U.S. doctors should regularly screen all adults under 65 for anxiety, an influential health guidelines group proposed Tuesday.

It’s the first time the U.S. Preventive Services Task Force has recommended anxiety screening in primary care for adults without symptoms. The proposal is open for public comment until Oct. 17, but the group usually affirms its draft guidance.

The recommendations are based on a review that began before the COVID-19 pandemic, evaluating studies showing potential benefits and risks from screening. Given reports of a surge in mental health problems linked with pandemic isolation and stress, the guidance is “very timely," said Lori Pbert, a task force member and co-author. Pbert is a psychologist-researcher at the University of Massachusetts’ Chan Medical School.

The task force said evidence for benefits, including effective treatments, outweighs any risks, which include inaccurate screening results that could lead to unnecessary follow-up care.

Anxiety disorders are among the most common mental health complaints, affecting about 40% of U.S. women at some point in their lives and more than 1 in 4 men, Pbert noted.

Black people, those living in poverty, people who have lost partners and those who have other mental health issues are among adults who face higher risks for developing anxiety, which can manifest as panic attacks, phobias or feeling always on edge. Also, about 1 in 10 pregnant and postpartum women experience anxiety.

Common screening tools include brief questionnaires about symptoms such as fears and worries that interfere with usual activities. These can easily be given in a primary care setting, the task force said, although it didn’t specify how often patients should be screened.

“The most important thing to recognize is that a screening test alone is not sufficient to diagnose anxiety," Pbert said. The next step is a more thorough evaluation by a mental health professional, though Pbert acknowledged that finding mental health care can be difficult given shortages of specialists.

Megan Whalen, a 31-year-old marketing specialist who was diagnosed with anxiety in 2013, says regular doctors should screen for mental health issues as commonly as they do for physical problems.

“Health is health, whether the problem is visible or not," said Whalen, of Hoboken, New Jersey.

She has gotten help from medicine and talk therapy, but her symptoms worsened during the pandemic and she temporarily moved back home.

“The pandemic made me afraid to leave home, my anxiety telling me anywhere outside of my childhood house was unsafe," Whelan said. “I absolutely still struggle with feelings of dread and fear sometimes. It’s just a part of my life at this point, and I try to manage it as best as I can."

The task force said there isn’t enough solid research in older adults to recommend for or against anxiety screening in those aged 65 and up.

The group continues to recommend depression screening for adults and children, but said there isn’t enough evidence to evaluate potential benefits and harms of suicide screening in adults who show no worrisome symptoms.

In April, the group issued similar draft guidance for children and teens, recommending anxiety screening but stating that more research is needed on potential benefits and harms of suicide screening kids with no obvious signs.

Guidelines from the task force often determine insurance coverage, but anxiety is already on the radar of many primary care doctors. In 2020, a group affiliated with the American College of Obstetricians and Gynecologists recommended routine primary care anxiety screening for women and girls starting at age 13.

Melissa Lewis-Duarte, a wellness coach in Scottsdale, Arizona, says rhythmic breathing, meditation and making a daily list of three things for which she is grateful have all helped with her anxiety.

“Doctors say, ‘Make sure you’re sleeping, control your stress.’ Yeah, I get that," but not everyone knows how, said the 42-year-old mother of three. “It’s difficult to prioritize self-care, but that’s what’s necessary.”

A lot of people added pets to their families during the pandemic, but quite a few "pandemic puppies" lack proper socialization. If you fit in that category, you can get some relief by taking your dog to a training facility.

Heather Gillihan is a certified professional dog trainer with Zoom Room. It's an indoor dog training gym with locations nationwide.

"I could train your dog really well," Gillihan said. "That's not going to do you a bit of good if you don't know how to follow up, right? So we believe that it's more important to empower the owner to train their dog."

Gillihan says the first step to building a bond with your pup is having some empathy for their feelings.

"Think about it from his point of view," Gillihan said. "So he's on the leash. He knows he can't run. Dogs, when they get nervous or afraid, they have two reactions: fight or flight. The fact that the leash is attached means his only option is to fight. So he's not an aggressive dog, but he doesn't know what's coming at him. So his point of view is 'I am stuck. I can't run. So I better sound scary because what if he's a bad dog?'"

If you show frustration with your dog, Gillihan says that makes the situation worse.

"He's already nervous and afraid, and now the person he loves most in the world is fussing at him," Gillihan said. "So it just makes that dog even more scary."

Gillihan says the good news is that you can retrain a dog's brain to like other animals.

"Let him know you have some really good food, like some barbecue, something that he has never had before, but smells amazing. Let him know you have it. But he doesn't get it until we see a dog. So as soon as he sees a dog and before he can react, you say, 'Yes!' and give him that barbecue. Think about what happens in his little brain now. 'Hey, mom, there's a dog. Can I have my barbecue? Because there's one right there.'"

The other common trait with pandemic puppies has been separation anxiety as people return to the office. Gillihan suggests you get a camera in your house. If your dog is panting, sniffing and soiling the house, that's separation anxiety. Otherwise, they may simply lack coping skills, and you can help with that.

"No big hellos or goodbyes," Gillihan said. "Make it non-eventful. You're just walking out. There are things you can do to help them, though, if you're going to be gone for a while. Such as toys, stuff about you, toys, puzzles."

If it is separation anxiety, Gillihan suggests you visit a dog behavior specialist with a veterinary background who can use medications to help your fur baby.

"What those dogs need more than anything is to be able to settle the brain so that they can be retrained," Gillihan said.

Gillihan says it's possible to have a well-rounded dog at any stage in their life. She notes it just may take a lot of practice and dedication through a training regimen.
 

As the importance of mental health becomes more widely accepted in the United States, men are still battling the stigma that it should not be discussed.

But that changed recently when famous MMA fighter Paddy “the Baddie” Pimblett delivered a moving public message after a fight, saying he has been struggling himself.

In his post-fight speech, Pimblett spoke about a close friend of his who had taken his life only days before the fight. He urged men to talk about their issues.

“I’d rather my mate cry on my shoulder than go to his funeral," he said.

The speech was an important message to men worldwide.

“I saw that clip of Paddy and I was just stopped. I had that sense of 'finally,'” said Eric French, a psychiatrist at the Mind Spa in Denver. “[Men] have these conceptions about [themselves] that we’re supposed to be strong, stoic, press forward no matter what is going on but we are human beings and that means there are aspects of ourselves that are no less real if we acknowledge them or not; that being our emotional state. And if acknowledging your emotional state makes you vulnerable, that’s not a bad thing.”

“I was always taught that a man is supposed to be strong, courageous. You bottle up all your feelings,” said Sam Peterson, a retired war veteran.

Peterson knows about that stigma first-hand. He was a bomb technician in Afghanistan for more than four years. The PTSD he developed from his time in the Army nearly led him to take his own life in 2014.

“It was very much like panic attacks, and, you know, I very nearly ended my own life because of it,” he said. “I had my .45 in my hand, you know, ready to pull the trigger and I got a text message from one of my very good friends and he’s like hey man come over. I sat down on the couch and I just bawled my eyes out for like three hours. Just letting it all out and it felt like someone had just taken my soul out of my body and just washed it in bleach and stuck it back in.”

After the speech by Pimblett, who is from the U.K., mental health clinicians in the region reported seeing more men coming to their practice for help.

“You have to have someone there who can hold up a mirror to your biases and help you break them down or you’re just going to be stuck in the same rut,” said Peterson.

“If you’re struggling and you get the sense that this feeling you’re having is not going away, it’s not going to go away,” added French. “It’s going to stay there until you face it.”

Since the Tokyo Olympics, Simone Biles has been open and honest about her journey with mental health and anxiety. And she's continuing to share what she's learned along the way. The Olympic gold medalist recently revealed that with the support of her therapist she’s found tools that help her manage anxiety, while still acknowledging her emotions.

The superstar athlete humbly accepted the Child Mind Institute’s Inaugural Trailblazer Award at the annual Child Advocacy Awards. During the event, Biles spoke to Harold S. Kopleqicz, M.D., the president, medical director, and co-founder of the Child Mind Institute, a nonprofit organization focused on helping families and children struggling with mental health and learning disorders, about her experience at the Tokyo Olympics and the tools she now uses to cope with anxiety.

“I have pretty bad anxiety sometimes," Biles said. She shared that her therapist suggested she write in a “worry journal,” to allow her to keep her anxiety in check daily.

She explained the method behind the worry journal: Write her worries down in the journal and then assign a time in the day to address those worries—for Biles it's between 12 to 1 p.m. “Anything I've written down in my worry journal, I use that hour to worry about the things then,” Biles shared. “And usually by the time 12 or 1 [p.m.] comes, I've already forgotten about all my worries so that kind of is a tool that helps me.”

Biles said she hopes to be a “voice for the voiceless” and to be a catalyst to open up the conversation around mental health. “I hope that I’ve allowed them to use their voices and be powerful with it because I know my career has been very successful, but I’ve also had my ups and downs,” she said. “I hope people see that and can relate to that being in their everyday life. Just to not give up and to move forward and keep pushing.”

The Child Mind Institute shared a video of Biles accepting the award to their Instagram account with the caption, “By being brave and protecting her mental health Simone Biles inspired others to do the same.”

During the 2021 Tokyo Olympics, Biles decided to pull out of the individual all-around competition due to the terrifying “twisties” that causes her to get lost in the air. The decision to put her own mental health and safety first was a scary choice for the athlete that ultimately led her on a path of mental health activism.

“I was feeling very overwhelmed because there was a lot and I think there was a lot of pressure outside the sport that was placed on me to compete at that Olympics,” she explained of the incident. “And we hadn’t had that kind of entertainment in a really long time due to COVID. I think it was really hard because everyone was counting on me to supply that entertainment, that happiness, that joy.”

The Olympic gold-medalist revealed that her therapist has been a major player in managing her anxiety, and she encourages others to seek the help that they need.

“I do keep close contact with my therapist–I love that. And it’s super exciting, so hopefully, more people are open to going to therapy and just knowing that they’re there for you and not to harm you,” she said.

Biles was initially resistant to therapy, but now credits therapy with helping her process her emotions and find herself. “One of the very first sessions, I didn’t talk at all,” she recently told Glamour. “I just wouldn’t say anything. I was like, ‘I’m not crazy. I don’t need to be here.’”

But over time the Olympic gymnast found comfort in her therapist and was able to see that anyone can benefit from seeking mental health support.

At the end of the day, Biles shared that she was surprised by the outpouring of love and support from others to take care of herself first. She added that she now focuses on everyday happiness which is “just waking up and having a positive outlook on life in general and to know that you’re blessed with another day.”

Ireland King and mom Michelle know the effect of the pandemic on mental health.

"I didn't want to leave my room," said Ireland King. "I didn't even feel like eating. My family felt like I didn't like them because I was so rude all the time."

"She basically came out and said she didn't wanna be here anymore," said Michelle King. "More than once."

The Indiana family is by no means alone.

"We describe it as a mental health tsunami going on," said Dr. Thomas Plante, licensed psychologist and psychology professor at Santa Clara University.

That tsunami has millions of Americans grasping for relief. Medication and therapy might be the medical solution, but that’s not always the answer.

"Some people act different to medications, it doesn't always work for people," said Heidi Strunk, president & CEO of Mental Health America of California.  

"A lot of times medication is trial and error."

Stigma, lack of equity and access and a mental health worker shortage are all challenges for people seeking help.

Experts say for the individual, there are some low-cost options.

A quick app store search shows dozens of apps, some focused on checking in with yourself, others can link you to a therapist.

Other ideas: 

• Jotting down what makes you happy 
• Getting movement or exercise 
• Journaling 
• Finding an outlet like music, video games, or art 
• Joining online or in-person support groups

"When you identify that, do it. There's power in doing what makes us happy," said Strunk. "These are things that people need to do, of course, before we get into crisis, but being proactive."

It's not just up to the individual.

"Lots of times it's really hard for people to do anything individually because they're paralyzed by the anxiety or the fear of the depression or whatever," said psychologist Dr. Thomas Plante. "And it's hard for them to really be proactive in helping themselves."

Plante says employers, bosses, family, and friends can start with a simple, "I get that."

"We need to journey with people in solidarity. You know, we need to be with them and we say, you're anxious. I get that. I get anxious, you're depressed, I get depressed," said Dr. Plante. "You know, you're feeling suicidal. I don't blame you, you know, but you know, the world is a mess."

And beyond that, people can follow up.

Another option: a warm line.

Warm lines aren’t crisis hotlines, but a tool for people before they’re in dire straits. There are more than 100 in the U.S. The majority are staffed by people like Bettye Foster, who have firsthand experience.

BETTYE FOSTER: We're all primary caregivers of someone with a mental health challenge.

LINDSEY THEIS: So even yourself?

FOSTER: Even myself. So I have a family member that I was the primary caregiver for. And some of our advocates are still that primary caregiver for someone.

It’s not a call for help, but it is a call to help. Because, as Bettye puts it:

"You see someone on the street and you're like, yeah, you don't know what's going on with that person," said Foster. "And you also don't know what's going on with the person who looks good, who looks well. You know, for that, you may think they've got it all together. You don't know, because mental illness doesn't have that kind of face."

Meanwhile, the Kings search for more help for Ireland. She’s lived through the COVID health crisis, and is now among the millions hit by the mental health crisis.

"There needs to be something. Something needs to change," said Ireland King.

"I’m not willing to let her slip through the cracks, and no other family should either," said Michelle King.

This story was originally reported by Lindsey Theis on Newsy.com.

President Joe Biden said Thursday a lot of Americans are feeling "down" because of the pandemic and anxious about the future — particularly heading into the holiday season — and urged those struggling with mental health issues to seek help if they need it.

"How many people do you know — and maybe some in this audience — who because of what you've been through, a loss of a husband, wife, brother, mother, father, son, whatever, or you've had something that's really impacted you with COVID, that you really find yourself just down?" Biden told Anderson Cooper at a CNN Town Hall.

The president said: "There's a lot of people who are just down. They're not sure how to get back in the game. They're not sure whether they want to get back in the game."

The president said so many events that people used to look forward to — a high school prom or a graduation ceremony, he said, for example — were canceled because of the pandemic. He said people have "a lot of anxiety," and that he often gets asked about what holidays like Thanksgiving and Christmas are going to look like because of the pandemic and issues with the global supply chain, which are causing delays in the deliveries of some goods.

"A lot of it has to do with us getting back on our feet and getting back on our feet in terms of our attitudes about what the future looks like for us," Biden said.

But he urged those struggling with mental health issues, perhaps exacerbated by the pandemic and lockdowns, to seek help.

"There's plenty of help," the president said. "Look, being down, having some problem in terms of needing some, some advice — if you have a broken spirit, it's no different than a broken arm. You shouldn't be ashamed of it. You should seek the help. There's a lot of people who can help."

The president said that many Americans are reluctant to return to work because of concerns about COVID-19. He also said many people are rethinking minimum-wage or low-paying jobs.

"People are now using this as an opportunity to say, 'Wait a minute, do I want to go back to that $7 an hour job?'"

The delta variant of COVID-19, which is more transmissible and may cause more severe illness than previous strains, has ripped through parts of the country with low vaccination rates for months, though cases have decreased in recent weeks. Biden and health officials have repeatedly pleaded with unvaccinated Americans to get vaccinated to protect themselves and those around them.

Biden said last week the nation was "headed in the right direction" on COVID-19 but that the country is now in a "very critical period" as he urged unvaccinated Americans to get the shot.

In a room of blue serenity, Amelia Moutin prepares for 90 minutes of what she describes as a completely unique sensation.

“I think if you let yourself go, it takes about 30 minutes, and then once you kind of settle in and let your mind and body meld together, it’s such a euphoric-relaxation experience that is like none other,” Moutin described.

The practice is called floating.

“Technically, you lay in 10 inches of water, and 1,100 pounds of Epsom salt. And so, with the buoyancy of the salt, you float right on top of the water,” Samana Float Center owner Heather Clift said.

Another term for it is sensory deprivation. The 94-degree water makes it challenging to know where your skin and the water meet creating a feeling of weightlessness. Clift says it was created by a gentleman named John C. Lilly in the early 1950s.

“Sensory deprivation is where we void you of all of your senses, so with no light and no sound, there’s no smells in the float tank and there’s no real feeling,” Clift said.

Moutin has been floating for a year now, and she tries to go once a month.

“It’s kind of like floating in your own little ocean, but you have no fear at all. There’s no sharks, there’s no tide, there’s no possibility of drowning, so there’s literally nothing that can take away from the experience,” Moutin said.

With no distractions, Moutin says she’s able to completely let go, relieving herself from the stressors of life. According to Clift, floating can help people who live with anxiety, PTSD, high blood pressure and insomnia among many other things.

“It takes you from your sympathetic nervous system, which is your fight or flight, that’s what keeps you alive, and it puts you into the parasympathetic nervous system. And that is called rest and digest,” Clift said.

Clift says shutting down your nervous system causes your body to drop its cortisol levels and replace it with dopamine. Dopamine is the hormone that makes our body feel happy and satisfied. It also boosts your immune system.

Before the pandemic even started, Clift says the self-cleaning process of the tanks was already very effective at killing germs.

“So, if there was anything that could live in 1,100 pounds of Epsom salt, the hydrogen peroxide would cling to it, it would go through the filter, and the UV light would blow it up, so it is impeccably clean," Clift said.

However, in case that’s not enough, they’ve also started using ozone to clean all surfaces.

“It kills SARS, coronaviruses…up to 99 percent,” Clift said.

Clift says many people have made floating a priority this year because they need it now more than ever. Moutin agrees.

“Ultimately as a world, we’re experiencing a traumatic event together, and trauma creates stress and issues in our tissues as we like to say,” Moutin said.

Even if you don’t notice any physical health benefits, Clift says floating is a great way to relax.

“I tell you to take a nap on some water for 90 minutes. How often can you do that? It’s really a special thing. Everybody should float at least once in their life,” Clift said.

Over half of people with chronic depression who attempted to stop their antidepressant medication relapsed into depression by the end of a year, compared to those who did not stop medicating, according to a randomized, double-blinded clinical trial released Wednesday.

The research, published in the New England Journal of Medicine, found that "quality-of-life measures and symptoms of depression, anxiety, and medication withdrawal were generally worse in patients who discontinued their antidepressant therapy."

Interestingly, the study did find a small percentage of people were able to successfully stop their antidepressant without having another depressive episode.

"Some people can stop their medication without relapse, although at present, we cannot identify who those people are," said coauthor Gemma Lewis, a professor of psychiatric epidemiology at University College London.

"I think we can be very cheered by the findings," said coauthor Dr. Tony Kendrick, a professor of primary care at the University of Southampton in the United Kingdom.

"This is really good evidence to support a patient's own decisions — in discussion with their doctor or other prescriber — about whether they should continue antidepressants or not," Kendrick said. "Both courses of action are reasonable."

Antidepressants for life?

When people slip into depression for the first time, current practice is to continue antidepressants between four to nine months after remission of their depression, said Dr. Jonathan Alpert, chair of the American Psychiatric Association's Council on Research, who was not involved in the study.

Remission is defined as a two-month period with no signs of major depression such as sadness and a reduced interest or pleasure in life.

"In my own practice, if the patient has a first episode of depression, and particularly if it was triggered by a life event — death of a loved one, failed business — then I try my best to get patients into remission (and) then I treat for a minimum of six months after they achieve remission," said Dr. Jeffrey Jackson, a professor at the Medical College of Wisconsin, who studies depression.

"If they stay in remission for those six months, then we can consider slowly tapering off the antidepressants — with the person carefully monitoring their own depressive symptoms," Jackson added. Jackson, who was not involved in the study, wrote an accompanying editorial published in NEJM.

Unfortunately, the danger of another bout of depression later in life is high, said Alpert, who is also the chair of psychiatry at Montefiore Health System in the Bronx.

"If one has had one episode of depression, the chances of a second episode sometime during one's lifetime is 50%," he said. "If somebody has already had two depressions, the chances of a third are even higher — over 75% of people who have had two or more depressions will have another."

Science has long known that people with recurrent depression have the most difficulty coming off antidepressants and the most likelihood of relapse when they do, Alpert added.

"For patients who have had three or more depressive episodes, I generally plan to treat them for life," Jackson said.

Addressing out-of-date research

Much of the research done on long-term effectiveness of antidepressants is old and limited, so the study was designed to fill that gap in knowledge, the study authors said.

"Many people are taking long-term antidepressants, and the evidence to advise them whether to continue maintenance or discontinue is poor," Lewis said.

The study recruited 478 people from 150 primary care practices in the U.K. Each person had experienced at least two depressive episodes or had been on antidepressant medication for two years or more. All felt well enough to stop taking their medication.

"This is the largest study that's been done in a real-world primary care setting," said Alpert.

"That's important because most patients with depression are managed by their primary care provider," Jackson said. "Most primary care providers only refer to psychiatrists if the patients are suicidal, homicidal, psychotic, bipolar or not responding to therapy."

Only people taking maintenance dosages of four antidepressants were included in the study: citalopram (Celexa), fluoxetine (Prozac), sertraline (Zoloft), and mirtazapine (Remeron). Other popular antidepressants, such as escitalopram (Lexapro), were not included due to the greater likelihood of severe withdrawal symptoms, the authors said.

All medications and the lactose placebo in the study were packaged identically in unmarked bottles so that both patients and researchers were blinded to the contents.

Half of the group was given reduced dosages of their antidepressant over a two-month period; by the beginning of the third month, all were taking placebo. The other half of the group continued to take their normal dose of antidepressant.

At the end of 52 weeks of follow-up, 56% of the people who had been weaned off their antidepressant had relapsed into depression, compared to 39% of the people who continued their medications.

"The patients who stopped their antidepressants experienced a relapse sooner than the patients who stayed on their antidepressants," Lewis said.

Symptoms of depression and anxiety were higher in the group who discontinued their medications as well, she added. But could those have been withdrawal symptoms instead?

"It's not always that easy to tell," Kendrick said. "If somebody's starting to get anxious, if they're starting to have sleep disturbances or are starting to feel low. Is that depression coming back? Or is it withdrawal symptoms?"

Regardless of the source of the symptoms, a number of people exited the trial even though they did not know if they were on medication or placebo.

"It was clear that they voted with their feet," Alpert said. "When they weren't doing as well, they were more likely to drop out of the trial and more likely to resume medications."

Long-term use

The study results did provide some insight into the benefits of long-term use of antidepressants, Kendrick said.

"It's reassuring to know that antidepressants people are taking long term do seem to be benefiting them, and this is not something that they're taking unnecessarily," he said.

There are side effects to many medications, such as weight gain and sexual dysfunction, "so we try to choose antidepressants and adjust the dose for a given person that they tolerate the best and have the fewest side effects," Alpert said.

"However, to the very best we know, there are no long-term consequences, such as increased risk of cancer, stroke, heart disease or liver problems by virtue of being on antidepressants," he added.

If you do decide to taper, do it slowly and add psychological therapy, which studies have shown "can help prevent the risk of relapse," Kendrick added.

"The latest guidelines are suggesting that you should take some weeks to come off antidepressants," he said. "If you're getting withdrawal symptoms and finding it difficult, you might need to take months to come off them."

What else can be done?

Antidepressants are, of course, not the only treatment for depression. There are many things people can do to improve their depressive symptoms while on medication or reduce the likelihood of a relapse once weaned off an antidepressant, Alpert said.

Physical activity is key. "It looks like even relatively moderate amounts of activity, like a brisk walk several times a week, can help in the treatment of depression and also help in relapse prevention," he said.

Social connections are important, too. Making an effort not to be isolated, by reaching out to others for social support, makes a difference, as do activities that are meaningful and rewarding, Alpert said.

"Community activities, volunteer activities, seem to be important in helping with depression," he said. "When people are pursuing goals that are meaningful to them, that's also helpful."

Evidence-based psychotherapy works. "People who opt to taper off their medications have a greater chance at staying well if they're pursuing certain forms of psychotherapy that have been shown in studies to be effective," Alpert said.

Cognitive behavioral therapy, or CBT, has been widely studied and considered to be comparable in effectiveness to antidepressants for depression. It's often used in conjunction with medication for people whose symptoms do not improve on antidepressants alone.

The therapy focuses on a person's thought process, attempting to interrupt false or negative thoughts about oneself and others that can lead to a depressive mood. Instead, people are encouraged to substitute healthier, more positive thoughts, which can improve self-image and behavior.

"It's not quite like lying on the couch and free associating," Alpert said. "There's specifics like homework assignments and skills that people acquire."

Acceptance and commitment therapy, or ACT, uses a similar approach, Alpert said, with more of a focus on accepting negative thoughts and discarding them.

"Rather than changing your thoughts, you accept the idea that they're just thoughts, they're not the same as reality, and they are not who I am," Alpert explained. "Realizing that thoughts like 'I'm not good enough' and so on are just thoughts, and learning how to push those thoughts away."

Interpersonal psychotherapy or IPT, focuses on changes in one's life that has to do with interpersonal relationships, Alpert said.

"Interpersonal therapy has to do a lot with relationships like losses or transitions in one's role with others ... and then working on those, like how can you go ahead with a life worth living and adapt to or will make the best of those transitions," he said.

Therapists will often tell patients about the different approaches, as one may be a "better match to where they are in their lives and the things that they're dealing with," he added. "There are many things that people can do in addition to medications."

SEATTLE, Wash. — Working in emergency services means putting yourself in dangerous situations.

Often, it is life or death, like when a devastating mudslide hit a community north of Seattle in 2014.

“I was deployed to the Oso mudslide about seven years ago and it was a mudslide that killed 40 people,” said Lt. Michael Dulas, with the Seattle Fire Department.

“My role was to help search the mudslide for people. So, we were literally digging, looking for people,” he said.

The weeks-long search effort left an impression on Dulas and hundreds of other first responders.

“We were up there for four 24 hour shifts in a row,” said Steve Yeutter, who works with Dulas at the fire department.

“The most normal part of that day was petting the search dogs at the end of the day,” said Dulas.

The Oso slide and its aftermath inspired Dulas to make a small but significant change within Seattle Fire. The department got dogs.

“Zoe’s a 2-year-old Bernedoodle, so half Bernese mountain dog and half poodle,” said Dulas.

Zoe is Mike’s dog and one of three therapy dogs who have joined the fire department as part of a pilot program. The other two, Hera and Bob, are also owned by Seattle firefighters.

“She’s just being a dog, bringing a smile to people’s faces, being goofy, doing dog things. And dogs are proven to lower your heart rate, lower your blood pressure,” said Dulas

Agencies across the U.S. are looking for a solution to the mental health crisis. Police and firefighters are now more likely to die by suicide than in the line of duty. About 30% of emergency responders will develop behavioral health conditions like depression and post-traumatic stress disorder (PTSD).

“For a number of years, those issues were really under-recognized, and it was just assumed, 'Oh, they’re tough. They see it every day,'” said Chip Schreiber, a clinical psychologist at UCLA who specializes in creating programs to reduce PTSD in first responders.

“Suicide and serious depression are the final common pathway of stress and symptoms that potentiate and then lead to greater conflict in the environment and ability to function in your family,” said Schreiber.

“In ’95, Seattle lost four firefighters in the Mary Pang warehouse fire. One of them was my very best friend. Randy Terlicker was his name,” said Yeutter. “Had a hard time for about 24 hours just even functioning.”

Yeutter has spent three decades with Seattle Fire.

Today, one of his jobs is working as a peer support coordinator, helping firefighters deal with a wide variety of scenarios.

“Possibly line of duty deaths, injuries to firefighters. Some of the other things that might trigger a response might be multi-casualty incidents, or possibly suicides or difficult runs with children,” said Yeutter.

Yeutter and Dulas both say they've had experiences where they wished there was more offered by the department.

“I lost a little brother who was in the Army to suicide. I’ve watched my older brother as a firefighter struggle with PTSD and that’s a lot of my motivation is just I want to take a different path and I want to be well,” said Dulas.

Both say there are more resources available to firefighters today.

“When you feel those reactions when you sick, when you feel stressed, when you can’t sleep for a couple weeks, get out there and ask for help,” said Yeutter.

“I want to see everyone retire healthy, happy, with their families intact and just go have a great life after,” said Dulas.

How's it going in that boiling lobster pot of stress?

The last year of living in a pandemic has stretched human coping skills so thin that experts fear many of us may soon snap, leaving people around the world coping with a mental health crisis of catastrophic proportions.

In the United States alone, a recent analysis by the U.S. Centers for Disease Control and Prevention found reports of anxiety or depression climbed from 36% to 42% in the six months between August 2020 and February 2021.

Yet some people — in fact, many people — somehow manage to weather stress just fine. Do those folks experience less pressure? That's certainly possible since not everyone has worked in an essential job or lost a job during the pandemic, or worse, lost a family member to the virus.

But it's also possible they have mastered the art of seeing stress as a normal, acceptable and even positive part of life.

With that view, experts say, comes resilience.

And just like rock, paper, scissors ... resilience covers stress.

Viewing stress as harmful can kill

It was 1998, and a random sample of Americans were answering questions about stress for the National Health Interview Survey, an annual household report designed to monitor the health of the nation.

The 1998 survey did something later years didn't do. It not only asked people how much stress they were under and how well they were coping, but it also asked them if they thought that stress had impacted their health.

More than 55% of nearly 29,000 people said they had been under moderate-to-severe stress over the last 12 months. Nearly 34% said stress had affected their health to some degree that year, and about a fourth of those said stress had made their health much worse.

Eight years later, researchers compared those answers to national death data to see who had suffered the greatest impact from stress. As expected, reporting high levels of stress did increase the risk of dying.

But here's where the study's results got really interesting — that risk only applied to people who believed the stress they were experiencing was significantly harming their health. In fact, the risk of premature death rose by 43% for people who viewed stress negatively.

What happened to the equally pressured people who didn't view stress as harmful?

They had the lowest risk of death of anyone in the study, even lower than people reporting very little stress, said psychologist Kelly McGonigal, who discussed the study in her book "The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It."

"The researchers concluded that it wasn't stress that was killing people," McGonigal wrote. "It was the combination of stress and the belief that stress is harmful. The researchers estimated that over the eight years they conducted their study, 182,000 Americans may have died prematurely because they believed that stress was harming their health."

Could it be a point of view?

"Just because you're experiencing stressful situations doesn't mean that it's damaging," said Mark Seery, an associate professor in the department of psychology at the University at Buffalo, SUNY. Seery has spent years studying why some people are more resilient under stress than others.

"Evidence suggests the way in which people experience stress seems to have an impact on whether stress is really damaging or not," Seery said, adding that it is influenced by how we "approach things psychologically."

And that, he said, "opens the door to considering ways in which people can learn to approach stress in a more versus less healthy way."

To understand how that can be the case, consider what happens to the body under stress. Ancient parts of the brain kick in — flooding systems with chemicals designed to ready the body for fight or flight.

The heart races, breathing quickens and the brain goes into high alert. Senses heighten; colors and sounds become more clear and vivid. You get a burst of energy and sharper focus so you can cope with the threat and survive.

That "good" stress can give you an edge in fighting or fleeing an attacker, but also when playing a competitive sport, speaking in public, interviewing for a job or even adapting to a pandemic quarantine.

Then, once the immediate threat is handled, your levels of stress hormones return to normal with no long-lasting effects, as nature intended. It's a win-win — or would be if we saw it that way.

But instead of welcoming a stress response, "normally we interpret these physical changes as anxiety or signs that we aren't coping very well with the pressure," said McGonigal in a 2013 TED talk.

What happens if we view our stress response as beneficial -- the way the body primes us for optimal performance — much like a finely tuned professional race car waiting for the flag to drop?

"Thoughts are super powerful, and the key is you create your thoughts," said Michelle Anne, a certified professional coach with training in neuroscience and leadership. "And when you learn to control your thoughts, you can rewire your response to stress or fear or anxiety. You're 100% in control."

McGonigal describes a study where college students were taught to rethink their attitudes toward stress as helpful: "The most fascinating finding to me was how their physical stress response changed."

In a typical stress response, she said, the heart rate goes up, and "blood vessels constrict," making it one of the reasons chronic stress is linked to cardiovascular disease -- and bad for the body.

"But in the study when participants view their stress response as helpful, their blood vessels stayed relaxed," McGonigal said, adding that it was a "much healthier cardiovascular profile. It actually looks a lot like what happens in moments of joy and courage."

Experiments on cardiovascular reactions to stress done in Seery's lab found similar results.

"In both challenge and threat, the heart beats faster and the (heart) muscle contracts harder," he said. "But under threat, the blood vessels are generally more likely to constrict and actually make it harder for the heart to pump blood.

"Under challenge, the pattern looks a lot like aerobic exercise, where really arteries in the body overall tend to dilate, and the heart actually pumps more blood," he added.

"This one biological change could be the difference between a stress-induced heart attack at age 50 and living well into your 90s," McGonigal said. "This is really what the new science of stress reveals — that how you think about stress matters."

Your brain on 'good' stress

When stress is viewed through more rose-colored glasses, the brain reacts differently, changing the ratio of stress hormones the brain releases — and that, experts say, can make all the difference in whether stress turns toxic.

During a more positive reaction to stress, the body makes a smaller amount of the stress hormone cortisol, which can be harmful at chronic levels. At the same time, the brain ups production of another steroid, dehydroepiandrosterone, or DHEA, which is often called the "anti-aging" hormone.

Having a naturally higher ratio of DHEA to cortisol appears to be protective against the negative effects of stress on the body.

Men in military survival school who performed at the top of their class with less distress had higher ratios of DHEA to cortisol in their blood. However, when men and women viewed their levels of stress at work to be intolerable, DHEA production dropped.

The body also makes another hormone during stress — oxytocin, the "cuddle" hormone that helps people fall in love and mothers care for their newborns.

When released in a more positive stress response, experts believe oxytocin may lead people to seek out more and better social contacts — another upside of stress.

"Scientists refer to this as the tend-and-befriend response," McGonigal writes in her book, which "motivates you to protect the people and communities you care about. And, importantly, it gives you the courage to do so."

It even generates new brain growth, according to Daniela Kaufer, acting associate dean and professor of integrative biology at UC Berkley. Kaufer runs her own lab dedicated to investigating how stress affects brain plasticity and deterioration.

Studies done by Kaufer in lab animals show moderate stress-activated growth in stem cells in a part of the brain that regulates emotional learning and helps with depression.

"You had more of those cells, and they were activated more in the next stressor, which helped the animal cope better. So we've shown that some stress can be beneficial for you," Kaufer said.

There's yet another benefit of oxytocin released during a stress response, according to McGonigal.

"Your heart has special receptors for oxytocin, which helps heart cells regenerate and repair from any micro-damage. When your stress response includes oxytocin, stress can literally strengthen your heart," she writes.

"This is quite different from the message we usually hear — that stress will give you a heart attack!"

Yes, chronic stress is bad

Of course, there's no way to equate everyday, transient stress to the life-long impact of losing a loved one — which so many have done during the pandemic — or ongoing multiple stressors such as divorce, single parenting, job loss, financial insecurity and chronic disease.

In fact, it's well established that chronic stress that lasts and lasts does enormous damage to the body, making many existing diseases and conditions worse.

"The more serious negative life adversities that people face, the more risks they face for negative psychological and physical consequences going forward in their lives," Seery said.

But his research has also found that if people experience some life adversity, they "actually have less negative and more positive reactions" to stress.

"It's not just a straight line where the more stuff that's happened you the worse off you are," Seery said. Instead, it's more of "a happy medium" where people who have experienced some adversity in life tend to be better off across a variety of different psychological and physical measures.

"So one takeaway message from this is that even if seriously bad things have happened to someone, that's not a death sentence, that doesn't mean that they're doomed to be forever damaged," Seery said.

"This suggests that the process of going through difficulties, even though it's bad in the moment, it can actually open the door for essentially a form of future growth, a propensity for future resilience, a toughness that makes people better able to cope with future stress," he said.

"I really look at it as a message of hope, a sort of silver lining."

CINCINNATI —

A new study shows many people infected with COVID-19 have long-term mental health symptoms.

Researchers are finding about one in three COVID-19 survivors had neurological or psychological issues long after getting sick.

The study was published in the journal, Lancet Psychiatry. It is the largest study of its kind, involving the medical records of more than 200,000 COVID-19 patients.

The most common diagnosis was anxiety, found in 17% of those treated for COVID-19, followed by mood disorders, found in 14% of patients.

The neurological effects are most severe in hospitalized patients but still exist in those that experienced more mild symptoms.

Researchers found that those with COVID had a 44% increased risk for neurological and psychiatric illness compared to people recovering from the flu.

Professor of Psychiatry, Neurology, & Neuroscience, Dr. Henry Nasrallah, calls the findings unsurprising because many viruses do cause an inflammatory response to the brain, which can trigger things like depression, anxiety, PTSD etc.

He said out of the total number of patients that developed a brain disorder, 20% already had one before, while the other 13% did not.

Doctors said these findings just reiterate how crucial it is to keep seeing your primary care provider even after you've recovered from COVID-19.

With COVID-19 restrictions on the verge of being loosened, if not dropped altogether – not everyone is ready to head back into the crowded spaces we all remember from pre-pandemic life, with or without a mask.

While some are celebrating the return to some semblance of normalcy, anxiety is being stoked in others. Mental health experts are calling the phenomenon ‘re-entry anxiety,’ and it’s affecting people from the the White House all the way to your house.

“Yesterday, as soon as the guidelines came out, we got a note that came across our emails that says you don’t need to wear masks here anymore,” White House press secretary Jen Psaki said.

But some people are saying being in large crowds after a year of isolation isn’t everyone’s ideal situation.

“It makes so much sense that our bodies and our minds are telling us ‘no.’” clinical psychologist Dr. Ashley Soloman said.

She said if the idea of returning to pre-pandemic life worries you, you’re not alone.

“I’ve seen so many people over this past year with COVID anxiety that was new to them as well as people who have perhaps struggled with anxiety in different points in their lives and it was extremely exacerbated by the pandemic,” Soloman said.

She said it’s important to start with small steps – a little league game over a MLB game played in a large stadium, short trips over flights, Airbnb’s over crowded hotels.

“Don’t feel like you have to go to a crowded stadium or concert as the first time that you’re reentering public life,” Soloman said.

She stresses the importance of being patient with others feeling more or less caution than you.

“I think it’s really important that we’re honest with each other about how we’re feeling and our comfort level in reengaging in our more social lives,” Soloman said.

And while restrictions are expiring, the pandemic’s effects are here to stay.

“The mental health issues that have come out during COVID are really not going anywhere,” Solomon said. “They’re really going to persist.”

She said if you’re venturing into a crowded space for the first time in months, you may want to do so with a partner – that way you have someone to confide in if you get overwhelmed.

This pandemic has triggered anxiety, depression, and elevated stress for so many, even if you've never experienced it.

So now, a local mental health organization is trying to reach out to those struggling and offer free resources to help.

"Anxiety is up, depression is up and people that live with mental health conditions already, those things really can be and have been exacerbated because of this last year," explained Colleen Thayer, the executive director of NAMI, the National Association of Mental Illness in Sarasota and Manatee Counties.

Thayer says this pandemic has caused many to suffer from anxiety, stress, and even depression. So, NAMI is launching a new campaign called "You Are Not Alone."

"We try to encourage people to really reach out," Thayer said.

Thayer says it's so important to take care of your mental well-being during this challenging time.

"Sometimes self-care is just so critical. And sometimes that means, you know, you take an extra 10 minutes to walk around your neighborhood or make a phone call to a friend or write. Or, you know, whatever people can do for their own self-care. We really try to encourage that," she added.

NAMI in Sarasota and Manatee counties offers many free resources, as well.

"We have support groups, and they're peer-led. So there are peer support groups for people that live with mental health conditions. And then, there are family support groups. And we also do a wide variety of education classes geared towards family members, peers, family members of younger people," Thayer said.

If you think you should tough it out and handle the extra stress, Thayer says it's important to talk about mental issues like you would any other physical issue.

"It is like any other kind of chronic health condition. It's manageable, and people can live very, very fulfilling and happy lives," she explained.

Along with in-person support groups, NAMI also offers free virtual support groups.

For more information on that and other free resources, click here. Or you can call NAMI's office directly at (941) 444-3428.

But if you need help right away, call the National Suicide Prevention Lifeline at 1-800-273-talk or 1-(800) Suicide. They both have someone standing by 24/7.

Wendy Ryan at WFTS first reported this story.