a role in depression.

Omega-3 Fatty acids have evidence for improving both depression and cognition in adults. Low levels of omega-3 are seen in people with clinical depression. Other than supplements, omega-3 is found in healthy fish, like salmon, and also some nuts and seeds.  

Though research on how diet directly affects depression symptoms is lacking, the food that are shown to promote better health have some things in common: less sugar, lean meats, LOTS of fruits and vegetables. [2] There is an emerging field of research regarding the gut microbiome (the bacteria that populate your gastrointestinal tract) that may offer some clarity as to how diet affects our mental health. [3] 

See our blog piece on food for more information: https://mantrahealth.com/post/developing-your-food-mantra

2. Improve your sleep hygiene: Sleep disruption is a common symptom of depression and can take the form of sleeping more or getting little to no sleep. Sleep hygiene refers to a set of behaviors that promote better sleep. Better sleep means better mood, more energy, more motivation. [4]

See blog piece on sleep habits: https://mantrahealth.com/post/by-kristel-carrington-medical-director-at-mantra-health

3. Establish a routine: There is a specific form of cognitive therapy called behavioral activation. Behavioral activation is a coping strategy designed to increase your contact with positively rewarding activities. In behavioral activation, you small and specific goals and work toward them. The key word is small. Focusing on one or two things that you want to work on. Behavioral activation helps to build a sense of mastery and accomplishment. 

4. Connect with nature: Nature can have a powerful influence on depression. Research suggest that interacting with nature can improve cognition and mood. [5] Many of us live in concrete jungles, which can make it difficult to even think about nature, so try to think about where you can reconnect with it. Remember what it’s like to see the vibrant colors, shapes, and contrasts that natural world offers. 

5. Connect with people: Depression makes the sufferer want to isolate, due to diminished energy to engage in social activities and due to feelings of guilt at the prospect of negatively affecting the moods of friends or family. We are social creatures and connecting with others in positive ways can improve mood and coping.

6. Mindfulness: Mindfulness is a practice that cultivates one’s awareness of the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations. It is used as a therapeutic technique that helps my clients connect their inner and outer worlds, thereby enhancing awareness of their daily lives in a different, more deliberate way. Research shows that activities like yoga, deep breathing, meditation, and journaling, help to promote a mindful mental state. [6]

7. Exercise: No surprise here. Exercise is associated with a greater reduction in depression symptoms, improved cognitive function, and better sleep. Research shows that exercise can be as effective as medication for treating depression. [7] Although there are no clear guidelines regarding advice on exercise for patients with depression, evidence shows that both aerobic and anaerobic exercise has positive effects. Shoot for 120-150 minutes a week of moderate exercise.

8. Challenge negative thinking: Depression can hijack your thinking into becoming more pessimistic and negative. You may find yourself focusing only on things that went wrong instead of the things that are going right. When working with my patients, I teach them about positive affirmations and have them make a list for themselves. They are often skeptical but once doing the exercise, they are reminded of things they are proud of and feel an improved sense of self-worth. They also recognize how much they’ve lost appreciation for those good things.  

9. LAUGH: Laughter really IS medicine. Laughter is a positive sensation, and seems to be a useful and healthy way to overcome stress. [8] I encourage my clients to seek laughter from their favorite sources. I still end up laughing until my stomach hurts when I watch old episodes of Martin. 

10. Seek Inspiration: What are you passionate about? Depression makes it hard to get excited about life. Whether you find it in art, nature, people, animals, volunteering, or activism, it is important to seek and cultivate things you are passionate about. When inspired we feel a deeper appreciation for life. 

Feeling relief from depression is not the only goal. You have to discover (or reconnect with) things that give you a sense of peace. Maintaining this balance helps foster your resilience when faced with challenges. 

Varteresian et al. Natural Products and Supplements for Geriatric Depression and Cognitive Disorders: An Evaluation of the Research. Current Psychiatry Reports. 2015

Firth, Wolfgang et al.The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta-Analysis of Randomized Controlled Trials. Psychosomatic Medicine. 2019

Dash et al. The gut microbiome and diet in psychiatry. Current Opinion in Psychiatry. Jan 2015

Carney et al. Cognitive Behavioral Insomnia Therapy for Those With Insomnia and Depression: A Randomized Controlled Clinical Trial. Sleep. 2017

Can Nature Walks With Psychological Tasks Improve Mood, Self-Reported Restoration, and Sustained Attention? Results From Two Experimental Field Studies

McCarney et al. Effectiveness of mindfulness-based therapies in reducing symptoms of depression: A meta-analysis. European Journal of Psychotherapy and Counseling. 

Exercise for Depression. JAMA Clinical Evidence Synopsis.2014

Therapeutic Benefits of Laughter in Mental Health: A Theoretical Review

You already know that a healthy diet has been shown to improve physical health, reducing the risk of heart disease, diabetes, and other common chronic conditions. Now, scientific research is increasingly showing the importance of a balanced diet for a balanced mind. It turns out you really are what you eat: diet can affect your emotions, focus, and mood. 

The Mediterranean diet has been shown to promote a healthy heart as well as a healthy mind. While there is no single definition of the Mediterranean diet, it tends to have the following characteristics, per the Mayo Clinic:

Daily consumption of vegetables, fruits, whole grains and healthy fats

Weekly intake of fish, poultry, beans and eggs

High-quality scientific research is emerging demonstrating the Mediterranean diet's benefits on mental health. This makes sense. Your brain uses a lot of energy and needs the right fuel, including nutrients, vitamins and the right fats. BDNF, an important molecule that influences the growth of brain cells, has been shown to increase in response to better nutrition.

The HELFIMED trial was a randomized control trial that compared patients eating a Mediterranean diet and taking fish oil compared to people who were not. The study demonstrated that people eating the Mediterranean diet had significant improvement in their depression scores. Another study, the SMILES study, also showed that patients on a Mediterranean diet were more likely to achieve remission in their depressive symptoms. Not only that, these patients also saved money on phone by eating the healthier Mediterranean diet. Psychiatrist Drew Ramsey, author of Eat Complete: The 21 Nutrients That Fuel Brainpower, Boost Weight Loss, and Transform Your Health and The Happiness Diet is an expert on nutrition and mental health. He identifies several important nutrients for brain health, including: Omega-3 Fatty acids, zinc, vitamin B12, magnesium, folate, fiber and probiotics, vitamin E, vitamin K, vitamin A, carotenoids, phytonutrients, monounsaturated fats, vitamin D, selenium, iron, thiamine, choline, calcium, potassium, iodine, and vitamin C.

“If it came from a plant, eat it; If it was made in a plant, don’t.” - Michael Pollan

The amount of nutritional information out there can be overwhelming. Here are some practical tips to help get you started on your very own happiness diet. Start with implementing one habit at a time and once you’ve mastered it, try the next one.

1. End your weekend with a “Smart Prep”

Schedule time at the end of your weekend to prepare meals for the week. You don’t have to prep for every meal, or even every day. Having a couple of healthy meals ready for the upcoming week will make it easier to eat well during a busy week. Keep things simple by chopping vegetables that you can easily store, or pre-cooking your favorite protein and grains (brown rice or quinoa) to store in the fridge.

Trips to the vending machine have costs on your wallet, but the costs to your health are even greater. Pack easy-to-eat vegetables (carrots, celery), fruits (apples, oranges) and nuts that you can eat during the day. Other healthy alternatives include trail mix and hummus. Having some healthy snacks throughout the course of the day will also help you avoid overeating when it’s time for lunch and dinner. 

It’s easy to feel overwhelmed by the number of recipes out there and numerous ingredients. Try to keep it simple with just 3 ingredient  meals. For example, you can combine one protein, one vegetable and one grain. Or you can combine 2 vegetables and grain. You get the idea. 

When you are extremely busy at work, school, or home, it’s easy to forget to drink water. But not drinking enough water is a huge mistake. Your brain needs ample water to carry out its functions effectively (like the rest of our body, our brain is mainly water). Dehydration can impair your ability to focus and zap your energy levels. Finally, drinking water can help stave off hunger and unnecessary snacking. Try carrying a water bottle with you when you are at work. If you find that you don’t have time to refill your water bottle during the day, get a BIG (32oz+) water bottle to ensure you stay well-hydrated all day. During the winter, switch the water for hot tea to keep you warm. 

Nutrient-rich vegetables are an easy way to add nutrition to a dish. For example, if you’re eating mac and cheese, try adding some Kale to it in order to add some nutrients to what would otherwise be a fairly nutrient-deficient meal. In fact, psychiatrist Drew Ramsey wrote an entire book on Kale and ways to incorporate it into your diet. But it doesn’t have to be kale, try adding spinach to smoothies, cauliflower to your tacos, etc. 

Bonus Tip -  Embrace the crock pot (or Instant Pot®)

Once you find food and recipes that you love, try cooking in larger quantities. Use a slow cooker (or a fancy all-in-one pressure cooker, like an Instant Pot), to cook large quantities of delicious, healthy food without having to be in the kitchen for hours at a time. There are numerous cookbooks that can help you find simple recipes - it’s easy (and fun) to experiment. 

People who are employed full-time spend most of their waking hours at work. With hyper-competitive work environments, increasing student debt, and a drive towards perfectionism, it’s no wonder that workers frequently experience anxiety at work. Good news: First, you’re not alone: in fact, about a third of people will have symptoms severe enough to meet criteria for an anxiety disorder at some point in their lives. That means even more people experience anxiety (feelings of nervousness, worry, unease) during the work day. Second, remember that anxiety is a normal part of emotional life. That said, when anxiety is holding you back or causing significant distress, it’s helpful to have some coping skills handy to help you weather the storm of emotions that come with a tough day. Here, two Columbia University psychiatrists offer 7 practical tips you can use to manage anxiety at work. 

Around one-third of adults in the United States do not get enough sleep). You’ve probably heard that sleep is important for memory and cognition, which is why people remind kids to get a good night’s rest before a test. You may have also heard that sleepy drivers are as bad as drunk drivers, which demonstrates the importance of sleep in motor performance and judgment. However, many people forget that restorative sleep is critical for optimal emotional performance and resilience. That’s where we get the phrase: “someone woke up on the wrong side of the bed.” Most people need 7-8 hours of sleep per night. Thrive Global’s sleep page has more information and more tips to improve your sleep. With our patients, our three favorite recommendations are: 

Create a bedtime routine to decompress prior to bedtime. 

Use sleep masks, earplugs, and/or white noise machines to minimize disruptions to sleep. 

Turn off your phone and all sound and light notifications or use software to eliminate blue light from your screens at certain hours. 

These simple tips will help you your mind to truly rest and repair from the day. 

Caffeine is the world’s most commonly consumed mind-altering drug. Like many, we drink coffee daily and enjoy the boost that it gives during the work day (especially in the mornings!). But, like any other substance, dosing matters. Many people fall into a problematic cycle of using caffeine to boost energy even late into the day. Too much caffeine can lead to spikes in your anxiety and worry at work. Having caffeine later in the day can negatively impact the quality of your sleep, hurting your productivity the next day and leading to more anxiety. Try to limit your daily coffee (or caffeinated tea consumption) to at most 2 (Starbucks tall-sized) cups per day, and switch to decaf if you need a pick-me-up after 3pm. 

Do you ever find yourself staring down an important task, not knowing where to start and feeling stuck? The accumulation of tasks is a common cause of workplace anxiety. If you then get paralyzed, other tasks begin to pile up and you find yourself falling behind, causing even more anxiety. If this happens to you, try switching up your order of operations and do the easiest (even mindless) tasks on your list first. This “productive procrastination” will give you a needed sense of accomplishment and build up momentum you can carry over to your bigger tasks. Feeling productive even at a few small tasks will give you peace of mind and boost your mood, helping to alleviate anxiety. 

4. Use noise cancelling headphones to block out distractions

These days, most people work in settings with open floor layouts. While this design enhances connectivity, it also brings with it distractions galore. Frequent interruptions, especially when working towards meeting a deadline, can impair productivity and raise anxiety levels. Noise cancelling headphones are an easy way to block distractions that most workers can use (I’m using a pair as I write this). Simply having the headphones on will signal to others that you’re busy and make them think twice before interrupting your flow. Try soothing music without words, like jazz or classical so that the lyrics don’t interfere with your focus. Or if you prefer, simply enjoy the silence provided by the noise cancellation.

If you’re feeling panicky or overwhelmed with anxiety, it may be time for a break to regain perspective. First, try taking a short walk or drinking a glass of water. If those don’t work, try an audio guide. There are 3 different types of audio guides we like: guided imagery, mindfulness, and progressive muscle relaxation. The premise is to have a soothing human voice refocus your attention and help you calm down. They have all been proven to reduce stress and anxiety.  There are numerous apps for this (check out a few we recommend here), and most of them have free exercises you can try. You can also find links just by searching Google or Youtube. By reducing the stress hormones associated with the fight or flight response, relaxation may even help boost your brain’s memory.

Anxiety may be a sign that you’re not working on the right things. Review your goals, both personal and professional. Then, compare your goals with your to-do list. A large disconnect may be a sign that you aren’t moving in the right direction. Your to-do list shouldn’t be limited to discrete work-oriented tasks to be checked off and just get you through the day. As you are making your list, ask yourself if your to-do items are leading you towards accomplishing your broader personal and professional goals. If they are not helping you lead the type of life you want to lead, it may be time to start course correcting. For example, if you have a personal goal of being physically fit or running a marathon, and exercise is not anywhere on your calendar or to-do list, try to add in 1 workout per week to start making your week look like the life you want. 

Finally, talking to someone about whatever is on your mind can help relieve symptoms of anxiety. You don’t have to speak to a therapist to get the benefit of human connection and communication. Whether you are speaking with a close friend, partner, or coworker, talking to another human being allows us to process our own thoughts and feelings while getting support from others. Other people can provide a fresh perspective on our anxiety and help “check the facts” to bring worries that have gotten out of hand back down to size. At the risk of sounding old fashioned, try to make these conversations in person. If that’s not possible, go for a video call or phone call. Texting is a great communication tool, but it won’t give you the same emotional connection to another person that hearing their voice will. 

Anxiety is a common part of work and life, and we hope these tips will help you manage your worry in a healthy way. However, if your worries are excessive and persistent or accompanied with debilitating physical symptoms (heart racing, sweats, stomach upset), they may leave you feeling physically and emotionally exhausted. If you feel anxiety symptoms are significantly impeding your ability to function at work or at home, you may have an anxiety disorder. Don’t feel you need to suffer in silence: reach out to a mental health professional to discuss your symptoms and the potential role of therapy and/or medications to help you with your anxiety. The good news is: treatment for anxiety disorders in general is highly effective, and the tools you learn will last a lifetime. 

7 Practical Strategies for Managing Anxiety at Work

I did not consider myself someone with sleep issues. I never struggled with insomnia, and I enjoyed sleep more than most people. I could fall and stay asleep very easily, in both public and private settings. I was that person in lectures, conferences, and focus groups who was asleep before the hour was up. My classmates teased me for my particular talent of maintaining an alert sitting posture even while sleeping. I tried to cope with fatigue by fidgeting, biting the insides of my cheeks, and drinking more coffee, but often I just gave in and passed out. This was my MO from high school through medical school. I was used to it and never gave it serious thought. With no consistent routine, I often stayed up late and told myself that I functioned well on ~4-6 hours of sleep per night. Then something changed: I met my partner during residency, and he was committed to consistently getting eight hours of sleep. I quickly adopted his habit but only reflected on it when I started noticing how this change was improving my life.  

I was no longer sleepy after sitting for more than 30 minutes. I no longer craved a nap (or coffee recharge) at 3pm. No more falling asleep in lecture, my attention and focus improved, and that constant tug of fatigue was gone. I drank less coffee, felt less irritable, and I literally felt lighter. What was the difference? I was reaping the benefits of sleeping eight hours every night. Not only was it a revelation, but it is now my broken-record anecdote used when trying to encourage clients to examine and/or change their sleep habits.

Neglecting sleep is common in adolescence and often continues into adulthood. In time, sleep becomes a victim of bodily self-neglect. With busy schedules and impending deadlines many adults tend to forego sleep because they hope it will give them back something they desperately need and feel deprived of - time. If you care about improving your overall health, start by examining your relationship with sleep.

As a psychiatrist, I spend a lot of time discussing sleep in the context of depression and anxiety. Most people agree that their sleep could be “better” and they could do more to optimize it, but sleep habits are some of the hardest to motivate people to address. I practice cognitive behavioral therapy (CBT), an evidence-based treatment that helps a person recognize and examine beliefs and attitudes they have about their lives, and how those beliefs drive their behavior. I have observed common themes in what clients express about their relationship with sleep. Here are a few typical examples: 

“I just can’t get to bed earlier. Period.”

“I can function just fine on less sleep”

“I need my phone/iPad/TV to fall asleep.”

“I’m avoiding having to face the next day” 

Do any of these resonate with you? Once identifying these beliefs, you can examine and challenge them, a process that is important in helping someone form new and healthier habits. Be honest with yourself about these ideas influence your behavior and what the actual consequences are. Consider the examples above. Feeling deprived by going to bed early is understandable. Still, unless you have a small child or have a job that expects you to be available 24/7, what is preventing you from physically getting to bed earlier? The later you go to bed, the less sleep you give yourself to function optimally the following day, which likely results in feeling too fatigued to carry out the goals you’ve set for the day. And contrary to popular opinion, you cannot make up for a week’s worth of poor sleep over the weekend. One or two days of increased sleep does not make up for the cumulative cognitive and physiological effects of chronic sleep deprivation, a term known as sleep debt. We all engage in these habits to some degree, but once you accept that the beliefs underlying your sleep habits are not helpful, you can start to make changes. I educate my clients on the concept of sleep hygiene, which refers to a set of behaviors that one can adapt in order to form better sleep habits and/or improve sleep quality. The list below cover the most important and commonly helpful tips to improve your sleep, and ultimately, help you bring your best self to everyday life. 

Consistency: This is crucial. Try to have a consistent bedtime and wake time. Maintain that consistency, even on the weekend. This is key to conditioning your body back to its natural sleep rhythms.

Exercise: People sleep significantly better and feel more alert during the day if they get at least 150 minutes of exercise a week.[iii] Try not to exercise (within 3 hours of bedtime, as that can interfere with falling asleep.

Turn off the screens: If electronics are part of your current sleep routine, be aware that light emitted from our screens suppresses production of an important sleep-promoting hormone in our brains.[iv] If background noise helps you fall asleep, there are meditation and white noise apps you can download and play while keeping your screen off.

Stock up on sleep promoting items: Environmental factors like ambient noise, poor mattress quality, abundant light through windows all decrease sleep quality. Invest in earplugs, sleep masks, black out curtains, and/or a good mattress.

Reduce/avoid caffeine and alcohol: Though people often use alcohol as a sleep aid, it actually worsens sleep quality. Avoid caffeine later in the day (after 1pm)

Keep naps short: Long naps during the day can disturb sleep quality at night. Think of it like a snack. A large snack before dinner time will reduce your appetite and how much you eat. Between 20 to 30 minutes is an ideal nap duration and less likely to disrupt sleep rhythms at night.

See your doctor: If your sleep issues are ongoing despite behavior changes, or if you are considering a medication, I strongly recommend checking in with your doctor to rule out medical causes of your sleep issues, discuss medications, or getting a sleep study.

Change your attitude about sleep: Studies show that people who placed high importance on adequate bedtimes report better sleep quality, mood, and perception of their health.[v]

Have some self-compassion: Self-criticism does not work. If you fall short of your goals intermittently, remind yourself that you are really making efforts towards change and that it is okay to be patient with yourself. 

There is a plethora of research correlating sleep disturbance with mood, anxiety, cognitive, and physical conditions. Despite my medical knowledge, I was oblivious about my poor sleep habits for a long time, and that recognition made me question what other habits I needed to examine. Embrace this self-inquiry and ask yourself where you can start making small changes. Those small changes will have lasting positive benefits. 

9 sleep hacks used by a Mantra psychiatrist

If you struggle with anxiety, you're not alone. In the United States, anxiety disorders are the most common mental health problem. The good news is they are also treatable. While treatment plans often include therapy and/or medication, there are some great apps to help you cope with anxiety.

These apps can be a great source of relief, especially if you don’t have access to a mental health professional. And even if you are already in therapy or taking medications, they are effective to use as a supplement to your treatment plan. Most of these apps have a free version or trial version that allows you to test it out the product before committing to any purchases. Here are our 5 favorite apps to help people with anxiety. 

Many people have heard of Headspace. Fun fact: they started out as a company that held in-person events. They quickly discovered that people attending wanted a way to benefit at home, so they transformed their product into an app. The app is described as “a personal meditation guide, right in your pocket."

Headspace offers introductory modules that aim to teach you the fundamentals of meditation and mindfulness. They even offer different meditation modules that focus on different problem areas, such as stress, focus, and anxiety.

What we like most about this anxiety app: 

Easy to select what's going to work for you and your schedule. 

Range of choices in terms of time (guided meditations for anxiety ranging from as short as 5 minutes all the way up to two hours.

Headspace is one of the more expensive meditation apps. 

Pricing: $12.99 a month, $69.99 a year (as of 9/1/2019)

The Stop, Breathe and Think app is easy to use and allows you to check in with yourself. When you start using it, the app walks you through a few basic questions about how you're feeling physically and mentally. It also allows you to connect the different emotions that you're experiencing at the moment. Then, based on your answers it makes recommendations on both guided and self-guided activities you can try. It has a wide variety of meditation modules, including for kids, college, pregnancy and many more.

According to a study they conducted, their users experienced 46% less anxiety, and, after the first session, had a 78% increase in positive feelings.

Customizes your experience based on the answers that you provide 

What could be better: Some of the modules lack free sessions, which may make it difficult to know whether it’s a good fit for you.

Pricing: $9.99 a month, $58.99 per year (as of 9/1/2019)

Anxiety can make sleep difficult and this app helps address that struggle. While Calm offers guided meditations on many different areas like stress, anxiety, and relationships, it has a robust focus on sleep. For example, they have sleep stories to help you slow down your thoughts at the end of the day and get a good night of sleep. The app’s interface is one of the sleekest we’ve seen and the collection of modules beyond sleep is impressive. 

What we like about this app for anxiety: 

Emphasis on helping improve sleep, which is critical for self-care and overcoming anxiety. 

Calm Body feature leads you through mindful movement and gentle stretching, which helps improve sleep as well.

The Masterclass feature gives you access to long form, high quality videos with doctors explaining strategies to overcome depression, sleep issues, and other issues related to anxiety.

What could be better: Some users feel that the free version could offer more modules. While it offers a ton of content, it’s the most expensive app on this list.

Sanvello allows you to establish a goal that you're working towards. Some examples include: feel happier, decrease anxiety, build confidence and improve social skills.

You can set the app to check in with you at specific times of the day or randomly. When it checks in with you, you'll be asked how you are, how your mood is and what your present feelings are. There is also a section for you to use for journaling. 

There is a free week-long module to help you decrease your anxiety. There are several other areas you can use with the paid version. For example, learning the CBT style techniques module helps you learn to manage your emotions.

This app has groups you can join to connect with others experiencing similar anxiety challenges. It is reassuring to know that you're not the only one struggling.

Ability to set goals and monitor progress over time. 

What could be better: Many fans of Pacifica were disappointed with the transition to the Sanvello brand, which significantly changed the interface. However, many continue to love the app, so it’s still worth checking out on your own.

Pricing: $8.99 a month or $53.99 a year (as of 9/1/2019)

The Worry Watch app creates a place where you can conveniently journal about your anxiety, a technique which has been proven to be helpful. You can track the details of how bad your anxiety is. The app walks you through questions to find out what area of your life you're worried about. It tracks if the worry is from a real or hypothetical situation. Then, it allows you to set reminders to come back and follow up on the thing you were worried about. This allows you to track the outcome of what happened. You can then find the patterns that you have with worry.  

Easy for you to spot key areas that are causing you anxiety. 

Pattern identification to help you notice many hypothetical worries never actually happen. 

What could be better: No free or trial version. No Android version.

Pricing: $3.99 (one-time purchase, as of 9/1/2019)

Apps are a great way to build skills like meditation to help you cope with anxiety, without taking much time out of your day. They are quick, easy, and convenient to use on your timeline. 

When it comes to choosing an anxiety app to use, all that matters is that it works for you. Check out the features of the apps listed here and see what one sounds like it addresses the area you are struggling in the most. Then, give it a try. Remember, if the app alone is  not working for you, it may be time to seek professional help with therapy and/or medications. 

Top 5 Apps to Help You Cope with Anxiety 

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