MONEY Health Care

5 Ways to Save on the Mental-Health Care You Need

Group therapy can be 50% less expensive than one-on-one sessions.

Get the treatment you need at a price you can handle.

Affordable mental-health care has been easier to come by in recent years. Insurance coverage, once riddled with onerous caps and restrictions, is now more widely available. “Things have gotten better for many,” says Andrew Sperling, director of federal advocacy at the National Alliance on Mental Illness.

Still, paying for care can be a challenge. The high out-of-pocket costs that you’re facing for all your health care extend to behavioral coverage too. And low reimbursement rates and billing hassles have led many therapists to not take insurance. A study published last year in the journal JAMA Psychiatry found that only 55% of psychiatrists accept private insurance; for all other medical specialties, that figure is 89%.

Here’s what you need to know about finding the best treatment at the best price.

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MONEY

Insurance Options are Better

Under a 2008 law that took effect in 2010, health plans offered by large employers that include mental-health coverage must treat it like other medical care. So a plan can’t cap annual visits or impose prior authorization rules for behavioral health if it doesn’t do the same for other illnesses, says Jennifer Mathis, director of programs at the Bazelon Center for Mental Health Law. Co-insurance rates have to be the same too. As the graphic above shows, the parity law hasn’t discouraged employers from offering coverage.

Any individual plan you buy on a state insurance exchange must include mental-health coverage; it’s one of the 10 essential benefits required by Obamacare. The provision in the law that lets children stay on a parent’s health plan until age 26 is another boon, since most major psychiatric conditions show up in late adolescence or early adulthood, notes Debbie Plotnick, senior director of state policy at the nonprofit Mental Health America.

Medicare coverage is also better. As of 2014, benefici­aries are responsible for only 20% of mental-health costs, down from 50%.

Your Employer Can Often Help

Especially if you have a high-deductible health plan, start with your company’s employee assistance program, says Kathleen Mahieu, leader of behavioral-health consulting at benefits consultancy Aon Hewitt.

About three-quarters of employers offer an EAP. These programs typically provide five or six sessions of no-cost counseling, even for family members. That’s enough for some people to resolve their issues, says Katherine Nordal, the American Psychological Association’s executive director for professional practice. An EAP can help you find a provider or connect you with other mental-health resources. “It’s a one-stop shop,” says Mahieu. And, she adds, EAPs pride themselves on confidentiality. Your boss won’t know, and you don’t even have to give your name.

Your Bill is Negotiable

When your therapist isn’t in your insurance network, you’ll have to pay upfront and submit the bills for partial payment (assuming you have out-of-network coverage) or, if you’re in an HMO, pay in full. Even if you are reimbursed, you won’t get back, say, 70% of the bill. You’ll get 70% of what the insurer considers “reasonable and customary,” leaving you on the hook for the rest.

If you can’t find an appropriate provider in your plan, ask your insurer to negotiate what’s known as a single-case agreement with someone who’s not in your network, says Barbara Griswold, a licensed marriage and family therapist in San Jose. That would let you to pay the in-network rate.

You can also ask about a reduced fee, says Griswold. “Almost every therapist has a sliding scale,” she says. Be realistic about what you’ll be able to afford and how long you’re likely to want therapy.

You Have Other Ways to Save

A university with a graduate psychology program may have a clinic, says the APA’s Nordal. Care is provided by doctoral trainees who are supervised by licensed psychologists. In an urban area, you may be able to find postgraduate training programs in psychoanalysis or cognitive behavioral therapy for experienced psychologists, says Geoffrey Steinberg, a licensed psychologist in New York City. (Google “training clinic” and the specialty you’re looking for.)

Another option: Ask your therapist if your condition might benefit from group therapy led by an experienced psychologist, which can be 50% less expensive than one-on-one sessions. Says Steinberg, “Group is so underrated and can be so valuable.”

Know Which Treatment Is Best for You

“No single therapy works for everybody,” says Renée Binder of the University of California at San Francisco’s School of Medicine. Consider these approaches for five common conditions.

1. Mild to moderate depression: Go for cognitive behavioral therapy (CBT). “A therapist works with you to break negative thought patterns by teaching specific skills,” says Binder. You might learn, for example, to ID overly critical self-talk (“Everything I do gets screwed up”) and reframe it in a positive way (“I flubbed a presentation, but I know I can rock it next time.”)

2. Severe depression: Combining antidepressants with CBT is better than meds alone, a recent Vanderbilt University study found. You need to see an MD or a psychiatric mental-health nurse practitioner for the prescription, but you can get therapy from a social worker or a psychologist.

3. Social anxiety: Your best bet is either CBT or psycho­dynamic therapy (in which you explore how your past experiences and unconscious affect you). In a study published in July in the American Journal of Psychiatry, these methods were equally effective at easing social anxiety.

4. Panic attacks: CBT is usually the treatment of choice. Some research suggests psychodynamic therapy may also work: A Weill Cornell Medical College study found that 12 weeks of biweekly sessions significantly reduced symptoms in more than 70% of patients. Medications may also be used.

5. Trauma: Look for a therapist who offers trauma-focused CBT or EMDR, which stands for eye movement desensitization and reprocessing (you’re asked to recollect the event while doing a motor task such as side-to-side eye movements). “Antidepressants and anti-anxiety meds are helpful in the short term, but therapy works to change thought patterns long term,” says Binder.

 

TIME Mental Health/Psychology

Here’s How to Make Waiting A Little Less Excruciating

clock
Getty Images

Some people are better at waiting than others, and there’s a reason for that

We’ve all been there—whether it’s a job interview or an exam or a medical test, once it’s over, there’s nothing we can do but worry and wait.

Some people are better than others at weathering these periods, able to go about their normal lives while only occasionally dwelling on what might happen. The rest of us are nearly paralyzed by the uncertainty, riding waves of hope and despair as we ruminate over every possible outcome.

Kate Sweeny, an associate professor of psychology at University of California Riverside, has made a career out of studying these differences in waiting behaviors. And she’s identified the personality traits that may make distinguish those who are better and worse at waiting—some of which, thankfully, may be adaptable.

In Sweeny’s latest study, published in the Journal of Personality and Social Psychology, she and a colleague studied 50 law school graduates who were waiting for the results of the California bar exam in 2011. The lawyers filled out detailed personality questionnaires that revealed how well they managed uncertainty, whether they were more optimistic or pessimistic, and their self-esteem. She and her colleague also explored how well the lawyers managed their emotions and expectations, and the coping mechanisms they tended to use when they were anxious, among other things.

Not surprisingly, they found that having an optimistic outlook and being more comfortable with uncertainty helped people handle waiting periods better. But they also found that self-esteem did not seem to have much effect on tempering anxiety during the waiting period. In other words, it didn’t matter whether the participants had reported having high self-esteem or not; what mattered more was whether they tended to have a positive outlook and expect the best.

“I was surprised, since plenty of other research suggested that high self-esteem should help people get through difficult periods when their ego is threatened,” says Sweeny.

It also turned out that people’s states during the waiting period were dynamic, changing depending on how close they were to finding out the outcome. At the beginning of the wait, it was harder for all of the participants to distract themselves from thinking about the possible outcomes, and all of them—even the optimists—became more pessimistic or entertained more negative thoughts about the result as they got closer to the moment of truth.

Sweeny and her colleague also learned some interesting things about the coping mechanisms that people use to get through the uncertainty and anxiety of waiting. While distracting yourself with other unrelated tasks or thoughts was a common tactic, it didn’t prove very successful, especially if the participants were trying very hard to consciously distract themselves. “The fact that they are trying so hard to not feel so anxious actually backfires, because it anything it keeps the uncertainty in mind,” she says.

Anticipating bad news and trying to find the positive in it—preparing ahead of time for failure, in other words—may not help to ease the anxiety during the waiting period, but can be helpful once the result comes, since it gives people a sense of control over their future.

And the same is true for distancing your sense of self worth from the outcome. The more space you put between the result and your sense of self, the easier the final outcome may be. “If you convince yourself the bar exam is not that important, and that it’s just a silly exam you have to take and doesn’t reflect on your or your abilities, that space might help you not have a crushing blow to your ego if the news is bad,” she says.

But for all the worriers out there who can’t distract themselves from the anguish of “what if”’ while waiting, there’s also some solace. The study found that those who had a harder time during the waiting period fared better emotionally after the result, regardless of whether it was bad or good. The participants in the study who had more anxiety and frustration while waiting for their bar exam results and ended up failing, for example, were more likely to turn around and start studying for the test again compared to those who didn’t worry as much about the outcome. And if they passed, the relief was sweeter. “There’s a relief when the waiting is over and things turned out well, and you don’t feel as bad if you get bad news,” says Sweeny. “Either way, it’s a little less of a harsh blow if you had a tough waiting period.”

Still, to make that period less painful, she’s currently studying the effects of mindfulness meditation to help those who can’t stop obsessing over the outcome while they wait. The technique, she says, is perfectly designed for managing such waits, since it focuses on helping people to accept their negative emotions but not be driven by them. So while waiting will never be easy, some things in your control, at least, may make it more bearable.

Read next: 5 Signs You Should Take a Break From Social Media

TIME psychology

How to Deal With Anxiety, Tragedy or Heartache — 4 Steps From Research

writing
Getty Images

“You don’t remember me, but I was in your experiment a year ago. I just wanted to thank you. It changed my life.”

James Pennebaker has had a number of people say this to him over the years.

In the early 80’s he came across a study showing that people who experienced personal traumas but didn’t discuss them were more likely to get sick.

He wondered if just writing about their emotional upheavals could help people recover. And the research he did changed lives.

In the 30 years since, hundreds of studies have documented the effectiveness of expressive writing.

It helped with anxiety, tragedy, heartache… It even gave relief to those coping with cancer, heart disease, chronic pain, and AIDS.

People who write about their problems gain a host of benefits including feeling happier, sleeping better, and even getting better grades.

Via Expressive Writing: Words That Heal:

Across multiple studies, people who engage in expressive writing report feeling happier and less negative than they felt before writing. Similarly, reports of depressive symptoms, rumination, and general anxiety tend to drop in the weeks and months after writing about emotional upheavals (Lepore 1997). Other studies found improvement in overall well-being and improved cognitive functioning (Barclay & Skarlicki 2009).

I wanted to learn more, so I gave the man himself a call.

Jamie Pennebaker is a professor at the University of Texas at Austin and the author of a number of books including:

Expressive Writing: Words That Heal

The Secret Life of Pronouns: What Our Words Say About Us

In this post you’ll learn how writing can help you overcome emotional hardships and the best way to use it to help you get past tough times.

Let’s get started.

Can Just 20 Minutes of Writing Change Your Life?

Bottling up your problems is stressful. People who keep their struggles a secret go to the doctor 40% more often than those who don’t.

Via Expressive Writing: Words That Heal:

…among those who had traumas, those who kept their traumas secret went to physicians almost forty percent more often than those who openly talked about their traumas (Pennebaker & Susman 1988). Later research projects from multiple labs confirmed these results. Adults whose spouses had committed suicide or died suddenly in car accidents were healthier in the year following the death if they talked about the trauma than if they didn’t talk about it… Not talking about important issues in your life poses a significant health risk.

Some of us talk to friends or see a therapist when life gets hard. But not everyone.

It’s risky. Talking about your problems can mean feeling judged. You’re putting yourself on the line when you’re most vulnerable.

But writing lets you get many of the benefits of talking about your problems without the risk.

Here’s Jamie:

…in an ideal world, it works very similar to talking to a friend. The killer problem is when you talk to a friend or even a therapist, you’re putting yourself on the line. For it to work that other person has to be completely accepting, and the reality is we don’t tell our friends a lot of really deep and personal things because we think it might hurt the relationship. That’s the beauty of writing. You don’t have to worry about other people looking down on you or feeling nervous about putting yourself out there.

But what is it about writing that calms the mind and helps us heal emotionally?

There are no solid answers but there’s plenty of research showing the human mind needs meaning — a story to make sense of what has happened.

Only then can it rest. Writing forces you to organize your thoughts into a coherent structure. It helps you make sense of life.

Here’s Jamie:

One thing is that writing helps to organize our experiences…What we find is that people who benefit tend to increase their use of words to suggest thinking. They’re using certain cognitive words. These include causal words like “because,” “cause and effect.” They include insight words: “understand,” “realize” “no” and so forth.

Not only do people who use expressive writing feel better afterward, but that relief has real world benefits.

Those who wrote about the stress of being laid off were more likely to find jobs.

Via Expressive Writing: Words That Heal:

Eight months after writing, fifty-two percent of the emotional writing group had new jobs compared with only twenty percent of the time management participants. The two groups went on the same number of interviews. The only difference was that the expressive writers were offered jobs (Spera, Buhrfeind, & Pennebaker 1994).

(For more on how to overcome regret, click here.)

So writing helps us open up when it doesn’t feel like there’s anyone we can talk to. And it makes sense of the things that shake up our lives.

So what’s the best way to actually do it? There are 4 steps:

1) Ask “How Long Has It Been?”

If you’re upset in the days immediately after a breakup or the death of a loved one, that’s natural.

But when you’re still feeling distressed months later, that’s when you need help and writing can really make a difference.

2) Commit To 20 Minutes For Four Days

Commit to writing about what’s bothering you for 20 minutes on four consecutive days.

This is what the bulk of the research shows provides the best benefits. You can do more if you want; this is a minimum.

Via Expressive Writing: Words That Heal:

What if you want to keep writing after twenty minutes ? Then keep writing. The twenty-minute rule is an arbitrary minimum. That is, plan to write for at least twenty minutes each day with the understanding that you can write more, but you shouldn’t write less… What if you find that you enjoy writing and want to continue past four days? Do it. Many people find that once they begin writing, they realize they have many issues to think about. Write for as many days as you need — just think of the four days as a minimum.

When’s the best time to do it? End of the workday seems to be a good time for many people.

Via Expressive Writing: Words That Heal:

Across multiple studies, we have had the most success with people writing at the end of their workday. If you have children and need to feed them, then after they have gone to bed might be a good time. The operative rule, however, is for you to have some free time after writing to let your mind reflect on what you have written.

(To learn more about what the words you use say about you, click here.)

Got it on your calendar? Good. Here’s what to do.

3) Write Write Write

Just write about what’s bothering you for 20 minutes straight.

Don’t worry about grammar or spelling. Don’t worry about what anyone might think. You can delete it or throw it out when you’re done writing.

Just write about what’s troubling you and don’t hold back.

Here’s Jamie:

Find a place you won’t get disturbed, and I want you to sit down and just begin writing about the thing that’s bothering you. Don’t worry about grammar or sentence structure or spelling. Just write. This is for you and for you alone. Plan to tear up what you’ve done when you finish. It’s not a letter to somebody. It’s not something for you to show someone to convince them that you are right. This is for you alone.

Longhand or typing doesn’t matter. Research even shows talking into a voice recorder works too.

Here’s Jamie:

You can write about the same event on each of the four days or you can write about different events. All that is entirely up to you. Just explore your very deepest thoughts and fears. That’s the basic idea.

(To learn about all the other issues writing can help you with, click here.)

In general, just doing the writing for 20 minutes for four days is enough to provide people with noticeable relief. But let’s go for bonus points.

There are a number of things Jamie has seen that correlate with better results.

4) Stuff That Can Help The Process

When writing, it’s helpful to tie the issue into other areas of your life. How does the problem relate to your work? Your family? Your relationships?

Here’s Jamie:

Let’s say you’re having problems because of a failed love. You may find once you begin writing that it’s related to other topics. You might tie this event to other areas in your life. Your childhood, your relationship with your parents, your relationship with other people… You might tie it to work, you might even link it to who you want to be in the future, who you’ve been in the past and who you are now.

People tend to benefit most from expressive writing if they openly acknowledge emotions.

Via Expressive Writing: Words That Heal:

Emotional experience is part of a trauma. The ability to feel and label both the negative and the positive feelings that occurred during and following the trauma is important.

Constructing a story is powerful.

Via Expressive Writing: Words That Heal:

Creating a narrative, including a coherent beginning, middle, and end, is a well-documented part of trauma treatment and holds much promise for benefits from writing about trauma.

Switch perspectives. Those who benefit the most can see the event through other people’s eyes.

Via Expressive Writing: Words That Heal:

People who have experienced a trauma initially see it from one perspective — their own. Indeed, when individuals first write about a massive upheaval, they first describe what they saw, felt, and experienced. Recent studies indicate that people who benefit the most from writing have been able to see events through others’ eyes.

You’re not writing an accident report for an insurance company. Don’t be distant. Make your writing personal.

Via Expressive Writing: Words That Heal:

A guiding principle of expressive writing is that you express yourself openly and honestly. People who write in a cold, detached manner and who quote Shakespeare, Aristotle, or Henry Ford may be fine historians and may even write a great editorial in the local newspaper. But impressive writing is not the point of expressive writing. People who benefit the most from writing are able to find a voice that reflects who they are.

(To learn more about how to improve your writing skills in general, click here.)

Let’s round up the info and see what Jamie recommends about how to best fit this into our lives.

Sum Up

Here’s how to use writing to overcome the things that upset you:

  1. Has enough time passed? Are you suffering longer than you should? Then writing can help.
  2. Commit to four days of 20 minutes a day. Most people write at the end of their workday.
  3. Write nonstop for 20 minutes about what’s bothering you.Don’t worry about errors or what anyone might think. This is for you.
  4. Tying in other areas of your life, acknowledging emotions, telling a story, switching perspectives and making it personal are all associated with better recovery.

You don’t need to wait until you’re getting divorced or somebody dies to use this. You can write whenever you think it might help. It’s literary ibuprofen.

Via Expressive Writing: Words That Heal:

Think of expressive writing as a tool always be at your disposal, or like having medicine in your medicine cabinet. No need to take the medicine when you are healthy, but when you are under the weather, you can always turn to it.

The science and the numbers are great but I have one more thing to add: I’ve used this myself.

A few months ago someone I cared about deeply betrayed my trust. No apology afterward. No concern for my feelings.

It made it hard for me to trust anyone afterward. I was second-guessing the motives of everyone in my life.

After writing for just 20 minutes it felt like a weight had been lifted off my shoulders. The rage stopped surging up. The rumination died down.

Chaos in your life doesn’t need to mean chaos in your head.

Okay, this blog post is over, folks. So maybe now’s the time to stop reading and start writing.

This piece originally appeared on Barking Up the Wrong Tree.

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MONEY Health Care

The 7 Biggest Health Problems Americans Face—And Who is Profiting

Bottles of prescription medicine in cabinet
Kim Karpeles—Getty Images/age fotostock

Here are the most-prescribed drugs in America.

Americans include two health-related issues among the 10 most important problems facing the U.S., according to a recent Gallup survey. Healthcare in general ranked fourth on the list, with Ebola coming in at no. 8. But is Ebola really among the biggest health problems for Americans? Not when we look at the chances of actually being infected.

So, what are the actual biggest health problems that Americans face? One way to answer this question is to look at what drugs are prescribed the most. Here are the seven top health problems based on the most-prescribed drugs in the U.S., according to Medscape’s analysis of data provided by IMS Health.

1. Hypothyroidism

AbbVie’s ABBVIE INC. ABBV -0.3092% Synthroid ranks at the top of the list of most-prescribed drugs. Synthroid is used to treat hypothyroidism, a condition caused by an underactive thyroid gland.

The American Thyroid Association estimates that 2%-3% of Americans have pronounced hypothyroidism, while 10%-15% have a mild version of the disease. Hypothyroidism occurs more frequently in women, especially women over age 60. Around half of Americans with the condition don’t realize that they have hypothyroidism.

2. High cholesterol and high triglycerides

Coming in at a close second on the list is AstraZeneca’s ASTRAZENECA PLC AZN -0.5824% Crestor. The drug is used to help control high cholesterol and high triglyceride levels.

According to the American Heart Association, nearly 99 million Americans age 20 and over have high cholesterol. Elevated cholesterol levels are one of the major risk factors for heart attacks and strokes. The problem is that you won’t know if you have high cholesterol unless you get tested — and around one in three Americans haven’t had their cholesterol levels checked in the last five years.

3. Heartburn and gastroesophageal reflux disease

AstraZeneca also claims the third most prescribed drug in the nation — Nexium. The “purple pill” helps treat hearburn and gastroesophageal reflux disease, or GERD, also commonly referred to as acid reflux.

Around 20% of Americans have GERD, according to the American Society for Gastrointestinal Endoscopy. A lot of people take over-the-counter medications, but that’s not enough for many others. Medscape reported that over 18.6 million prescriptions of Nexium were filled between July 2013 and June 2014.

4. Breathing disorders

The next two highly prescribed drugs treat breathing disorders. GlaxoSmithKline’s GLAXOSMITHKLINE PLC GSK 0.1386% Ventolin HFA is used by asthma patients, while the company’s Advair Diskus treats asthma and chronic obstructive pulmonary disease, or COPD.

More than 25 million Americans have asthma. Around 7 million of these patients are children. Meanwhile, COPD, which includes chronic bronchitis and emphysema, ranks as the third-leading cause of death in the U.S.

5. High blood pressure

Novartis NOVARTIS AG NVS 0.0423% claims the next top-prescribed drug with Diovan. The drug treats high blood pressure by relaxing and widening blood vessels, thereby allowing blood to flow more readily.

Around one-third of American adults have high blood pressure. Many don’t know that they are affected, because the condition doesn’t usually manifest symptoms for a long time. However, high blood pressure can eventually lead to other serious health issues, including heart and kidney problems.

6. Diabetes

Several highly prescribed drugs combat diabetes, with Sanofi’s SANOFI S.A. SNY -0.8972% Lantus Solostar taking the top spot for the condition. Lantus Solostar is a long-acting basal insulin that is used for type 1 and type 2 diabetes mellitus.

According to the National Diabetes Statistics Report released in June 2014, 29.1 million Americans had diabetes in 2012. That’s a big jump from just two years earlier, when 25.8 million Americans had the disease. Diabetes ranks as the seventh leading cause of death in the U.S.

7. Depression and anxiety

Eli Lilly’s ELI LILLY & CO. LLY -0.069% Cymbalta fell just below Lantus Solostar in number of prescriptions. Cymbalta is the leading treatment for depression and generalized anxiety disorder.

The Anxiety and Depression Association of America estimates that 14.8 million Americans ages 18 and older suffer from a major depressive disorder each year. Around 3.3 million have persistent depressive disorder, a form of depression that lasts for two or more years. Generalized anxiety disorder affects around 6.8 million adults in the U.S.

Common thread for common diseases

One thing that stands out about several of these common diseases affecting millions of Americans is that many people have one or more of these conditions — but don’t know it. This underscores the importance of getting a checkup on a regular basis.

Regardless of what the Gallup survey found, the odds of you getting Ebola are very low. On the other hand, the chances of you or someone in your family already having one of these seven conditions could be higher than you might think. Perhaps the truly biggest healthcare challenge facing Americans is knowing the status of their own health.

TIME ebola

How to Talk to Your Kids About Ebola

Electron micrograph of Ebola virus
NIAID/EPA

Here's the best way to calm kids' fear and anxiety over Ebola

Even Centers for Disease Control and Prevention director Dr. Tom Frieden admits it: “Ebola is scary.” But for kids seeing alarming headlines without understanding the context of the disease, Ebola can seem like a looming and personal threat.

TIME spoke to Dawn Huebner, a clinical child psychologist and author of the book What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety about the best way to talk about Ebola with your kids—without scaring them silly.

What should I say to my child who is really scared about Ebola?
Let them know that it’s important to think about proximity—how close they themselves are to the virus. Which is to say: not very. “It’s really important to underline that we are safe in the United States, and that people who have contracted Ebola have been in West Africa or were treating patients with Ebola,” says Huebner. “Not only should parents underline how rare Ebola is, and how far away the epidemic is occurring, but also how hard the disease is to contract.” Huebner says parents can tell their older children that direct contact with an infected person’s bodily fluids like vomit or diarrhea is necessary to spread Ebola. “This has been reassuring to the children I see, as they know they are not going to be touching that,” she says.

By ages 7 and up, kids begin to grasp that their worries and fears aren’t always rational. “Parents can talk to kids about how one of the ways worries and anxiety get their power is by making us think about things that are very unlikely,” says Huebner.

Should I keep my child away from the news?
Your kids can watch the news to stay informed, but media overload is not always a good thing. “The news is often sensationalized and gives kids the idea that they are at an imminent risk,” says Huebner. When kids see endless stories about Ebola on the news, they don’t always realize they’re hearing the same thing on loop. “I’ve had kids come into my office who are under the impression that there are hundreds of people in the U.S. with Ebola.”

How do I know if my child is reacting appropriately to the news?
“An appropriate reaction would be to feel nervous and ask some questions, but to be reassured by the parents’ answers,” says Huebner. Psychologists distinguish between questions that are information-gathering, and questions that are reassurance-seeking. If a child asks reassurance-seeking questions—like “Are we going to be ok?”—once or twice, that’s normal. But asking the same questions over and over signifies that a child is really dealing with anxiety and that their concern is not being curbed. At that point, parents may need to sit their children down for a longer conversation to address their fears and concerns.

My kids don’t want to fly on an airplane over the holidays. How do I convince them they are safe?
It’s important to emphasize that the vacation destination is one that is safe, and not at great risk for Ebola. Parents can also stress that no one in the United States has yet contracted Ebola from a plane ride. However, parents should avoid making comparisons, like “It’s more likely to get in a car crash than to get Ebola.” That will only stress a child out more.

Ebola freaks me out too, and I accidentally overreacted in front of my child. How do I fix this?
“One of the wonderful things about children is that you really can revisit things that didn’t go so well the first time,” says Huebner. If parents slip up with an overreaction, they should have a conversation with their children and reference the moment. She suggests a conversation opener like this one: “I was thinking about when you overheard me on the phone with my friend. I was really overreacting. I got nervous when I heard about Ebola, and you saw me when I was nervous. Now I’ve gotten information and I’ve calmed down, and I’ve realized this is a very sad thing that’s happening far away. It’s sad, but it doesn’t have to be scary for us.” Rational, calm conversations will help ease a child’s fears about Ebola.

TIME health

I Baked 50 Pies To Deal With My Anxiety

Homemade pie
Courtesy of Muriel Vega

I never feel as calm as I do when I’m cutting fruits or mixing custards

xojane

This story originally appeared on xoJane.com.

Pie crusts are finicky things. No matter how much you think you’ve mastered the ingredients, something as tiny as one minute too long in the bowl can make the whole experience unbearable. Well, unbearable for me.

You see, I don’t like change or things not going according to plan. It makes my hands shake, gets me in fights with my boyfriend and gives me weeks-long migraines. At least, I used to react like that. I’ve always had to deal with anxiety, and the older I get, the bigger life decisions I have to make, making my anxiety creep up to the surface more often.

Last winter, I had a small breakdown triggered by a pretty serious fight with my mother. We’ve never really seen eye-to-eye, but over time, we’ve tried to get along better and spend time together. After this fight, we did not talk for about 2 weeks and my stress levels were off the charts. It was crippling. I wasn’t able to write, a terrible thing as I am a freelance writer, and I was unable to focus on my regular job. It wasn’t healthy and I had to do something about it.

I’ve always liked to bake. Before she died, my grandmother taught me how to bake cakes and the Panamanian pastries that to this day are my favorite things to make. However, I’ve never attempted making a pie. I like eating pies, but I had no idea what went into them.

One night around Christmas, I was aimlessly scrolling through Instagram and saw a blogger’s post about her grandmother’s pie recipes and how she was going to attempt to make 100 of them. Something clicked in my brain and it just felt right. I figured if I could concentrate on learning a new skill in the kitchen, I could work through my feelings about my stress, anxiety and my current fight with my mom, all while I attempted to make pie crust.

I know, I have no idea how my brain made those connections. I thought 100 would be too ambitious for me, so I decided to make 50 pies by Christmas 2014, so about a year.

At first, I didn’t even know where to start. I searched for pie recipes on Pinterest, trying to figure out what would be an easy, yet a bit challenging to make. Then I heard about the gals at Four & Twenty Blackbirds. They were about to come out with a book and were guest blogging around the Internet with their Salted Honey Pie recipe. I grabbed the ingredients at the grocery store, including a very expensive, but good local honey. I’ve never spent more than $2 on honey and here I was, spending almost $20. I decided that since it was my first go, I would make the pie with a frozen crust.

Here’s the thing about pies – they are all about chemistry. The ingredients need to be a certain temperature, otherwise they won’t mix and the whole pie turns into a giant mush pile. Well, I didn’t know this. As I started to mix the dry ingredients, I went ahead and added the hot melted butter. That was a mistake. The whole pie filling became a greasy mess and I could feel my frustration rising.

I threw everything away and started over. The second time I used the butter at room temperature and it mixed beautifully, but then sometime between adding it to the pie crust and putting it in the oven, I spilled it everywhere. I walked away, crying, over literally spilled pie filling.

I got myself together because this was ridiculous and decided that a pie wasn’t going to conquer me. This was my personal challenge and I was going to complete it, no matter what. I felt empowered and I made everything for the third time. When it came out, it was a perfectly brown custard. As we ate this both salty and sweet creation, I knew I had to keep going.

I felt encouraged by the whole experience and one of my best friends got me the Four & Twenty Blackbirds pie book for Christmas. After that, each time I would get frustrated because I forgot an ingredient, the pie crust didn’t roll out, or the custard wasn’t jiggly enough, I took a deep breath, laughed about it and redid whatever I needed to do. I started having fun with it and it became a really fulfilling challenge. Even better, among all of this, I was able to get things right with my mom and I was generally feeling more relaxed.

The more pies I baked, the more my friends encouraged me. They started requesting them for parties. Everyone started asking me what pie number I was on or what my next pie was going to be. I started posting them on Instagram under the #muriels50pies hashtag. It became bigger than me and that was awesome. I started thinking of recipe pairings, what design to make next on the top crust, what fruits are in season, and planning my schedule around making these pies.

The more advanced I get, the more ambitious I get. I now know how make crusts from scratch and 8 out of 10 times, they don’t end up in the trash. I feel like a badass when I get it right on the first try. I’ve learned pie secrets like rolling out your pie crust with a cold rolling pin so I’m that weird person who has their rolling pin in the freezer, or adding vodka for flakiness so I mean, who are we kidding, I already keep vodka around the house.

As silly as it sounds, the pies have pushed me past myself and challenged what I can do. I never feel as calm as I do when I’m cutting fruits or mixing custards. I’m currently on pie #30 and with only 20 more pies to go in this challenge, it makes me sad that it’s almost over.

But if I learned anything about finding pie crust in weird places or realizing my dog is covered in flour after I finish baking, it’s that those little things that stress us out on a regular basis are not worth it. Who knew pies would be the recipe to a more relaxed, healthy life? Plus, let’s be honest, life is always better with a slice of pie.

You can view all of my pies so far on my blog.

Muriel Vega is a writer and editor living in Atlanta.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Mental health/Psycholog

For Social Anxiety, Therapy Beats Antidepressants

For the estimated 7% of people who suffer from social anxiety disorder, antidepressants are often the first line of defense. But a new meta-analysis published in The Lancet Psychiatry found that cognitive behavioral therapy (CBT) is actually more effective—and unlike with antidepressants, the effects last after you stop.

The analysis looked at data from more than 13,000 people with severe social anxiety across 101 clinical trials. CBT came out on top as the most effective therapy overall, as well as the most effective type of talk therapy.

Here’s how it works: “You set up these experiments to test whether people’s beliefs about themselves and the world are really accurate representations,” says study author Evan Mayo-Wilson, research scientist in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. In doing that, you’re getting people to experience the anxiety, learn to cope with it, and in a real-world sense, challenge those maladaptive and incorrect beliefs about themselves and the world around them.”

People with social anxiety experience self-consciousness or fear from ordinary situations, like giving a speech or riding the subway, sometimes to a debilitating degree. In CBT sessions, the therapist identifies the beliefs, thoughts and behaviors that are feeding this fear, then find creative ways into them. If a person is afraid of being stared at on the subway, for instance, a therapist might tell them to take a trip and make funny faces to see how passengers react.

Another perk of CBT was that fewer people relapsed after treatment, the study found. And many of those who practiced CBT had sustained benefits without the side effects of medication.

“Greater investment in psychological therapies would improve quality of life, increase workplace productivity, and reduce healthcare costs,” Mayo-Wilson said in a press release. “We need to improve infrastructure to treat mental health problems as the evidence shows they should be treated.”

TIME Mental health/Psycholog

4 Signs Your Body Image Isn’t Healthy

woman-holding-shoulder
Getty Images

Last week, Tallulah Willis—daughter of Bruce Willis and Demi Moore—bravely shared her struggles with body dysmorphic disorder in a video for StyleLikeU. “I’m diagnosed [with] body dysmorphia,” Willis, 20, told the fashion blog. “[My biggest insecurity] is my face. That’s where my diagnosis came into play. Because of the position I was born into, I would read these things on the Internet and I was like, well, Why would someone write that if there wasn’t some basis for truth out there?”

“It was something I never wanted to say out loud because it was so painful.” Willis goes on to talk about how hearing mean comments about her face drove her to dress provocatively and lose a lot of weight, thinking she could draw the attention to her body instead. “I started starving myself,” she says. “I got down to 95 pounds.”

Health.com: 10 Signs You May Have OCD

This is exactly why body dysmorphic disorder (or BDD) can be so difficult to diagnose, explains Health contributing psychology editor Gail Saltz, MD. “Disordered eating can be a symptom of it, but there is no surefire sign. What body dysmorphic disorder really means is that you are so preoccupied with either a real (but slight) or imagined imperfection that you become consumed by it.”

Plenty of healthy people have a body hang-up or two that makes very little sense (mine’s my fat ankles, full disclosure), so how do you know when someone you love is really struggling? Here are four ways to recognize body dysmorphia.

They always need reassurance about that one thing

“Most people who have body dysmorphia are not going to talk about it openly because they feel a lot of shame,” Dr. Saltz says. “But sometimes, it’s a friend who keeps asking you repeatedly for reassurance about this one body part.” If supportive comments like “No, your arms aren’t fat, really!” or “No, your nose is beautiful” don’t seem to make them feel even a little better, that could be a red flag.

Health.com: 12 Signs You May Have an Anxiety Disorder

They dress in a way that doesn’t make sense

Obviously, you don’t have to agree with every style choice your friends make, but think twice if she’s dressing in a way that suggests she’s trying to compensate for that one thing. “For example, she’s putting on a tent of a dress and saying it’s to hide her belly that doesn’t exist,” Dr. Saltz says. Or in the case of Tallulah Willis, she mentioned that she would wear short-shorts and push-up bras in a bid to shift attention away from her face.

Health.com: 12 Ways We Sabotage Our Mental Health

They go to extremes

“Dysmorphia fits in with this constellation of anxiety disorders like obsessive compulsive disorder,” explains Dr. Saltz. “It’s a compulsion that gets in the way of your life.” So in the same way that no amount of hand washing satisfies a person with OCD, no amount of “fixing” seems to help people with BDD. Some patients may even get plastic surgery, and then still think they need more work done after they’ve healed, while others try a progressively restricted diet to lose, say, an imagined double chin.

Health.com: 7 Strategies to Love the Way You Look

They’re hiding out

“The thing separating a normal insecurity from a problem with body dysmorphia is how much it affects your ability to function,” Dr. Saltz explains. If you notice that that she’s not going out as much, or she doesn’t want to date, or maybe she’s turned down a promotion because she doesn’t want to have to give presentations, those are signs her body issues are getting in the way of her life.

Amelia Harnish is an Associate Editor at Health.

This article originally appeared on Health.com.

TIME Sex

Losing Your Virginity Is Better Than Ever

New study shows that the "first time" is more enjoyable for this generation than for previous ones

If you’re a young virgin, you’re in luck! According to a new study from the Journal of Sex Research, losing your virginity these days is more enjoyable than it’s been in 20 years, at least if you’re a woman.

Researchers found overall gender differences in male and female approaches to virginity loss, which shouldn’t surprise anyone. Men are much more likely to have a “pleasurable experience” than women (a truth universally acknowledged) but also reported more anxiety surrounding the act. Women were much more likely to feel guilty after having sex for the first time.

But the good news is that those differences have changed significantly since the research started in 1980. While men reported the same amount of “pleasure” from their first sexual experience across three decades, women have reported a significant increase in first-time-fun-times since the study began. Men also reported less anxiety over the three decades, and women reported less guilt. Which means losing your virginity now is probably going to be a better experience now than ever before.

The researchers also point out that the findings are consistent with the theory of erotic plasticity, which states that female sexuality is more likely to change with social and cultural norms.

But if women are reporting more pleasure and less guilt from their first time, and men are reporting less anxiety, that’s good news for everyone!

 

TIME Marijuana

Six Ways Science Says Marijuana May Hurt Your Health

New Year Celebration
Partygoers smoke marijuana during a New Year's Eve party at a bar in Denver, celebrating the 2014 start of retail pot sales in Colorado. Brennan Linsley—AP

With the increasing push for the legalization of marijuana across the country, science is rolling out research on why pot may not be so harmless.

Boosters of marijuana legalization often speak about the relative harmlessness of the drug, especially when compared to alcohol and tobacco, which kill millions of people a year worldwide. But while the evidence suggests that pot is less damaging than some other legal drugs, the exact effects of marijuana on human health have not been well studied. Existing research is often limited in scope and rarely shows a clear causal connection.

But there have been some worrying findings, especially considering the increasing use of marijuana by American adults. A paper published this year in Forensic Science International, for instance, described two rare deaths of young men that were attributed to heart conditions resulting from marijuana use.

With legalization taking place in Colorado and Washington State, more research will now be possible. For now, here is a tour of what has been documented so far about marijuana’s negative effects.

1. It can interfere with learning

Marijuana interferes with the brain’s cannabinoid receptors, affecting cognitive functions such as movement, memory, and emotional control. A recent small study found that impairment in working memory occurs immediately after marijuana use. Subjects who received a higher dose of THC—marijuana’s main active chemical—took significantly longer to complete immediate recall and mental calculation tasks.

2. It can lead to dangerous driving

Pot impairs functions key to driving, including reaction time, hand-eye coordination and depth perception, a study by the University of Chicago reported. In the first full year after medical marijuana was legalized in Colorado, there was a 12% increase in traffic fatalities, according to data analysis by researchers at Columbia University. However, studies have not been able to provide consistent evidence to prove that the effects of marijuana cause an increased rate of collisions. According to a different study published in Accident Analysis and Prevention, the closest comparison to the culpability of accident when under the influence of marijuana is to a driver who has taken penicillin, anti-depressants or an antihistamine, which suggests marijuana’s effects have a nominal impact on accident risk. More research is needed.

3. It may harm the developing brain.

Although a causal connection has yet to be found, studies show regular marijuana use—once a week or more—can change the structure of the teenage brain. Marijuana affects memory and problem solving abilities, both of which can impact academic performance. Researchers from the Harvard School of Medicine and Northwestern University Feinberg School of Medicine surveyed a small group between the ages of 18 and 25 and noticed structural abnormalities in the brain, specifically in grey matter, the nucleus accumbens, and the amygdala, after recreational marijuana use.

4. It could make you panic.

Marijuana may alleviate anxiety for some, but for others it can cause it. THC can cause increased heart rate, poor coordination, or lightheadedness, which can be triggers for anxiety attacks. Some research suggests that people who frequently use of marijuana—and who started using it as young adults—were more likely to have anxiety disorders or depression. Whether cannabis use causes anxiety disorders, however, is not known.

5. It can be addictive.

One in 10 users exhibits symptoms of dependence, according to the American Psychological Association. Marijuana’s rate of dependence liability of 9% is comparable to that of anti-anxiety medications and is well under the liability rates of alcohol (15%) and tobacco (32%), according to a study by the Institute of Medicine. However, the reason why some become addicted and others don’t remains unclear. Genetic studies have suggested that the involvement, or lack thereof, of CB1 receptors in response to cannabis can influence the likelihood of addiction. The receptor gene has been found to have a connection to the development of dependence to drugs and alcohol. Studies done on animals suggest that cannabis triggers reward centers in the brain, including neurons that produce dopamine, which could also encourage continued use.

6. It can stress your heart

Marijuana-related deaths are so rare as to be treated as mythological by marijuana boosters, but a paper published this spring in Forensic Science International does describe the deaths of two healthy men, ages 23 and 28, who experienced heart trouble after using marijuana. “To our knowledge, these are the first cases of suspected fatal cannabis intoxications where full postmortem investigations, including autopsy, toxicological, histological, immunohistochemical and genetical examinations, were carried out,” the authors write. The authors surmise that the cardiovascular events were the result of increased heart rate that can happen in some pot smokers, particularly in the first hours after using marijuana. Nonetheless, the authors conclude, that the “absolute risk of cannabis-related cardiovascular effects can be considered to be low, as the baseline risk for most cannabis smokers is low and cannabis-induced changes are transient.”

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