Mindfulness meditation worked as well as a standard drug for treating anxiety in the first head-to-head comparison.

The study tested a widely used mindfulness program that includes 2 1/2 hours of classes weekly and 45 minutes of daily practice at home. Participants were randomly assigned to the program or daily use of a generic drug sold under the brand name Lexapro for depression and anxiety.

After two months, anxiety as measured on a severity scale declined by about 30% in both groups and continued to decrease during the following four months.

Study results, published Wednesday in the journal JAMA Psychiatry, are timely. In September, an influential U.S. health task force recommended routine anxiety screening for adults, and numerous reports suggest global anxiety rates have increased recently, related to worries over the pandemic, political and racial unrest, climate change and financial uncertainties.

Anxiety disorders include social anxiety, generalized anxiety and panic attacks. Affected people are troubled by persistent and intrusive worries that interfere with their lives and relationships. In the U.S., anxiety disorders affect 40% of U.S. women at some point in their lives and more than 1 in 4 men, according to data cited in U.S. Preventive Services Task Force screening recommendations.

Mindfulness is a form of meditation that emphasizes focusing only on what's happening at the moment and dismissing intrusive thoughts. Sessions often start with breathing exercises. Next might be "body scans" — thinking about each body part systematically, head to toe. When worried thoughts intrude, participants learn to briefly acknowledge them but then dismiss them.

Instead of ruminating over the troubling thought, "you say, 'I'm having this thought, let that go for now,''' said lead author Elizabeth Hoge, director of Georgetown University's Anxiety Disorders Research Program. With practice, "It changes the relationship people have with their own thoughts when not meditating."

Previous studies have shown mindfulness works better than no treatment or at least as well as education or more formal behavior therapy in reducing anxiety, depression and other mental woes. But this is the first study to test it against a psychiatric drug, Hoge said, and the results could make insurers more likely to cover costs, which can run $300 to $500 for an 8-week session.

The results were based on about 200 adults who completed the six-month study at medical centers in Washington, Boston and New York. Researchers used a psychiatric scale of 1 to 7, with the top number reflecting severe anxiety. The average score was about 4.5 for participants before starting treatment. It dropped to about 3 after two months, then dipped slightly in both groups at three months and six months. Hoge said the change was clinically meaningful, resulting in noticeable improvement in symptoms.

Ten patients on the drug dropped out because of troublesome side effects possibly related to treatment, which included insomnia, nausea and fatigue. There were no dropouts for that reason in the mindfulness group, although 13 patients reported increased anxiety.

The study "is reaffirming about how useful mindfulness can be when practiced effectively,'' said psychologist Sheehan Fisher, an associate professor at Northwestern University's Feinberg School of Medicine who was not involved in the study.

Dr. Scott Krakower, a psychiatrist at Zucker Hillside Hospital in New York, said mindfulness treatments often work best for mildly anxious patients. He prescribes them with medication for patients with more severe anxiety.

He noted that many people feel they don't have time for mindfulness meditation, especially in-person sessions like those studied. Whether similar results would be found with online training or phone apps is unknown, said Krakower, who also had no role in the study.

Olga Cannistraro, a freelance writer in Keene, New Hampshire, participated in an earlier mindfulness study led by Hoge and says it taught her "to intervene in my own state of mind.''

During a session, just acknowledging that she was feeling tension anywhere in her body helped calm her, she said.

Cannistraro, 52, has generalized anxiety disorder and has never taken medication for it. She was a single mom working in sales during that earlier study — circumstances that made life particularly stressful, she said. She has since married, switched jobs, and feels less anxious though still uses mindfulness techniques.

Dentists say they've been treating more stress-related oral health issues. 

In a survey by the Health Policy Institute and American Dental Association, dentists reported a 71% increase in teeth grinding and clenching, a 63% increase in chipped or cracked teeth and a 62% increase in those experiencing joint disorder symptoms, which include jaw pain and headaches. 

"It's a way for the body to fight stress, a little bit, and it is not unusual. We've known it for many, many years that stress can provoke patients into going into a grinding or clenching habit," said Dr. Leila Jahangiri, a professor of prosthodontics at New York University.

Jahangiri said these issues could be more common in the pandemic because of stress, but also because patients may have delayed visits. She said while patients may not notice signs of grinding or clenching, there may be some indicators patients can watch for.

 

"Some of the common signs are headaches, sometimes they're neck aches," she said.

"In more severe situations, patients can get jaw aches," Jahangiri added. She said these habits can prompt mobility of teeth and lead to shifting.

This story was originally published by Newsy.

What's supposed to be the happiest time of year can quickly turn into a stressful flurry of holiday activities and endless shopping lists, even in the best of times.

Many people spread themselves too thin trying to make this time of year perfect, which can lead to burnout. And in a pandemic? It's asking the impossible.

It's not easy to switch gears, but it really doesn't have to be this way. Here's how to relax as the season comes to a close and the new year begins.

Prioritize your tasks

Some people may think they need to do everything to have a happy holiday season, but that isn't the case, said Sarah Clark, a research scientist in the department of pediatrics at the University of Michigan in Ann Arbor.

Families should communicate with each other what the most important activities are so they know what traditions can be cut, she said.

"You don't have to do it all, but you can't expect to read everybody's minds," Clark said.

Baking to connect with others

Baking can be a therapeutic activity that brings people together, said baker Eric Pallant, author of "Sourdough Culture: A History of Bread Making From Ancient to Modern Bakers."

His specialty, sourdough bread, takes plenty of love and care for a great loaf. It also allows people to take a break from the hustle and bustle of life and reconnect with each other, he said.

"That you've taken the time to make it and make it with your hands and share it with somebody else, what could be more wonderful?" Pallant said.

Running out of ingredients because of supply chain issues? Try these easy baking hacks to substitute ingredients.

Take a walk

Walking is a great way to reduce anxiety and lower stress, especially outside in nature.

It can also help increase your energy levels, giving you more stamina to complete the tasks on your list or having fun with loved ones.

Other forms of exercise will certainly offer similar health benefits, but walking is a great option for those not accustomed to exercise, said Evan Matthews, associate professor of exercise science and physical education at New Jersey's Montclair State University.

"It is likely a familiar movement, removing the learning curve that occurs with a new form of physical activity and the intimidation factor many feel when starting out," he said.

Put the phone away

Scrolling through hundreds of social media posts is one way people take a break during a busy day, but it actually increases stress, said Vaile Wright, senior director of health care innovation at the American Psychological Association.

"It's probably reflective of individuals that are not establishing boundaries as well as they could be," she said.

Wright recommended blocking out times during the day where you turn your notifications off. If you need someone else to hold you accountable, take a walk with them without any electronics (including a smart watch).

Take a power nap

With all the activities going on, getting enough sleep is often one of the first things that is cut, despite it being one of the most important parts of your health. While adults should get at least seven hours each night, a quick nap might be a holiday solution.

Taking a short afternoon nap can leave you feeling refreshed and ready to take on the rest of the day, according to Dr. Rajkumar Dasgupta, associate professor of clinical medicine at the Keck School of Medicine of USC in Los Angeles.

The nap length should not exceed 20 minutes because anything longer could put your body into a deeper stage of sleep, he said.

If you sleep for longer than that, you could wake up feeling more tired than when you went to bed, which is called sleep inertia, Dasgupta said.

Call a loved one

It's easy to feel out of control when you're overwhelmed and stressed, but a short call to a trusted family or friend can remedy that, according to research published earlier this year in JAMA Psychiatry.

Talking for only 10 minutes on the phone with a loved one can make you feel less lonely, said Maninder "Mini" Kahlon, associate professor of population health and executive director of Factor Health at The University of Texas at Austin's Dell Medical School.

The key is to make sure the person on the other end of the call is an empathic, active listener, she said.

Other people in your life may need a good listener during this time, so reach out to loved ones and be that listener for them, too.

"Prioritize just listening to them in their words and where they prioritize their interests," Kahlon said.

These simple but meaningful activities can go a long way in helping you de-stress, so take some time to incorporate a few of them into your routine.

You're racing around town, trying to purchase a present for everyone on your list. The past week has been filled with evenings of chauffeuring your family to holiday parties and visits with Santa, leaving everyone exhausted.

The most wonderful time of the year can also be the most stressful.

One in five parents admitted their stress likely negatively impacts their children's enjoyment of the holidays, according to a C.S. Mott Children's Hospital National Poll on Children's Health at University of Michigan Health.

Parents can set unrealistic expectations of how the holiday season should be, said poll author Sarah Clark, a research scientist in the department of pediatrics at the University of Michigan in Ann Arbor. She is also co-director of the C.S. Mott poll.

Adults often try and fit in many holiday traditions like wearing matching outfits for the Christmas card or attending annual parties, she said, at times so many that it can cause palpable tension and stress in a household.

"Something parents should keep in mind is that adhering to traditions is not always what is most important to the kids and definitely adds to that holiday stress," Clark said.

Clark recommended parents sit down with their children to find out what their expectations are rather than assuming anything.

Parents should ask open-ended questions such as "What did you like best?" or "What do you remember from other holiday seasons?" she said. This will help parents prioritize what is important to the family, which in turn decreases the long to-do lists many households have this time of year, Clark explained.

Another strategy to tackle those long lists is to set aside more time than you think you need to do them and start completing tasks sooner, said CNN contributor John Duffy, clinical psychologist in Chicago and author of "Parenting the New Teen in the Age of Anxiety."

"Parents allow themselves to get into the holiday spirit earlier in the season," Duffy said. "By taking their time, they also regulate their stress levels far better than they would otherwise."

Parents also feel the pressure

One in four parents said they set high expectations for themselves during the holidays, which detracts from their enjoyment of the season too.

Of the 2,020 parents polled in October, one in six said they have high-stress levels during the holidays, with almost twice as many mothers reporting they feel stress than fathers.

Traditional gender roles likely come into play here, with mothers taking on many of the chores and shopping tasks of the season, Clark said.

"Other members of the family might say, 'Who cares if we do holiday cards this year?' But if it's important to the mother, that will get put on her plate and be more stressful to her," she said.

Mothers are more likely to find stress relief when other family members pitch in to help compared to fathers, the poll found. However, it can be difficult for some mothers to accept help because they have a specific vision of how the holidays should go, Clark said.

The key is to accept the help for what it is and let go of some of the expectations, she said.

Fathers, on the other hand, are more likely to throw themselves into work to handle the stress, according to the poll.

"This choice certainly protects men from the many stressors that the holidays can bring, but far too often, they often miss some of the joy of those tasks," Duffy said.

Practicing good mental hygiene

The holidays are a great opportunity that is often overlooked for how to set an example of practicing positive mental health, Clark said.

When parents are feeling stressed, they should articulate it to their children and talk about the action they are going to take to destress, she said.

"It could be, 'We are not going to go to the neighborhood holiday event this year because everybody feels tired. We're just going to get in our pajamas early and stay home and eat popcorn and watch a movie,'" Clark said.

Duffy recommended parents take frequent breaks to watch an episode of their favorite television show, go for a walk or step aside and take a moment to breathe. To avoid holiday burnout, he also suggested parents take a day or two off work to rest and rejuvenate if possible.

Parents should also be aware of how certain holiday activities can trigger their stress because it is likely to affect the entire family unit, Duffy said.

His family often gets invited to many holiday events, but he said he would prefer to go to one or two. To feel energized for the evening holiday activities, he said he takes extra time for himself on those days so he can be fully present.

Keeping a routine

With school out of session for the break, the poll found many parents relax household rules. Around 20% of parents said they relaxed screen time rules, and 19% said they were less strict on bedtimes.

"There's a famous Christmas song that says, 'Mom and Dad can hardly wait for school to start again,' so I think parents need to be realistic that school is the natural scheduler for a lot of families," Clark said.

In lieu of a school schedule, Clark recommended parents create a schedule that prioritizes children getting enough sleep and good nutrition.

With regular sleep, children are less likely to be cranky and have an emotional outburst, which may negatively affect the entire family, Duffy said.

Diane Foxen is a NICU nurse in Silicon Valley, and lately, she has been feeling the added stress of taking care of premature and sick babies during COVID-19 challenges.

When Foxen gets home, it’s more of the same. She’s a foster mom for the Humane Society Silicon Valley. When the pandemic hit, the humane society thought for sure she wouldn’t have time to foster.

“I didn’t have any at the time, and I was like, ‘Where are my kittens? I need kittens. It’s kitten season. I need something to destress,” Foxen said.

Foxen ended up taking on five kittens. She says caring for the sick kittens helps her destress.

Mutual Rescue, a nonprofit that supports animal rescue groups and shelters across the country, is looking for more stories like Foxen’s.

The rescue group has been telling short stories of how shelter animals have helped people facing obesity, suicide, addiction and PTSD.

“In 2010, my doctor told me to buy a funeral plot because I would need one in the next five years, but I’m still here, because a shelter dog saved my life,” said Carol Novello, the group’s founder.

Now, Novello wants to share stories of how rescue animals have been helping people during the pandemic.

“As the folks that are on the true front lines taking care of patients watching them die, coding them, they're going to need someone or something to talk to when they're finished,” Foxen said.

Mutual Rescue wants people to submit short videos of how their pets have helped them during the coronavirus pandemic. You can email them to

hello@mutualrescue.org

.

Submitters could be contacted about being part of a new docuseries the group is working on. The nonprofit is accepting videos until Monday.

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.

People have been living in a storm of stress during the ongoing pandemic and political turmoil, which has had a negative impact on our well-being.

A little bit of stress is good, and essential for survival, but severe or prolonged stress can increase the risk for stress-related diseases, including cardiovascular disease, diabetes, depression, Alzheimer's disease, cancer and others.

Chronic stress is thought to contribute to excess inflammation throughout the body that plays a critical role in the onset and progression of stress-related disease, along with elevated levels of the hormone cortisol.

"Some concerns with consistently high levels of cortisol include elevated blood glucose levels, weight gain, increased appetite, GI issues, hypertension, and suppression of the immune system," explained Felicia Porrazza, a Philadelphia-based registered dietitian who helps stressed-out clients find natural ways to improve their overall wellness.

Dr. Caroline Messer, a New York City-based endocrinologist, always talks to her patients about managing stress. "It's unbelievably important for their sense of wellbeing," she said.

"Often when patients come in with hair loss, fatigue and insomnia, they assume there's a direct hormonal underpinning, but these symptoms can actually be stress-mediated with a secondary increase in cortisol levels," Messer said.

Here's how to start making healthy changes to reduce your stress levels.

Try meditating

Meditation practice leads to decreased physiological markers of stress in a range of populations, according to a 2017 systematic review and meta-analysis of 45 studies. Specifically, meditation can help to lower cortisol levels, blood pressure and heart rate.

A consistent meditation practice also helps us better respond to stressful situations, according to Ellie Burrows Gluck, a Vedic meditation teacher and the co-founder and CEO of MNDFL, a meditation studio in New York City that also offers live-streamed, at-home practices with meditation experts at MNDFL TV.

To meditate, simply bring your full attention to your breath, inhaling and exhaling through the nose. When your mind starts to wander, come back to your breath without judgment.

If you would like some support for your meditation practice, a guided meditation app can help you get started. Martha McKittrick, a New York City-based registered dietitian who provides nutrition counseling and wellness coaching to many stressed-out clients, likes Headspace, Calm, Insight Timer and Buddhify.

Find a hobby you enjoy

That can mean practicing an instrument, painting, cooking or playing with your children.

"I think anything that takes you away from day-to-day concerns is helpful for lowering stress levels," Messer said.

"The key is to focus on what you are doing to block out the rest of what is going on. I play classical piano, and I love to bake with my kids ... and (when I engage in these activities), I forget about the pandemic and work stressors."

Schedule daily movement or exercise breaks

Engaging in regular physical activity is a great way to help manage stress and strengthen your immune system, too.

Aerobic exercise, which increases heart rate and the body's use of oxygen, boosts levels of endorphins, which work directly on opiate receptors in your brain to reduce pain and boost pleasure, Messer explained. Exercise also reduces levels of the body's stress hormones, specifically adrenaline and cortisol, explained MaryAnn Browning, founder and CEO of Brownings Fitness in a previous CNN interview.

Messer advises patients to engage in aerobic exercise for 30 minutes, three times per week. "Aerobic exercise allows the muscle and liver to remove glucose from the bloodstream, increases metabolism, and can improve sleep patterns."

Try riding on a stationary bike or simply taking a brisk walk. "As long as you are pushing yourself," Messer said. And if you don't want to go outside, you can just walk around in circles in your apartment while you talk to people, according to Browning, who added that she is able to get up to 23,000 steps in a day by walking and conversing at the same time.

Boost intake of stress-reducing foods

Foods like salmon, trout, mackerel, anchovies, sardines and herring are a rich source of stress-busting omega-3 fatty acids known as DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid).

Vitamin C-rich foods, like red and green peppers, oranges, grapefruit and kiwi, may be helpful in lowering psychological stress and blood pressure, according to one study.

And fermented foods like yogurt, kombucha, kefir, tempeh and sauerkraut contain friendly bacteria known as probiotics, which have the ability to reduce stress and cortisol levels.

Avoid strict dieting

Limiting calories to very low levels has been shown to increase cortisol levels.

"If you are cutting back on calories too much in attempts to lose your 'pandemic weight,' you may actually be doing your body harm," McKittrick said.

Eating enough carbohydrates is important, too, since they prompt the brain to make serotonin, a neurotransmitter that has a calming effect in the body, according to McKittrick. On the flip side, diets that are very low in carbs can boost cortisol levels, she explained.

It's also important to avoid long stretches without food. Doing so can cause drops in blood sugar, which can cause irritability and worsen stress, according to McKittrick. Try to eat something every four hours or so.

Cut back on caffeine

High amounts of caffeine can boost cortisol levels and intensify the effects of stress on the body, McKittrick explained. It's important to pay attention to how your body reacts to caffeine; you might need to cut back or try herbal tea instead if you are feeling stressed.

Improve sleep hygiene

Sleep deprivation can contribute to higher stress levels, and stress can also contribute to poor sleep quality, ultimately compounding stress.

Aiming for seven to nine hours of sleep is key, as it helps to decrease cortisol and your adrenal load.

If you have trouble getting that amount of sleep, taking two naps that are no longer than 30 minutes each — one in the morning and one in the afternoon — has been shown to help decrease stress and offset the negative effects that sleep deprivation has on the immune system.

If you find you need additional support, meeting with a sleep psychologist can help in establishing healthy sleep/wake cycles, Messer said.

Try yoga

Research has shown that yoga can help in reducing cortisol levels and blood pressure.

Engaging in a regular yoga practice has helped me to reduce my stress levels. My girls and I love the YouTube channel Yoga with Adriene and have made it part of our bedtime routine!

Consider acupuncture

"I recommend acupuncture to my patients when other avenues have failed ... and a lot of patients swear by it," Messer said. Feeling calmer and sleeping better are some of the touted benefits, she explained.

Enjoy nature

Getting outside and spending some time in nature can help relieve stress, improve your mood and boost feelings of happiness and well-being, according to the American Heart Association.

Research has revealed numerous health benefits from being in nature, McKittrick explained. Being near green spaces in particular has been associated with reduced stress, and is associated with reduced symptoms of anxiety and depression.

Listen to music

Playing your favorite tunes can also reduce stress levels, according to McKittrick. Upbeat music may be helpful as a mood booster, while slower music can help to quiet your mind, relax your muscles and release stress.

Seek support and connection

Being isolated can cause an increase in cortisol levels, Messer explained. "Humans are meant to be social, it's through our social connections that we keep our stress levels down," she said.

If you can't be with a friend or loved one in person, a phone call or Zoom meeting can help you stay connected.

Now that you have these tips, let's get started. Pick one stress-busting strategy to start with this week, and then add another one the following week. Put reminders on your calendar so you will have your own personalized week-by-week plan for combatting stress.

Building on these behaviors will boost your confidence and empower you to continue creating a lifestyle with lower levels of stress and improved health and wellness. That's a silver lining while surviving a storm of stress, isn't it?!

HAMILTON COUNTY, Ohio —

Rising COVID cases driven by the delta variant are already putting pressure on hospitals as some hit capacity over the weekend.

“We’re seeing, not only our cases rise, we’re seeing our hospitalizations rise as well as intensive care admissions within the region,” said Hamilton County health commissioner Greg Kesterman.

Kesterman said in three weeks, Hamilton County COVID cases went from averaging about 13 a day to averaging 71 a day.

Regional numbers from the Health Collaborative show hospitalizations have jumped in one month from about 40 to more than 130. Now, 40 is the number of people on ventilators in the Southwest Ohio region.

The numbers are lower than they were at the peak of the pandemic, but hospitals are already under stress.

“Over the weekend, a couple of our hospitals hit capacity,” Kesterman said.

“We have a very different starting point going into this surge. It will take less cases to put a strain on the hospitals,” said vice president of clinical strategies for the Health Collaborative Tiffany Mattingly.

Mattingly said last year hospitals stopped elective procedures and other wellness efforts to make space for the oncoming surge. All of those procedures have returned.

“We are definitely at a different stress point than we were last fall,” Mattingly said.

Kesterman said the hospital system has room for more patients, but at any given time, a hospital could hit capacity. If COVID cases continue to rise, expect hospitals to reexamine those elective procedures again.

“I think the hospitals are going to have to evaluate all of those modes of decompression to make sure we have room for all patients who need care,” Mattingly said.

The pandemic year that will go down in history set records for stress, worry, anger and sadness among both men and women worldwide, according to a new planetary survey of emotions in 2020.

Stress levels rose the most, with a "record-high 40% of adults worldwide" saying they experienced stress "a lot of the previous day," according to Gallup's 2021 Global Emotions Index. That was the highest level in the 15 years, the report said.

Globally, women with young children at home bore the brunt of the stress, worry, anger and sadness that people experienced during the pandemic of 2020.

Stress increased in half of the 116 countries surveyed, with "double-digit increases in stress in 21 countries," the report said. That means almost 190 million more people worldwide experienced significant stress last year than in years past.

Sickness and death from COVID-19 was obviously a huge part of the stress and negative emotions, as was the economic impact of the pandemic, the survey found.

"Half of those working at the time of the pandemic said they earned less money because of COVID-19, and 32% of people said they lost their job," Jon Clifton, Gallup's global managing partner, wrote in his opening statement on the survey.

"In all, 80% of people said COVID-19 affected them in some way."

Not every country experienced stress during 2020, the report noted. It ranged from a high of 66% in Peru, "which represents a new high for the country," to a "low of 13% in Kyrgyzstan, where stress levels have historically been low and stayed low in 2020," the report said.

A negative trend continues

For 15 consecutive years, polling giant Gallup has asked people around the world about their positive and negative emotions. For this report, Gallup surveyed nationally representative samples of 160,000 people from 116 countries during 2020 and early 2021.

Just as it did in 2019, Iraq led the world on the negative experience index in 2020. Gallup found 56% of Iraqis said they experienced pain, 51% reported anger and 50% reported sadness.

Taiwan scored lowest on the negative emotion index, the same ranking it attained in 2019.

Globally, the increase in negative emotions actually began 10 years ago, the report said. One key reason is political and economic upheaval. Partly for those reasons, people in Lebanon and Turkey reported few positive experiences in the survey.

"The majority of Lebanese people have not experienced enjoyment in their daily lives since 2018, and for Turks, this has been true since 2017," the report said.

Besides political and economic turmoil, another reason for negativity in many nations was a growing belief that both governments and businesses are corrupt.

"Majorities of people believe corruption is widespread in the governments of 79 out of 101 countries and areas in the world, and a majority in 85 out of 110 countries think this is true of businesses," Clifton wrote in his introductory remarks.

Income inequality is another factor in how people view their lives, Clifton continued: "Many countries that report high income inequality also happen to be the countries that report a lot of negative emotions, such as anger."

Resilience still prevailed

While negative emotions rose, many people in the world showed surprising resilience, the survey found. For their positive emotion index, the polling group asked questions about feeling respected and well-rested, doing interesting or enjoyable activities, and smiling and laughing.

Results showed that globally, humankind managed to remain stable in positive emotions despite the negative impact of the pandemic — with the exception of laughing and smiling.

"In the span of a year, the percentage of people who said they smiled or laughed a lot the previous day dropped from 75% to 70%, which is also the lowest measure Gallup has ever recorded for this question," the report said.

El Salvador led the world in positivity, with an index score of 82. Latin American countries have traditionally dominated the positive index, and Nicaragua, Paraguay and Colombia also had high scores. Three Nordic countries, Iceland, Norway and Finland — who are traditionally in the top 10 on rankings of national happiness — also had high scores.

The United States did not rank in the top 10 in positivity. But Gallup interviews done for the survey in early 2021, around the time vaccines were being approved, found people's ratings of their lives rebounded and hit "new all-time highs," the report said.

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."

The United States is home to a number of beautiful public green spaces (think: Longwood Gardens or the Chicago Botanic Gardens), but none of them compare to the Netherlands's Keukenhof.Located in Lisse, Keukenhof is home to seven million flowers each year. It's the second-largest flower garden in the world behind the Dubai Miracle Garden. According to its website, Keukenhof is specifically a "spring park." For eight weeks each year, it invites flower enthusiasts from all over the world to admire its seasonal blooms, which are all planted by local companies. This annual event gives each company a chance to display its living catalog to the public, but it also takes millions of dollars and year-round labor to prepare for.As Insider reports, gardeners must map out their design and select which particular flowers to feature in their display — which can take months to finalize. Next, they must order the bulbs and hand plant all of the seeds ahead of Keukenhof's opening, a feat that usually takes gardeners about three months. Before planting, they must also spend time ripping out the bulbs from the year prior. The majority of the flowers are, of course, tulips. For this year's show, 800 different types were hand-selected by quality and color. Because tulips have a life span of around a week and a half, gardeners use a special technique in which they stagger early- and late-blooming bulbs to make sure tulips continue to flower throughout Keukenhof's eight-week season. Last year, Keukenhof was closed for the first time since its opening in 1950 due to COVID-19. This year, Keukenhof decided to take a risk and gear up to re-open for its spring flower exhibition, but due to public health guidelines, the garden's opening has been postponed until further notice.That said, we simply can't let seven million beautiful flowers go unnoticed! Keukenhof has created a virtual tour of its gardens, so you can enjoy its beauty no matter where you are.The "Keukenhof Spring Series" is a six-part series that showcases the garden's diverse and colorful blooms. The best part: It's available to watch on Youtube free of charge. So sit back, enjoy the show, and start planning for next year's in-person visit.Part 1PGlmcmFtZSB3aWR0aD0iMTAwJSIgaGVpZ2h0PSI4MDBweCIgc3JjPSJodHRwczovL3d3dy55b3V0dWJlLmNvbS9lbWJlZC9GdFNXYlVTbExjWSIgdGl0bGU9IllvdVR1YmUgdmlkZW8gcGxheWVyIiBmcmFtZWJvcmRlcj0iMCIgYWxsb3c9ImFjY2VsZXJvbWV0ZXI7IGF1dG9wbGF5OyBjbGlwYm9hcmQtd3JpdGU7IGVuY3J5cHRlZC1tZWRpYTsgZ3lyb3Njb3BlOyBwaWN0dXJlLWluLXBpY3R1cmUiIGFsbG93ZnVsbHNjcmVlbj48L2lmcmFtZT4=Part 2PGlmcmFtZSB3aWR0aD0iMTAwJSIgaGVpZ2h0PSI4MDBweCIgc3JjPSJodHRwczovL3d3dy55b3V0dWJlLmNvbS9lbWJlZC83RDdrczVtTUlNcyIgdGl0bGU9IllvdVR1YmUgdmlkZW8gcGxheWVyIiBmcmFtZWJvcmRlcj0iMCIgYWxsb3c9ImFjY2VsZXJvbWV0ZXI7IGF1dG9wbGF5OyBjbGlwYm9hcmQtd3JpdGU7IGVuY3J5cHRlZC1tZWRpYTsgZ3lyb3Njb3BlOyBwaWN0dXJlLWluLXBpY3R1cmUiIGFsbG93ZnVsbHNjcmVlbj48L2lmcmFtZT4=Part 3PGlmcmFtZSB3aWR0aD0iMTAwJSIgaGVpZ2h0PSI4MDBweCIgc3JjPSJodHRwczovL3d3dy55b3V0dWJlLmNvbS9lbWJlZC9VN2l0b1dZd25OOCIgdGl0bGU9IllvdVR1YmUgdmlkZW8gcGxheWVyIiBmcmFtZWJvcmRlcj0iMCIgYWxsb3c9ImFjY2VsZXJvbWV0ZXI7IGF1dG9wbGF5OyBjbGlwYm9hcmQtd3JpdGU7IGVuY3J5cHRlZC1tZWRpYTsgZ3lyb3Njb3BlOyBwaWN0dXJlLWluLXBpY3R1cmUiIGFsbG93ZnVsbHNjcmVlbj48L2lmcmFtZT4=You can watch the remainder of "Keukenhof Spring Series" here.