Illness Anxiety in the Pandemic Era

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Illness Anxiety in the Pandemic Era

By MICHAEL SHAPIRO, PhD

May 2020

I’ve never been a Harry Potter fan. In fact, I’m not even exactly sure what the Harry Potter series is about. My understanding is that it revolves around a bunch of kids who ride broomsticks and play some kind of anti-gravity version of basketball at a private school in some place that looks kind of like the Rocky Mountains, but with fewer Starbucks. Oh, and one of the kids has a scar on his head.

I also know that an important component of the storyline involves a “Book of Spells” or some such thing. Evidently, this book has all the rules or spells (or whatever) that adolescent magicians need to do their job or learn their craft (or whatever).

So, here in the equally magical world of Behavioral Health, we have also have mysterious book known as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (known to you Muggles as “the DSM 5”). This single volume contains a detailed description of every mental disorder anyone has ever had, or could possibly have. These disorders span from the easily recognizable (like depression) to the obscure (like trichotillomania, or compulsive hair-pulling). I’ve often told people that if you look through the DSM 5 long enough, you’ll find some disorder that fits you, no matter how mentally healthy you may feel at the moment.

Anyway, in the DSM 5, there’s a diagnosis called Illness Anxiety Disorder. To qualify for that diagnosis, you have to be obsessively worried about the possibility of acquiring a serious illness. You have to be constantly anxious about your own health, and in an attempt to relieve that anxiety, you have to either engage in excessive health-related behaviors (for example, repeatedly checking your body for signs of illness) or totally avoid healthcare (e.g., staying away from hospitals and doctors’ offices).  Interestingly, another requirement is that this preoccupation with your own health has to be “excessive or disproportionate.”

Ah! Therein lies the big philosophical question: in the days of the COVID-19 pandemic, aren’t we all obsessively and disproportionately preoccupied with acquiring a serious illness? Aren’t we all engaging in health-related behaviors and avoiding hospitals and doctors’ offices?  In fact, haven’t we been ordered to do these things by our local governments? If so, does this mean that we are all suffering from Illness Anxiety Disorder?  More importantly, if we’re all doing these things, then is it really a disorder at all, or are we exhibiting completely normal behavior, just like everyone else?

I’m not exactly sure, but I think my head just imploded while trying to sort this all out. Personally, my hope is that our obsessive preoccupation with the coronavirus can still be considered a “disorder” because that’s good for my business. In fact, I’d like to take this opportunity to thank social media for contributing to my business by fanning the flames of anxiety with an inescapable, constant barrage of false, inflammatory, and often contradictory information. Thanks, Facebook!

But seriously, I have seen many patients over the last two months who are understandably worried and have expressed their anxiety through unanswerable questions and despairing comments like, “Am I going to catch this?”, “Will this ever end?”, “I’m afraid they’re going to lift restrictions too soon!”, and “I feel trapped!” This anxiety has been brought about by a stressful event, sort of like what happens in Posttraumatic Stress Disorder. However, with PTSD, the threat has already passed, and it was probably something very visible (like a tornado or other natural disaster). With the coronavirus, we have an invisible threat, we don’t know when it will end, and we don’t even know if it has touched our lives yet or not. In this respect, a global pandemic is unique amongst stressful events!

So, how can you calm yourself in the midst of so much uncertainty? Before answering that, let me first mention that we here at SR-AHEC are applied scientists–rigorously trained health care providers–who, I’m proud to say, do nothing that isn’t based on solid, verifiable science! We try to rely solely on treatments that have been tested and validated under the cold, dispassionate light of the scientific method! That’s why we don’t bleed patients with leeches anymore (well, except maybe that one time last year. But come on! I couldn’t think of anything else to do, and I made sure that it was covered by insurance first).

The practice of employing only scientifically proven medical techniques is known as “Evidence-Based Medicine” (EBM). What does EBM have to say about dealing with our anxieties in this time? Well, it just so happens that the Centre for Evidence-Based Medicine (no, I didn’t misspell a word. This place is located in the UK, where they spell some things rather oddly) has analyzed many scientific articles on the topic and has come up with the following evidence-based suggestions:

  • Minimize your exposure to the news and other media (I recommend no more than an hour per day to get caught up on the day’s events).
  • Use trusted sources to access information about the pandemic (as I said in my last blog, you can pretty much trust anything that has been bears the CDC seal of approval).
  • Stay connected with family and friends, online or via telephone (just don’t lose your temper when you can’t figure out how to turn on the audio).
  • Provide help and support to other people in the community (like your elderly next-door neighbor, who could use a little help with the groceries).
  • Practice meditation and mindfulness (this can be as simple as stopping whatever you’re doing, taking a deep breath, observing your own body for signs of tension, and asking yourself what you need to do next).
  • Look after your body by maintaining a healthy diet and exercising regularly (see our earlier “Guidance to Good Health” blog about exercises you can do at home. Oh, and keep your hand out of the Cheetos).
  • Avoid unhealthy coping strategies, like drugs and alcohol (interestingly, online sales of alcohol have gone up by 243% during this pandemic! Even sales of Corona beer have, ironically, increased by 50%! How weird is that?).
  • Keep doing activities you enjoy (preferably not playing video games or watching movies that involve death, destruction, or mayhem. Sesame Street is probably OK…just stay six feet away from Cookie Monster. I question his personal hygiene).

I would add to these a brief three-step cognitive behavior therapy exercise that I do with my patients:

Step 1: Ask yourself, “What is the worst possible thing that could happen to me?” Your answer may be something like, “I’m going to catch this and die.”

Step 2: Force yourself to consider the best possible scenario: for example, “I’m going to be completely OK. The statistics are on my side.”

Step 3: Consider the most likely scenario, and develop a plan for that: for instance, “I may get infected, but for most adults, the symptoms are mild. If I get sick, I’ve figured out exactly where to go for emergency care, and I might actually get caught up on all my Downton Abbey episodes while I’m recovering.”

These steps may all seem fairly self-evident, but once again, they are based in fact and have been verified by research, so I trust them. So, Illness Anxiety Disorder or just a “normal” reaction to a really abnormal situation?  Who cares? It’s what all the cool kids are doing. Just do what the science says. Oh, and for social distancing, just use Harry Potter’s “cloak of invisibility.” I think he has one of those.

Lemmings, Toilets, and Reptile Brains: How Should We Respond to COVID-19 Hysteria?

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Lemmings, Toilets, and Reptile Brains: How Should We Respond to COVID-19 Hysteria?

By MICHAEL SHAPIRO, PhD

March 2020

There is a myth with which we’re all familiar. It has to do with lemmings. As you might know, lemmings are adorable little rodents that are typically found in or near the Arctic tundra. They are usually around 6 inches in length, with a cute stubby tail, soft fur, and the appealing little face that is characteristic of some of our most cherished herbivores (like the Easter bunny). They migrate in large herds, and during their migratory season they appear suddenly, en masse, seemingly out of nowhere.

However, the most persistent myth about lemmings is that when their population becomes unsustainably great, they commit mass suicide by following each other off of tall seaside cliffs. This myth is partly based on the fact that every three or four years, a slice of lemmings (no…really! That’s what a group of lemmings is called!) will get so big that they’ll head out and try to migrate elsewhere, where there’s more room, and they assume that their property taxes will be lower. In doing so, they often cross a body of moving water (like a river), and several of them – (the ones who were too arrogant to wear life vests) will drown.

The myth that this was actually a form of suicide took hold in 1958, when Disney filmmakers aired a documentary that showed a bunch of lemmings jumping to their death. However, contrary to our abiding faith in all Disney productions, this was completely staged! Yes, Disney actually pushed the poor creatures off a cliff while the cameras were rolling, in order to perpetuate the myth that lemmings follow each other blindly unto death! Although completely fraudulent, it’s a good thing they did this with lemmings and not mice, or there would be no Mickey to induce vacationers into Disney theme parks, where people blindly follow each other en masse over a financial cliff.

I said all that to say this: the lemming has become a metaphor for someone who blindly follows the crowd, even into the face of a catastrophe. As I’ve listened to the news and have strived (futilely) to find even a single sheet of toilet paper within a 20-mile radius of my home, the lemming metaphor has popped into my mind more than once. We have been inundated with news about the emerging coronavirus pandemic, and very little of that news has been good. Consequently, we watch each other anxiously, waiting to act on any new piece of information with a hair trigger. For example, I’m reasonably certain that the recent run on toilet paper (which future historians will undoubtedly refer to as “The Great Fecal Hygiene Crisis of 2020” or something like that) was started by one guy in one WalMart in one small town who looked at a shelf of TP and said, overly loudly (as people are apt to do in WalMart) something like, “Gosh, I wonder if I should buy some extra?” Cue the lemmings.

At this point, you might want to invoke the misunderstood and sometimes misused term, “mass hysteria.” This term (also known as “mass psychogenic illness” or “mass sociogenic illness”) refers to the rapid spread of symptoms through a population where there is no viral or bacterial agent to account for those symptoms. So, let’s get this straight from the get-go: to attribute the symptoms of covid-19 (the illness caused by the coronavirus) to “mass hysteria” is a misnomer, because it suggests that the symptoms are not real. Nothing could be further from the truth, and we need to take seriously this threat to global health. Instead, it’s our reaction to that threat that bears some scrutiny.

With this in mind, the term “moral panic” is a more accurate description for the phenomenon that has left you without any toilet paper. This term, as it is currently used, links the collective anxiety of a group (in response to some perceived danger or threat) to social media influences. According to sociologist Stanley Cohen, this happens in stages: first, something (or someone) is identified as a threat to community interests. Next, the threat is depicted in symbolic or overly simplified form by the media. This raises public concern, which in turn provokes a response from authorities or policy makers. Then, the ensuing panic over the issue results in some kind of change within the community…and the next thing you know, there you are, left on the potty, searching desperately for any reasonably soft piece of paper (or other material) within easy reach.

In this way, moral panic is a self-perpetuating problem. Panic is contagious. It spreads like proverbial wildfire, as it has following many media revelations that have called to question our way of life. For example, look what happened to Halloween after the New York Times published a 1970 article about people tampering with unwrapped treats (which had actually happened only once, in a small town in upstate New York). As a result of that single article and subsequent panic, we now have Trunk or Treat…and individually wrapped candies that are infuriatingly difficult to open.

So, how do we avoid contributing to moral panic? How do we keep from making matters worse by panicking over every new piece of information? Well, let’s start with this: don’t panic over every new piece of information. With few exceptions, panic is an irrational response to some stimulus, or a disproportional response to a perceived threat. Jumping to irrational conclusions (often based on erroneous information) propels panic; not the other way around. The panic response is governed by the instinctive, primitive part of your brain, which is often referred to by neuroscientists as the mesencephalon or “reptilian brain.” To avoid panic, one must tame the reptile by engaging the telencephalon, or “thinking” part of the brain. How do we do that?

First, choose not to accept your first instinctive reaction to something fearful. Suppress the primitive part of your brain. After all, it’s that part of your brain that tries to get you to eat with your hands when you’re at a fancy restaurant or pee off your porch when you feel the call of nature (um…okay, maybe that’s just me). Instead, gather more information before deciding how to react. To do that—and this is vitally important—seek out sources of information that the “thinking” part of your brain tells you are trustworthy! For example, when it comes to new information about covid-19, I think we can have total confidence in the CDC. It is an established public health institute that’s been around since 1946 and is crammed full of really, really, really smart people who have built entire careers out of studying the propagation of infectious diseases. Unlike us, they spend every day knee-deep in pathogens, applying their big brains to solving problems just like this one. Yeah, I think we can be absolutely OK with doing whatever they tell us to do. They’re not lemmings, they’re scientists.

In contrast, look with a very skeptical eye on any post or sound bite that is launched by a partisan political group, a corporation that stands to capitalize on the crisis (including popular media), or the guy in your neighborhood that bought all that Purell to re-sell at $75.00 a bottle. They’re not scientists, they’re the Disney filmmakers who are pushing the lemmings over the edge.

Even less trustworthy is your cousin, uncle, brother-in-law, or cousin’s uncle’s brother-in-law who posts on Facebook and considers the shortage of toilet paper to be the prelude to the collapse of civilization which, as he’ll remind you, he has been predicting since the beginning of civilization. As far as modern science can determine, having no TP has a mortality rate of zero. It may be a temporary inconvenience, but it is not the end of the world (in fact, if you own the Charmin company, things are looking pretty good from your perspective, aren’t they?). Let’s keep things in perspective.

Once you’ve decided not to listen to biased, partisan, or un-scientific sources, now do this: don’t listen to anything. Take a break. No, I’m not urging you to ignore reality, repress your feelings, wear rose-colored glasses, or minimize this threat to our collective health. I’m not going to try to pacify you with a cliché (“Don’t worry. We’ve been through all this before. Look at the bubonic plague of the 14th century! We’re still here, aren’t we?”); I’m urging you to momentarily stop the barrage of inflammatory, often conflicting information. Stuck at home? Don’t watch the news, watch SpongeBob. Listen to music (just not the soundtrack to Outbreak). Read a fiction or fantasy novel, for cryin’ out loud…it’s one of those leafy paper things over there on your shelf. Once again, I’m not advocating burying your head in the sand (after all, there are germs there, too!). I’m just urging you to give it a rest and put it in neutral for a little while. Afterwards, you’ll feel energized, refreshed, and ready to think rationally.

Lastly, don’t contribute to the panic by becoming a virus yourself. How do you think they came up with the term “going viral”? Like a virus, information (everything from cute puppy videos to hate speech) gets disseminated when one “host” (electronics consumer) shares with several others who, in turn, share with others…thereby spreading the information (or dis-information) exponentially. This kind of indiscriminate sharing has an almost magical ability to magnify disproportionally the importance of whatever it is you’re sharing. I mean, come on; was “Gangnam Style” really that fascinating? Would it ever have lived for more than a few seconds outside of the petri dish of social media? Yeah, I don’t think so either.

So, when your aforementioned cousin’s uncle’s brother-in-law posts his perception of the impending world cataclysm, please don’t respond, and please don’t “share” with others. Let’s practice some electronic “social distancing.” Don’t contribute to moral panic, and don’t be a lemming or a reptile or a host to an electronic virus. The very fact that you’re reading this blog is proof that you are an intelligent, rational, thinking human being with excellent taste and a critical eye. Time to start acting like one. Meanwhile, I’ll continue to stand here in the grocery store, staring at this shelf of duct tape and brown lunch bags, wondering if they would make an acceptable proxy for toilet tissue.

Relationships. Who needs ‘em?

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Relationships. Who needs ‘em?

By MICHAEL SHAPIRO, PhD

February 2020

A quick peek at my calendar reveals that it’s February. Ah, February…the month that hosts the most famous holiday that isn’t really a holiday: Valentine’s Day. As of the time of this writing, we’re now about a week past this annual high-pressure reminder to do some nice stuff for (or to) someone you love. I believe I’ve dodged marital suicide for one more year by making sure I took my wife out for an extravagant and lavish dinner. Fortunately, Applebee’s never disappoints.

As the number of Valentine’s Days that are left to me slowly dwindles, it has caused me to contemplate the value and importance of relationships (not just romantic ones). According to Harvard Health Publishing, positive connections with others yield benefits for both physical and emotional health. Numerous studies have shown that people who have social support from family, friends, and the community have fewer health problems and actually live longer than people who are solitary or socially withdrawn. Evidently, this is because positive relationships reduce stress; and stress is known to interfere with cardiac functioning, the immune system, and even the health of your gut. Engaging in “caring behaviors” has even been found to trigger stress-reducing hormones (and, it’s far cheaper than a spa day)!

This all makes sense if consider the fact that humans are extremely social animals. We depend on each other. We have to. We’ve always had to. Think about it from the standpoint of evolution: unlike lions and wooly mammoths and alligators and such, primitive man was not blessed with tremendous strength or speed or stealth. However, we “aced” it in the brain department. Man quickly figured out that if we worked together, we had a better chance of survival and reproduction (especially the reproduction part, which doesn’t work particularly well when you’re alone). As a result, in order to encourage mutual survival, man developed a highly social brain that actually allows us to feel good when we experience social interactions, and to feel a kind of pain when we are socially rejected or marginalized. Even the emotion of sympathy (feeling sorrow or pity over someone else’s misfortune) served an evolutionary function by making sure that we were motivated to work cooperatively to help each other survive.

I once read a study that was conducted by the Gallup organization, which (as you may know) is an analytics company based in Washington, DC. In this study, when people were asked why they became homeless, why their marriage failed, or why they overeat; they often attributed these problems to the poor quality (or complete lack) of friendships. A subsequent study on friendship yielded some surprising findings. For example, a majority of married people indicated that friendship is more than five times as important to them as physical intimacy within the marriage (okay, I presume these weren’t newlyweds). Similarly, it was found that if you have a “best friend” at work, you are seven times more likely to feel engaged in your job! If this is true, your office should sink some money into a nice water cooler (which is the traditional hub of gossiping, lollygagging, and other “friendship at work” activities).

So, now that we know how important it is to have close relationships (both family and friends), why doesn’t everyone have them? Because, like a high-performance sports car, they are often difficult (and expensive, both economically and emotionally) to maintain. They require work, time, commitment, and even money. If such a high level of effort seems repulsive or exhausting to you…just look around you. This may be why you’re alone right now, sitting alone in your grandmother’s basement, eating Cheetos and playing World of Warcraft (is that still a thing?). In contrast, if you’re willing to make the effort in the interest of enriching your life with positive relationships, here are some steps to take:

Be intentional. I’m no farmer (in fact, I’m notorious for my “brown thumb”), but from what I understand, a domesticated plant is unlikely to grow on its own. It has to be made secure in the soil and then nurtured, pruned, fed, and watered. Like growing a plant, one must be intentional about cultivating a friendship. Don’t wait for it to happen; take the initiative. Call a friend and make that appointment for a cup of coffee, or to go to that movie you’ve both wanted to see. However, remember this: friendships are built around common interests. Just because you’ve been dying to see that Monster Truck Jam, it’s entirely possible that your companion may find all that noise and mechanical mayhem to be a little, shall we say, “off-putting.” Also, as I mentioned in a previous blog, men and women tend to cultivate friendships differently: men bond “side by side” (i.e., by participating in a common activity, like playing golf or fixing a car); while women value “face to face” activities (like talking over a cup of tea). Make a plan, then take some initiative!

Communicate. Those of us who are married know that unspoken feelings and hidden secrets are like flesh-eating bacteria to a long-term relationship. Unspoken feelings burrow, fester, and eventually begin to erode the framework of the relationship that you’ve taken so much time and effort to build. If you harbor unresolved anger over a past offense but don’t want to undergo the aggravation and effort of “fighting it out” until it’s resolved, it will grow and become distorted. What actually happened will soon become your perception of what happened…which, with so many feelings behind it, gets magnified and ends up looking very little like the truth. So, before things get out of hand, voice your feelings in a non-confrontational way. Marriage therapists are big on the “I message.” This is a technique wherein you express a complaint from the perspective of how you feel, rather than accusing or blaming the other person. For example, instead of, “You’re always late! You’re never on time!”, you might try, “When you’re late, I feel like I’m low on your priority list.” Another good prelude is, “Help me understand.” Using this helpful technique, “You went out motorcycle riding with your buddies instead of taking me out for Valentine’s Day?” becomes “Help me understand how you thought that going out with your friends would be a good idea” (just a random example, of course. Not like this has ever happened to me). As I tell my patients, when it comes to having an emotional discussion with someone, it’s all about paving the road first (in case the metaphor eludes you, I’m talking about carefully choosing your words to smooth out the bumpy hazards ahead).

Forgive. The way I see it, each offense that hasn’t been talked-through or forgiven becomes like a nuclear warhead, waiting to explode. Over the years, each of these armed missiles gets “stockpiled” in the back of your mind. If you know anything about nuclear physics (and I sure don’t), you know that there is only a limited amount of fissionable material that can be stored together before the whole pile reaches critical mass, resulting in an explosion of tremendous magnitude. I’ve seen this happen with couples who have been married for many years. Rather than putting the work into dealing with resentments, they amass these nuclear weapons until they’re finally ignited by something that, on the front end, seems very trivial (like leaving your underwear on the floor. Once again, not a personal example). The spouse is left to wonder, “What the heck brought that on?”

Believe it or not, there is a significant amount of scientific literature that cites the actual health benefits of forgiveness. Research from Stanford University’s Forgiveness Project and Clinic (yeah, there’s really such a thing!) has shown that forgiveness not only benefits the other person, but it’s critical for our own physical and mental health. Studies have revealed that people who are more “forgiving” have fewer health problems, less depression, and fewer symptoms of emotional stress. In contrast, failure to forgive increases the risk of a number of illnesses, including cardiovascular disease and even certain forms of cancer. Even the risk of injury by accident is higher in people who do not forgive! In the laboratory, people who were merely asked to imagine not forgiving someone showed unhealthy changes in blood pressure, muscle tension, and immune response. The exact opposite happened when people were asked to imagine a “forgiveness” scenario.

So, it’s important to forgive when we believe we’ve been mistreated or misunderstood. Of course, easier said than done, right? In an effort to forgive someone, it might first help to understand what forgiveness is not. It does not mean what we condone hurtful actions (like abuse). It does not mean that we forget what happened (“forgive AND forget” is a poetic but often impossible standard). Most importantly, it does not always mean that we completely repair the relationship or reconcile with the offender (especially when the offender has no interest in fixing things). Instead, forgiveness is a choice; an action that we decide to take, regardless of how the other person feels or responds. It’s a decision—often difficult to make and subsequently stick to—to not hold the other person’s offence against them. It often takes time, and it’s often a decision that has to be renewed every day! It will become easier over time, although everyone’s timeline is different.

So there it is. If you understand the importance of relationships and want to help them thrive, you can be intentional, communicate, and forgive. Takes some work? Yes. Sometimes confusing? Certainly. However, here in the 21st century, when relationships are becoming progressively more remote and toxic (thanks again, social media!), there is no single more valuable pursuit when it comes to ensuring our own health and survival! Now…it’s almost March. Where did I store those chocolate Easter eggs from last year?

New Year’s Reservations…I Mean, Resolutions

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New Year’s Reservations…I Mean, Resolutions

By MICHAEL SHAPIRO, PhD

January 2020

It occurred to me this week that I had not written a blog entry for the month of December, 2019. For the year 2020, I will resolve to pay better attention to deadlines…and then to not make any more resolutions!

Speaking of which…what is the deal with New Year’s resolutions? We’ve all made them; and we’ve all failed to keep them. When we fail, most of us feel guilty. We then resolve to stop beating ourselves up about it…which ends up being the only resolution we keep, at least until next year, when the cycle starts all over again!

Are we really so weak-willed? Do our best intentions always have to go bad? Is the custom of setting New Year’s resolutions just another yearly process to set ourselves up for humiliation and failure? Good questions! Let’s make a resolution to get to the bottom of this!

According to one of my most trusted scientific sources (the History Channel), the first New Year’s resolutions were probably made about 4,000 years ago in ancient Babylon. Each year, after spending 12 days crowning a new king (or pledging loyalty to the reigning king), these ancient partiers would make a promise to pay all debts and return all borrowed objects (like CDs, power tools, and stuff like that), in the hope that the gods would bless them with prosperity during the ensuing year. Later, the ancient Romans (who actually invented “January”) would begin each year by offering sacrifices and making a promise to behave themselves for the rest of the year. We all know how that turned out. At some point, making New Year’s resolutions became a secular (rather than religious) practice. Instead of resolving to improve ourselves as a community, we decided to look inward and make personal goals for self-improvement. Unfortunately, statistics show that although around 45 percent of Americans make New Year’s resolutions, only about 8 percent keep them. Where do you fall in that statistic? Yeah, I thought so.

So, should we throw the New Year’s baby (the cute one with the sash) out with the bathwater? I don’t think so. Setting goals is an admirable and commendable practice! Doing so prevents us from becoming stagnant. A resolution is a promise to ourselves to keep growing, improving, and changing for the better! As a psychologist who works with patients who suffer from medical disorders that are mediated by lifestyle (for example, obesity, diabetes, and hypertension), I’ve seen that goal-setting can be a lifesaver…as long as those goals are set properly! To this end, we health care professionals (or was it the ancient Babylonians?) have come up with an acronym for goal-setting that can easily be applied to New Year’s resolutions: SMART. Specifically, make resolutions that are Specific, Measurable, Attainable, Realistic, and Time-based. Let’s look at each of these individually:

A “specific” goal is one that is, well, specific rather than vague or overly general. For example, rather than resolving to “look better in 2020” or “lose this gut” (yeah, that’s one of my favorites); one might say, “I resolve to lose 10 pounds.” This places the goal in clear view, thereby making it more realistic and attainable (more on that in a minute).

A goal also has to be “measurable,” mainly to help you know when you’ve achieved it! After all, to “look better in 2020” is pretty subjective: my idea of “looking better” probably differs from yours (personally, if I leave home with my hair combed and my underwear on the inside of my pants, I’m looking pretty good!). Whether your goal involves weight loss, exercise, or something else; it’s helpful to have a numerical way to measure your progress, be it in pounds, inches, days, HbA1c levels (for you diabetics), calories, school grades, blood pressure values, or number of good deeds done.

An “attainable” goal is one that is not so far from where you are now, just a small “bump” up or down, thereby making it more easily reached. For example, a weight loss goal of one pound per week is much more manageable than 20 pounds per week…which brings us to the next part of the acronym: a “realistic” goal is one that is reasonable for your body type, your resources, and your circumstances.

I’ll confess that I’ve always held on to two important personal goals: to become an astronaut, and to invent teleportation (you know, like on Star Trek). Unfortunately, now that I’m in my 60’s and have established a fairly stable career path (oh, and don’t have a sufficiently high IQ or even a decent understanding of subatomic physics), I’m beginning to think that these goals may be slightly—and I mean just slightly—unrealistic. Similarly, if your goal is to become a millionaire this year; or to diet and exercise until you look like Natalie Portman or David Gandy (who, according to a study performed in the UK, are the most beautiful people in the world, based on what are considered to be the most universally attractive physical traits); you might want first want to take a look at your bank account, your investment portfolio, and your image in a full-length mirror.

Lastly, a “time-based” goal has a specific expiration date. This will ensure that you stay motivated, which is more likely when you set a definite time limit. When your timeframe is vague or non-existent (“I need to lose weight this year,” “I gotta get around to fixing the house,” “I’m finally going to clean out the basement”), it only give you an excuse to put it off. Besides, time limits provide a “checkpoint” for you to assess your progress. If you haven’t lost that one pound by the end of the week, you can stop and re-assess whether or not that goal was realistic and attainable. If you did meet your goal, you can pat yourself on the back, and then set a new goal that’s even more challenging (“Now that I know I can handle walking one mile a day, I’ll set a new goal for a mile-and-a-half!”).

So, if you’re looking back on all the resolutions you didn’t keep in 2019 but are not yet ready to completely give up on the grand old tradition of making New Year’s resolutions; try making some using the SMART goal paradigm. However, as of the day of this writing, it’s already January 3…so you’d better hurry up and get started. Personally, I think I’m actually only a few days away from finally nailing the whole teleportation thing…

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Now is the Time: Catch-up to Get Ahead on Childhood Immunizations

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Now is the Time: Catch-up to Get Ahead on Childhood Immunizations

By Adm. Brett P. Giroir, M.D.,Assistant Secretary for Health

August 2020

During National Immunization Awareness Month, the U.S. Department of Health and Human Services (HHS) is urging healthcare providers and parents to “catch-up to get ahead” on childhood immunizations.

The COVID-19 pandemic has led to worrisome declines in well-child visits and routine immunization rates. Although we have made progress to reverse this trend, without high vaccination rates there is a risk for outbreaks and further strain on our nation’s healthcare system.

As a pediatric critical care physician, I know all too well the devastating consequences that diseases, like whooping cough and measles, can have on children and their families. It is tragic to see a child become sick, or even die, from a disease that we can prevent with safe and effective vaccines. In our fight against the COVID-19 pandemic, we cannot let down our guard against preventable childhood diseases. Now is the time to get every child back on track with recommended vaccines.

To increase childhood immunization rates and reduce potential outbreaks of vaccine-preventable diseases before flu season, HHS is coordinating the “Catch-up to Get Ahead” effort. Together a number of government and private sector partners will enhance access to essential immunization services by:

  • Increasing immunization opportunities by encouraging extended office and clinic hours for the administration of catch-up vaccines;
  • Informing parents about COVID-19 safety precautions and practices in place in healthcare settings and encouraging them to take their children to get vaccinated; and
  • Catching children up on their immunizations to mitigate pressures on our healthcare system when the influenza and SARS-CoV-2 viruses begin co-circulating in the coming months.
  • Promoting the importance of childhood immunizations.

It’s imperative to make sure our children are vaccinated on time throughout their childhood before they are exposed to potentially life-threatening diseases. Vaccines are a safe and effective way to guard our children against 16 serious diseases, such as rubella, polio, and cancers caused by HPV.

Getting children back on track with recommended vaccines is safe, but there may be delays, as many children need to catch-up during this time. Additional precautions are in place in healthcare settings to prevent the spread of SARS-CoV-2, the virus that causes COVID-19. Most vaccines are also available at no or low cost to the parent. Parents should talk to their healthcare provider if they feel that cost is a barrier to getting their children vaccinated.

To learn more about vaccines and vaccine-preventable diseases, visit vaccines.gov.