Don’t Over-Tax Yourself Over Tax Season!

With the April 15 tax deadline looming, it’s an anxious time for many people. Try these tips to keep your financial stress under control at tax time ­— and all year round.

Break It Up. A mountain of paperwork for your tax return or for any other financial responsibility, like applying for a college loan or mortgage, can seem overwhelming. Break up the process into smaller chunks, such as gathering pay stubs, finding your home mortgage interest statements, or organizing your receipts. Then tackle each task one by one. But before you do so…

Make a Plan. This is even more important when you’re on a tight deadline (like being just a few days away from April 15). Once you’ve broken down what you need to accomplish into pieces, put those steps in order and write down how and when you’re going to make each one happen. This will help you feel like you have control over the process. Being out of control is very stressful!

Keep Mentally Fit. Eat well, get a full night’s sleep, find a way to exercise every day, and connect with friends and loved ones. Financial deadlines may have you feeling like you need to lock yourself away and pull an all-nighter with a bag of potato chips and your 1040, but you’ll just raise your stress level, and you probably won’t accomplish your goal anyway.

Resist Unhealthy Temptations. When stress arises, it’s tempting to cope in unhealthy ways such as binge eating, smoking, or drinking alcohol. Avoid these negative coping strategies. Instead of a cigarette or a glass of wine, take a walk or call a friend to vent.

Don’t Go It Alone. It’s not too late to get help. Ask for help from a spouse, a trusted friend, or ideally, a financial professional like a certified public accountant. Some tax professionals will even save you the step of visiting their office and will review your documents and calculations online. Having too much on your shoulders and no help is a recipe for anxiety.

Request an Extension. If you’re utterly overwhelmed and you feel like there’s no way you’ll have it all together by April 15, talk to a tax professional about how to request an extension on filing. You’ll still have to pay your estimated taxes on time (or pay interest), but you’ll have an extra six months to get your paperwork in order.

Plan Ahead for Next Year. If you’ve procrastinated about your taxes this year, use the stress you’re experiencing now as you try to get everything together at the last minute for a good cause: Keeping you on track to plan ahead for tax time 2016. Set a realistic budget and stick to it, and keep track of your finances as you go along. Having a plan and living within your means makes your life much less stressful.

by David Ginsberg, M.D., clinical associate professor and vice chair for clinical affairs, Department of Psychiatry, and chief of the Psychiatry Service, NYU Langone Medical Center in New York City.

Are Some Jobs More Stressful Than Others?

Everyone has bad days on the job—a project that you put hours into bombs or a task you need to accomplish is difficult and stressful. But are some jobs harder overall on our mental health than others? Depression may be more likely to occur in some professions, research suggests. And according to a new study by researchers at the National Institute for Occupational Safety and Health, suicides in the workplace, while not commonplace, are on the rise. Their research, published in the March 16 online edition of the “American Journal of Preventive Medicine,” showed that 270 people committed suicide in the workplace in 2013, a 12% increase over 2012.

Men and those over 65 were more likely to commit suicide in the workplace than others. Law enforcement jobs -- police officers, firefighters, and detectives -- had the highest rate of workplace suicides with 5.3 suicides for every 1 million workers. Farmers, ranchers, fishermen, and forestry workers came in next with 5.1 suicides per one million. The authors also noted that minorities may be at a greater risk for workplace suicide compared to non-workplace suicides. Their research did not include military jobs.

This month’s “JAMA Psychiatry” also addressed the topic in a “Viewpoints” op-ed co-authored by two medical interns from New York who said that being a physician, especially a young intern, may leave some people vulnerable to mental illness and suicide. Doctors are twice as likely to kill themselves compared to non-physicians, and female doctors are three times more likely to do so than their male counterparts, according to the American Foundation for Suicide Prevention (AFSP). According to AFSP, though, the workplace can be an ideal place for suicide prevention programs. Their Interactive Screening Program (ISP), for example, is an anonymous online survey that IDs at-risk people and connects them with support. The NFL and the Boston Police Department have used the program. The authors of the “Lancet Psychiatry” op-ed say some work programs, like one at the U.S. Air Force, have successfully addressed workplace depression and mental illness in a variety of ways. One initiative: The USAF designates certain supervisors as mental health “gatekeepers.” Their job is to identify at-risk employees and channel them to screening and mental health services.

Want more info on managing workplace stress? Read about APA’s Partnership for Workplace Mental Health. Learn more about the American Foundation for Suicide Prevention’s ISP program by contacting the Program Director at isp@afsp.org. Read Mayo Clinic’s article: Work-Life Balance: Tips to Reclaim Control.

by Mary Brophy Marcus, health writer, APA

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Living in the Moment with Mindfulness

By Brandon Cornejo M.D., Ph.D.

I hope your first week of 2012 was a good one! How are those New Year's resolutions going? If your goal is to exercise more, my "Mindfulness" two-part blog post should help you stay motivated. In part-one of my post, I discussed the concept of "mindfulness" or living in the moment.

Now I will share how you can use mindfulness to stay focused on a particular goal like exercising. Since exercise and mindfulness enhance mood, decrease stress, and improve negative thinking, these tips will benefit us all as we enjoy 2012!



Tips for staying in the present moment while exercising:

·         One of the most basic tools that you can use in mindfulness is your breathing. By focusing on the sensation of air traveling in and out of your body (just like you do during meditation), you can be grounded in the present moment.

·         You may also try a mantra to stay in the "now" (for example, runners often count out their footsteps – “1, 2, 3…1, 2, 3” – or a mountain biker or skier may constantly remind themselves to “relax”).

·         Applying either technique will keep you in the moment rather than thinking about negative thoughts and feelings that influence behavior in a non-productive fashion during your exercise.

·         Paying attention to physical feelings of your body and your surroundings as you exercise will prevent you from going into “automatic pilot” (when you act and react without conscious awareness).

·         By learning to stay present, you can accept physical discomfort as a temporary state that will soon pass.

·         As you continue your workout, you can “label” both positive and negative thoughts that occur while exercising. Labeling these thoughts will help you understand which thoughts and feelings are limiting your success and need to be changed.

Try out some of these tips and see how you start removing unwanted negative thoughts to overcome challenges that may have held you back in the past. Mindfulness matters when it comes to achieving that New Year's resolution this year.

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Live Longer by Making Mental Wellness Your Mission

By Felicia Wong, M.D.

September is National Recovery Month and SAMHSA's National Wellness Week (Sept. 17-23), a time to remind us why "wellness" is so important to our overall health. Did you know, people with mental and substance use disorders die decades earlier than the general population, mostly due to preventable medical conditions?

Each day, we face all sorts of demands and drama which can lead to insomnia, lack of concentration, problems in our relationships, and other mental health issues. In a past blog post, I identified coping tools for dealing with stress and boosting your overall well-being. Here are "Top 8 Tips for Mental Wellness." I hope you will take another look and share with your loved ones this week. 

1) Help Others. People who consistently help others experience less depression, greater calm, and fewer pains.

2) Take Care of Your Spirit. People who have strong spiritual lives may be healthier and live longer. Spirituality seems to cut the stress that can contribute to disease.

3) Stay Positive. Positive emotions can boost your ability to bounce back from stress.

4) Get Physically Active. Exercise can help relieve insomnia and reduce depression.

5) Get Enough Sleep. Not getting enough rest increases risks of weight gain, accidents, reduced memory, and heart problems.

6) Eat Well. Eating healthy food and regular meals can increase your energy, lower the risk of developing certain diseases, and influence your mood.

7) Deal Better with Hard Times. People who can tackle problems or get support in a tough situation tend to feel less depressed.

8) Get Professional Help if You Need It. More than 80 percent of people who are treated for depression improve.

Which tips on this list are missing in your life? Today is the perfect time to take action! Your wellness matters. 

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Yoga Helps Heal Heart & Emotional Scars of Cancer

By Felicia Wong, M.D.

“Cancer is a very alienating and existential disease. I know of no other common disease that immediately causes so much fear, anxiety, depression, confusion, and a sense of impending disaster in a patient or his/her significant others when they hear the word “cancer” for the first time.” --- Murray Krelstein, MD, a psychiatrist and cancer survivor.

Although oncologists, family members, and friends can provide significant sources of support, adding a mental health professional to a cancer patient’s treatment team is often helpful. Talking about the emotions and worries associated with cancer can be difficult, and it is important to have a therapist who is familiar with these situations. Additionally, cancer patients and survivors often suffer from sleep disorders, depression, anxiety, fatigue, and other mood changes.

Researchers at the University of Rochester Medical Center found that among patients receiving chemotherapy, over three-quarters suffer from insomnia. Those who suffer from insomnia are, in turn, more likely to suffer from fatigue and depression. For 65% of cancer survivors, insomnia continues even after the completion of chemotherapy.

Cancer is a diagnosis that affects both body and mind. So, it makes sense that cancer patients and survivors practice yoga to improve their quality of life.

While research on the use of yoga for cancer is relatively new, there have been recent studies confirming yoga’s mental health benefits. A Harvard Health Publication highlights the benefits of yoga for stress, depression, and anxiety:

- By reducing perceived anxiety, yoga appears to adjust stress response systems. This, in turn, reduces heart rate, lowers blood pressure, and can make breathing easier.

- There is evidence that yoga practices helps increase heart rate variability, an indicator of the body's ability to respond to stress more flexibly.

Optimizing wellness after a cancer diagnosis and beyond involves a complex integration of interventions that address both the mind and the body. Ideally, a psychiatrist is part of the cancer treatment team. However, if this is not available, please ask your doctor for referrals.

For additional resources on coping with cancer:
http://www.cancersupportivecare.com/live.html
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Coping with Stress in America

By Adair Parr, M.D.

A survey by the American Psychological Association highlighted the negative impact that stress can have on families and children. This is an extremely important topic that affects many family caregivers, who are under a great deal of stress taking care of loved ones. More and more Americans are affected by stress. The survey indicates that many Americans feel that they are experiencing unhealthy amounts of stress. The economy is one of the main reasons. Fewer are satisfied with the ways that their employer helps employees balance work and non-work demands and many are concerned about job stability.

In addition, stress impacts the entire family. Children recognize when their parents are stressed and that could make them feel sad and worried. Nevertheless, parents frequently underestimate the impact that their own stress has on their children.

Stress affects both our mental and physical health. Some people manage stress by smoking, drinking or over-eating. That can lead to bigger problems. The study shows that Americans understand the importance of healthy behaviors like getting enough sleep, exercising and eating healthy. However, lack of time and motivation gets in the way of following through on these goals. Willpower was identified as a barrier to many healthy behaviors, even when they are recommended by a health care provider.
Managing your stress is extremely important. Stress does affect the family members you care for. There are healthy ways to manage your stress. Some suggestions are: exercising or playing sports; listening to music; spending time with friends and family; going to religious services; journaling; and practicing yoga / meditation. 


If you find that you are overwhelmed or suffering physical symptoms from stress like headache, poor appetite and insomnia, or if you are feeling depressed or suffering from chronic irritability and crying spells, you may need to see a mental health provider. The Healthy Minds website has brochures about dozens of mental health issues including early warning signs of mental illness.
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National Caregivers Month: Alzheimer's Disease

By Felicia Wong, MD

Alzheimer’s Disease is a progressive, irreversible brain disease. The cause is poorly understood, and there is no known cure. Symptoms of Alzheimer’s include memory loss, confusion, impaired judgment, personality changes, disorientation and loss of language skills. It is the most common form of irreversible dementia.

Watching someone you love slowly lose their memory, thinking and reasoning skills can be heartbreaking. Caring for a person with Alzheimer’s Disease is a difficult task and can become overwhelming at times. As Alzheimer’s patients gradually lose their memory and their skills , each day brings new challenges to the caregiver. This is why I wanted to recognize caregivers for Alzheimer's patients in November, which is National Family Caregivers Month and Alzheimer's Disease Awareness Month.

Over time, communication diminishes, rewards decrease, and without strong support from family, friends and the community, caregivers of Alzheimer's patients face challenges to their very own well-being. Maintaining emotional and physical fitness while providing care for a loved one with Alzheimer’s Disease is crucial. Preparing and protecting yourself, understanding your loved one’s experience, and accepting help from others can reduce the stress associated with care-giving, and maximize the joys of being there for a loved one.

Here is a link to tips to help caregivers of loved ones with Alzheimer’s cope.

Additional support for Alzheimer’s and Dementia Caregivers, including warning signs of caregiver burnout, and tips on how to plan your own self care can be found on Helpguide.

Find additional information on Alzheimer's and other issues affecting mental health in seniors on the American Psychiatric Association's Healthy Minds website.
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National Family Caregivers Month: Self-Care for Caregivers

By Felicia Wong, MD

I love helping others. That is why I became a doctor, and why I love my job as a psychiatrist. But when I was a pre-medical student in college, my mom shared the following words of wisdom with me:  “In order to take care of others, you need to take care of yourself first.”

It took me a moment to understand the importance of the point she was making. I had taken a break from my community service projects due to a sports injury, and was eager to return to them. However, at that time, I was not fully recovered and was often in pain, and would tire easily. My mom encouraged me to take some more time off in order to focus on my own recovery and healing. Initially, I felt guilty taking the time out for myself. But in the end, I realized mom was right. Once I became strong and well again, I had so much more to offer to others.

Caregivers tend to be selfless, and expect a lot of themselves without recognizing their own need for self-care. Studies have found that caregivers have higher levels of depression and stress than non-caregivers. Sometimes caregivers are so committed to helping others that they forget to take care of themselves. They fail to recognize that if they drive themselves to exhaustion or sickness, they may not be able to help at all.

Warning signs of caregiver burnout from the non-profit Helpguide.org include:

• You have much less energy than you used to
• It seems like you catch every cold or flu that’s going around
• You’re constantly exhausted, even after sleeping or taking a break
• You neglect your own needs, either because you’re too busy or you don’t care anymore
• Your life revolves around caregiving, but it gives you little satisfaction
• You have trouble relaxing, even when help is available
• You’re increasingly impatient and irritable with the person you’re caring for
• You feel overwhelmed, helpless, and hopeless

Key strategies to prevent burnout include getting the help you need, seeking emotional support, and taking time out to care for yourself.

• Learn and use stress-reduction techniques.
• Attend to your own healthcare needs.
• Get proper rest and nutrition.
• Exercise regularly.
• Take time off without feeling guilty.
• Participate in pleasant, nurturing activities.
• Seek and accept the support of others.
• Seek supportive counseling when you need it, or talk to a trusted counselor or friend.
• Identify and acknowledge your feelings.
• Change the negative ways you view situations.
• Set goals.

For additional strategies for self-care for caregivers, visit the Family Caregiver Alliance, and watch for my next post on caring for someone with Alzheimer's. 

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Mental Health Checkup: Tension, Anxiety and Tuning In

By Gina Duncan, M.D.

Continuing my Mental Health Checkup series, here are some additional factors to consider as you evaluate your mental health:

Tension and Anxiety — Are you feeling tense and wound up all the time? How about nervous and anxious? Is it hard for you to unwind at the end of the day? We live in a fast-paced society and stress has become a common part of our everyday lives. If, however, you are finding that you’re unable to take mental breaks during the day where you can feel totally relaxed and worry-free even for a few moments, then that could indicate that your stress is approaching dangerous levels. Relaxation is a skill that many of us have to learn and practice. There have been some great previous posts with relaxation tips as well as ways to cope with anxiety and stress.

Writing in ajournal is one way
to stay "in touch" with yourself.

Tuned In — In general, how “in touch” do you feel with yourself? Do you feel like you’re experiencing emotions and you don’t know why, like being angry or crying “for no reason”? It’s not uncommon to get so busy that you don’t have time to process everything that is happening on an emotional level in real time. However, taking some time to write in a journal or talk to a friend can be critically important to good mental and emotional health, particularly when you find yourself in periods of great transition or change. The danger of being out of touch with yourself emotionally is that you may respond to difficult situations in ways that you later regret (such as impulsively sending off an angry email to your boss, or taking out your frustration on your kids). It is also difficult to advocate for yourself and your needs when you don’t know what those needs are. Being able to take a moment and identify that “I feel angry because _____.” or “I am hurt because _____.” can take you a long way in staying in touch with yourself.

Tomorrow I will write about avoidance and eating habits.

Maternal Mental Health: Can Stress Harm Your Chances of Getting Pregnant?

By Felicia K. Wong, M.D.

Getting pregnant is an exhilarating experience for some couples. But it can also be a very frustrating, and heart-wrenching, experience for others. Age, smoking, obesity, and alcohol are studied and known factors to effect pregnancy success.


Anecdotal reports have long linked stress with infertility, but to-date, there has not been much scientific evidence to prove the connection. On August 11, 2010, the BBC published an interesting article describing an Oxford University study that demonstrates for the first time that high stress levels may delay pregnancy. Their findings suggest that perhaps the best thing a couple can do to prepare for pregnancy is to relax.


Dr. Cecilia Pyper, of the National Perinatal Epidemiology Unit at the University of Oxford, measured stress hormones in 274 healthy women aged 18-40 planning to have a baby naturally. They found that those who were most stressed had a reduced chance of becoming pregnant that month. Dr. Pyper said: "The findings support the idea that couples should aim to stay as relaxed as they can about trying for a baby....In some people's cases, it might be relevant to look at relaxation techniques, counselling and even approaches like yoga and meditation."


The study, aimed to improve understanding of the factors that influence pregnancy in normal healthy women, was published in the journal Fertility and Sterility. The research was carried out in collaboration with the Eunice Kennedy Shriver National Institute for Child Health and Human Development in the US. It is part of a larger study looking at the effect of factors like smoking, alcohol, and caffeine on chances of pregnancy.


This being the first of such studies, more research is needed to further link the role of stress and pregnancy. In the meantime, it can’t hurt to relax! 
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RELAX: Feel the stress melt away

By Felicia K. Wong, M.D.

The winter snow may still be months away from melting, but now that the hubbub of the holiday season has passed, it’s time to rest, relax and de-stress!

Easier said than done right? For many of us, finishing one project just means we can start the next. We live in a fast-paced society where there is a lot of pressure (both external and internal) to “go-go-go”. In other words, we live in a world that is full of stressors and stress.

Our body responds to stress by producing stress hormones. These hormones help you respond to “fight or flight” situations and historically helped our ancestors run to safety from lions. However, these days there are (usually) no lions to run from and instead, when the body is chronically stressed, these hormones can take a toll on physical and mental health. People who are under a lot of stress are often emotional – anxious, irritable and depressed.

Ideally, you can try to change the situation that is causing your stress. But if the situation is fixed, there are relaxation methods that can be useful strategies to cope with stress.

Relaxation is a skill. It is something that we are not necessarily born knowing how to do. Good news! Relaxing techniques can be learned and practiced.

I’d like to share with you a relaxation technique called Progressive Muscle Relaxation (PMR). This is a great way to reduce overall body tension. Here is a video to introduce the practice and help you get started:


Each person will find for themselves unique ways to relax – be it through exercise, yoga, music or meditation. PMR is just one strategy. There is no right or wrong way to relax, and no one technique that will work for everyone. So, find out which ones work the best for you and get started!

Before practicing PMR, consult with your physician if you have a history of serious injuries, muscle spasms, or back problems, because the deliberate muscle tensing of the PMR procedure could exacerbate these pre-existing conditions.

Too busy to relax?

By Gina Newsome Duncan, M.D.

For most of us, stress is a part of everyday life—at home, at work, during our commute. Even going on vacation can be stressful. Stress not only has a psychological effect. It also has a physiological effect. That is, it affects us physically, leading to direct changes in our heart rate and blood pressure, and over time, our risk for certain illnesses such as heart attacks and strokes.



Stress also plays a significant role in anxiety, depression and other mental illnesses. This is detailed in the book The Relaxation Response, by Dr. Herbert Benson, a Harvard physician and expert in Mind/Body medicine.

Relaxation, the antidote to stress, can often seem like a luxury. How many of us picture a hot bubble bath complete with scented candles and soothing music, or a long walk on a sun-soaked beach as the perfect way to relax? The problem is that most of us don’t have time to do these things on a regular basis. When you’re in the midst of a crisis, or have a deadline looming at work, it’s not always possible to take an extended break.

The good news is that there are steps we can take psychologically to improve how we feel physically. With practice, you can learn how to relax anywhere and in any situation.

Some of the most common relaxation techniques are:
1. Deep breathing
2. Progressive muscle tension and relaxation
3. Guided Imagery/Visualization
4. Mindfulness

If you have a moment, try this simple exercise right now:

Sit in a comfortable position, either reclining slightly or laying down.
Take a deep breath in while slowly counting “one-thousand-one, one-thousand-two”. Then exhale, while counting “one-thousand-one, one-thousand-two, one-thousand-three, one-thousand-four”. Repeat this for several minutes.

Next, while maintaining a slow, regular pace of breathing, move on to progressive muscle tension and relaxation. This means tensing and relaxing the different muscle groups of your body one at a time. For example, start with your feet, curling your toes under… holding…and then relaxing. Then move on to your legs, stomach, etc, until you have worked your way up to your head.

How did that feel? Don’t worry if you couldn’t relax right away. It takes practice!

Most major bookstores and entertainment stores carry relaxation CDs that incorporate the breathing and muscle relaxation techniques described above. Combined with guided imagery and soothing music, these CDs can be a great way to learn the relaxation response if you don’t feel confident doing it on your own. A quick Google search can also pull up many websites with different types of relaxation exercises, suggestions, and even video.

The best thing is that this can take as little as 5 minutes and can be done anywhere—at your desk or while parked in your car—anytime you need to recharge.

Taking time to relax is not a luxury, it’s a necessity!

Holiday Anxiety

By Jeffrey Borenstein, M.D.

As we begin the holiday season, people have hopes and perhaps expectations of an ideal holiday. Time with family and friends, time off from work or school, plans to travel – but the preparation and anticipation is often stressful. While some people may experience feelings of sadness this time of year, often people experience anxiety.

Family gatherings – both large and small may bring up memories and emotions which have been on the back burner but which now result in a higher level of emotions. The holiday season is also a busy time, juggling usual work/school/household activities with holiday preparations. With time off from work and school, our usual routines are interrupted, which is an additional stressor. All this can result in feelings of anxiety. What should you do?

Most importantly – step back and realize what emotions you are feeling. If you are experiencing heightened anxiety, there are steps you can take. I was interviewed for a New York Times article that may be helpful: “Easing Anxiety in All It’s Forms.”

Excessive drinking during the holidays is also a problem for many people. Some use alcohol to help with their stress and anxiety, and those with alcohol problems are particularly vulnerable. Instead of helping, drinking can do the opposite and make you feel worse.

To help you cope during the holidays, make sure you get adequate sleep, make sure you exercise (and walking counts), and share your feelings with friends or family. If you begin to feel overwhelmed and have difficulty functioning, you should seek professional assistance. Most importantly – realize that you are not alone. Many people experience holiday anxiety. Accept support from family, friends, and if need be professionals.

Maintaining Health in Stressful Jobs

By Bill Callahan, M.D.

I have been asked frequently in the past 10 days how psychiatrists deal with their own reactions to what they hear every day and what its impact is on them.



When I became a psychiatrist after five years as a flight surgeon in the military, I was struck by how much of the four years it takes after medical school to become a psychiatrist was spent on making sure that we dealt with our emotions, knew our own warning signs for stress, and would set limits on a reasonable work load. We are also trained to know when to ask for a consultation with a colleague, or to get additional training for ourselves. Our educational requirements are life-long and part of our commitment to do our best for you.

A big part of my role is to be the “personal trainer for emotions.” At the end of each day, after spending eight hours immersed in the emotions and struggles of other people, I spend some time experiencing the different emotions that work caused in me. That will mean being able to cry to relieve sadness that is created, feeling the full impact of anger, as well as the affection I feel for the people I work with. This process lowers anxiety and stress and prevents a toxic buildup of emotion every day.

In future posts I will talk about how to feel healthy anger, since I find this is the most misunderstood emotion, and the fear of feeling it is a major source of stress for many.

I already had the fundamentals of a healthy life from my military flight surgeon experiences. Daily exercise for at least 45 minutes, combining aerobic and weight training, sleeping from 7 to 9 hours a day, moderate alcohol use and avoiding it all together when under increased stress or emotional strain, and making sure I took time to have fun with family and friends are things we can all do as well.

Please leave your own tips for what you do to relieve stress in the comment section.