4 Strategies for Better Decision-Making

Individuals with “big picture” styles of reasoning make better decisions. Learn four strategies for “big picture” thinking to get optimal results.

A recent study found that a “big picture” style of thinking led to better decision-making. (“Better” decisions were defined as those resulting in maximum benefits.)

If you took the Myers-Briggs (a personality assessment), and fell on the “Intuition” side of the spectrum (like me!), it’s likely you’re already a “big picture” thinker. If you’re on the “Sensing” side, you’re more apt to examine individual facts before considering the sum of all parts.

“Big picture” thinking is a practical and balanced method of reasoning. It suggests taking a step back (zoom out!)… and looking to see how all pieces fit together for more effective decision-making.

The following strategies promote “big picture” thinking for better decision-making:

1. Get a good night’s rest

Researchers from the Beth Israel Deaconess Medical Center found that sleep is essential for “relational memory” (or the ability to make inferences, i.e. “big picture” thinking).

Before making a tough decision, sleep on it; you’ll wake up with a new perspective! In addition to healthy sleep hygiene, the following strategies have been found to improve sleep:

2. Don’t deliberate for long

Research indicates that when weighing out options, it’s ideal to take small breaks. For more effective decision-making, don’t deliberate for long periods of time or you’ll start to lose focus. If things become fuzzy, you won’t see the big picture.

3. Bay day = bad decision

One study found that a positive mood is related to a “big picture” thinking style. Good moods are associated with broader and more flexible thinking. A positive mood enables someone to step back emotionally, psychologically distancing themselves from the decision at hand.

If you’re feeling salty, hold off on making that decision. Instead, try one (or all!) of the following research-based techniques for boosting your mood:

4. Get a second opinion

Ask around to learn how others’ view your situation. Every perspective you collect is another piece of the “big picture” puzzle.

Seek opinions from those you trust (only those who have your best interests in mind). Make sure you ask a variety of people (especially those with whom you typically disagree). The end result is a broader and more comprehensive awareness of what you’re facing.


Employ all four strategies to optimize your thinking style and decision-making skills!

Cassie Jewell, M.Ed., LPC, LSATP


  • References
  • American Academy of Sleep Medicine. (2010, April 4). Maintaining regular daily routines is associated with better sleep quality in older adults. ScienceDaily. Retrieved July 18, 2018 from http://www.sciencedaily.com/releases/2010/04/100401085336.htm
  • American Academy of Sleep Medicine. (2008, June 12). Moderate Exercise Can Improve Sleep Quality Of Insomnia Patients. ScienceDaily. Retrieved July 18, 2018 from http://www.sciencedaily.com/releases/2008/06/080611071129.htm
  • American Chemical Society (ACS). (2012, August 19). Good mood foods: Some flavors in some foods resemble a prescription mood stabilizer. ScienceDaily. Retrieved July 10, 2018 from http://www.sciencedaily.com/releases/2012/08/120819153457.htm
  • American Psychological Association. (2018, April 23). Let it go: Mental breaks after work improve sleep: Repetitive thoughts on rude behavior at work results in insomnia. ScienceDaily. Retrieved July 18, 2018 from http://www.sciencedaily.com/releases/2018/04/180423110828.htm
  • Baycrest Centre for Geriatric Care. (2012, May 14). A walk in the park gives mental boost to people with depression. ScienceDaily. Retrieved July 18, 2018 from http://www.sciencedaily.com/releases/2012/05/120514134303.htm
  • Berman, M. G., Kross, E., Krpan, K. M., Askren, M. K., Burson, A., Deldin, P. J., Kaplan, S., Sherdell, L., Gotlib, I. H., & Jonides, J. (2012). Interacting with nature improves cognition and affect for individuals with depression. Journal of Affective Disorders, DOI: 10.1016/j.jad.2012.03.012
  • Beth Israel Deaconess Medical Center. (2007, April 21). To Understand The Big Picture, Give It Time – And Sleep. ScienceDaily. Retrieved June 17, 2018 from http://www.sciencedaily.com/releases/2007/04/070420104732.htm
  • Black, D. S., O’Reilly, G. A., Olmstead, R., Breen, E. C., & Irwin, M. R. (2015). Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances. JAMA Internal Medicine, DOI: 10.1001/jamainternmed.2014.8081
  • Curry, O., Rowland, L., Zlotowitz, S., McAlaney, J., & Whitehouse, H. (2016). Happy to help? A systematic review and meta-analysis of the effects of performing acts of kindness on the well-being of the actor. Open Science Framework
  • Demsky, C. A. et al. (2018). Workplace incivility and employee sleep: The role of rumination and recovery experiences. Journal of Occupational Health Psychology, DOI: 10.1037/ocp0000116
  • The JAMA Network Journals. (2015, February 16). Mindfulness meditation appears to help improve sleep quality. ScienceDaily. Retrieved July 18, 2018 from http://www.sciencedaily.com/releases/2015/02/150216131115.htm
  • Labroo, A., Patrick, V., & Deighton, J. served as editor and Luce, M. F. served as associate editor for this article. (2009). Psychological distancing: Why happiness helps you see the big picture. Journal of Consumer Research, 35(5), 800-809. DOI: 10.1086/593683
  • Northwestern University. (2017, July 10). Purpose in life by day linked to better sleep at night: Older adults whose lives have meaning enjoy better sleep quality, less sleep apnea, restless leg syndrome. ScienceDaily. Retrieved July 18, 2018 from http://www.sciencedaily.com/releases/2017/07/170710091734.htm
  • Ohio State University. (2018, July 13). How looking at the big picture can lead to better decisions. ScienceDaily. Retrieved July 18, 2018 from http://www.sciencedaily.com/releases/2018/07/180713111931.htm
  • Spira, A. P. (2015). Being mindful of later-life sleep quality and its potential role in prevention. JAMA Internal Medicine, DOI: 10.1001/jamainternmed.2014.8093
  • Stillman, P. E., Fujita, K., Sheldon, O., & Trope, Y. (2018). From “me” to “we”: The role of construal level in promoting maximized joint outcomes. Organizational Behavior and Human Decision Processes, 147(16), DOI: 10.1016/j.obhdp.2018.05.004
  • Turner, A. D., Smith, C. E., & Ong, J. C. (2017). Is purpose in life associated with less sleep disturbance in older adults? Sleep Science and Practice, 1(1), DOI: 10.1186/s41606-017-0015-6
  • University of Michigan. (2009, June 3). Feeling Close To a Friend Increases Progesterone, Boosts Well-being and Reduces Anxiety and Stress. ScienceDaily. Retrieved July 18, 2018 from http://www.sciencedaily.com/releases/2009/06/090602171941.htm
  • University of Oxford. (2016, October 5). Being kind to others does make you ‘slightly happier’. ScienceDaily. Retrieved July 18, 2018 from http://www.sciencedaily.com/releases/2016/10/161005102254.htm
  • Zisberg, A., Gur-Yaish, N., & Shochat, T. (2010). Contribution of routine to sleep quality in community elderly. Sleep, 33(4), 509-514.

11 Self-Care Ideas You May Not Have Considered

(Updated 1/13/20) Self-care is a vital piece of the wellness puzzle. This post is intended for the well-informed “self-carer,” who already knows about (and maybe even practices) deep breathing, massage, aromatherapy, etc. and wants to expand their horizons. This is also for people (like me) who don’t get much from your typical self-care practices (i.e. lighting a scented candle).

Self-care is a vital piece of the wellness puzzle. As a mental health professional, I practice self-care to prevent burnout. (Once a counselor reaches burnout, he/she is no longer able to fully meet a client’s needs; if you’re not taking care of yourself, how are you going to help someone else?)

To illustrate the importance of self-care, consider a vehicle; it requires ongoing maintenance for optimal performance and safety. Similarly, we require self-care. It’s a concept that encompasses a variety of needs, including health, solitude, human connection, self-love, spiritualty, and more.

I’ve read many articles, posts, and books on self-care; there’s a wealth of information out there. Commonplace self-care tips, such as taking a bubble bath or meditating, make up the majority of posts on the topic; but unoriginal content has no place here. And to be honest, some (okay, a lot!) of the ideas make me want to roll my eyes. (Lighting a scented candle? Nope, not gonna do it for me.)

This post is intended for the well-informed “self-carer,” who already knows about (and maybe even practices) deep breathing, massage, aromatherapy, etc. and wants to expand their horizons. This is also for people (like me) who don’t get much from your typical self-care practices.

Here are 11 unique ideas:

1. Create an inspirational scrapbook or a “bliss book” 

Any time you happen upon something that makes you smile, inspires you, or motivates you, add it to your scrapbook (or journal or binder). Maybe it’s a photo, a happy thought you jot down, or a magazine article. Alternatively, you could create a “bliss board” on Pinterest.

Creating a bliss book (or board) has the potential to generate positivity and compassion. Whenever you need an emotional pick-me-up, flip through your scrapbook. Share it with others to generate a double dose of cheer!

2. Plan a trip 

If you can’t take a vacation, you can at least plan! Preparation is half the fun (for me, at least)! Look up places you’d like to travel and research things to do there. Create an itinerary. Set a tentative travel date (even if it’s years from now) so you have something to look forward to.

3. Poop in public bathrooms (without shame)! 

If you’re one of those people who avoid going number 2 in public bathrooms, stop. Holding in your poop is uncomfortable and may result in constipation. If you’re embarrassed about the smell, carry a travel-sized container of Poo-Pourri. If it’s the sound that makes you anxious, run the water or flush as you go. When your body tells you it’s time to go, listen! 

4. Treat yourself to a monthly subscription box 

I love getting mystery packages in the mail! It’s akin to receiving a care package when you’re a kid at summer camp. And when it comes to subscription boxes, there are many to choose from. Currently, I subscribe to four: Ispy (5 makeup samples in a cute makeup bag for $10), PLAY! by Sephora (5-6 makeup samples for $10), Trendsend (5-8 clothing items and no styling fee!), and StitchFix (a mix of 5 clothing items, shoes, and accessories with a $20 styling fee – fee is deducted from total).

Subscription boxes are fun and a great way for me to build a professional wardrobe and to try new makeup products. (Disclaimer: I receive a referral bonus if you sign up for a subscription service via one of my links.)

5. Sort through childhood toys or photos

Allow yourself time to reminisce. My sister and I recently went through a box of old dolls and stuffed animals; it was the most fun I’ve had in a long time. It released a flood of happy memories and it felt great to laugh. (We chuckled over my Barbie dolls, which all had short, spiky hair; I was a very literal child, so when my sister declared “Barbie haircut day,” I took it to heart. My sister, on the other hand, only pretended to snip her Barbies’ hair. I cried rivers that day.)

I also enjoy looking at old family photos. See below for a pic from the year my mom went on a mission to create the perfect Christmas photo letter (the kind moms send out to impress relatives and old friends). “Fred the Christmas Goose” didn’t make the cut.

6. Create something

Practicing holistic self-care means stretching your mind; you benefit from the challenge. Avoid stagnation by stepping outside your comfort zone. Feed your creative side by building a chair, writing a song, painting a picture, knitting a scarf, or putting together a model.

Personally, I enjoy creating art; while not entirely lacking in talent, I’m no Picasso. Most of my projects are equivalent to the work one would accredit to a moderately talented 8-year old. Every once in awhile, I’m pleasantly surprised. (See below for a sketch I posted on Instagram.) Drawing or painting elicits a sense of accomplishment; it’s something I feel good about. Acknowledging your contributions builds self-esteem and confidence.

7. Engage with a stranger, an acquaintance, a friend, or a family member

Establishing meaningful human connection is essential for wellness. To make the most of this tip, try something you normally wouldn’t. (For example, chatting with a stranger is not my norm. To practice this tip, I’d strike up a conversation with my seatmate on a plane [providing, of course, that they’re open to friendly conversation.) Practicing self-care means building (or strengthening) connections. 

8. Go exploring 

As a child, nothing thrilled my soul quite like adventure; I explored by trampling through the woods behind my house, traversing streams and following hidden trails. My adventures often involved the discovery of “treasure,” an odd rock or ruins of some sort. Today, I’m just as adventurous; however, I spend less time crashing through woods and more time traveling the world.

Exploration promotes curiosity, which is essential for growth. If you’re not a fan of outdoor activities like hiking or backpacking, try exploring a city or neighborhood. Consider driving through unfamiliar developments. Explore restaurants or shops in your town. Whatever you decide, pursue it with the enthusiasm of the 6-year old adventurer you once were.

9. Redecorate your office or a room in your home to make it soothing, energizing, or inspiring

Every time you’re in the room, you’ll experience positive vibes. Paint the walls, add plants, declutter, hang a portrait, change the curtains, create a rock garden, etc. – whatever promotes positivity.

10. Change something about yourself

There’s a lot to be said for loving yourself, flaws and all. On the flip side, if there’s something you’re extremely unhappy with, consider changing it. If you’re overweight and have tried every sort of diet, but still can’t shed those pounds, talk to a doctor about weight loss surgery or schedule an appointment with a plastic surgeon. If you’re tired of feeling sluggish and lacking energy, adjust your sleep schedule, diet, and exercise routine (and make sure you see a doctor to rule out a medical issue). If you’re constantly broke, get a second job or find another way to bring in income; enroll in financial courses or schedule an appointment with a financial advisor.

Sometimes, self-care involves drastic change. If you’re deeply troubled over some aspect of your life, and it’s something you’re unable to accept, change it (while recognizing it will require work!) This is your life; take action.

Note: This tip is only for things you have control over; recognize what you can and cannot change. For example, I don’t like my flabby arms; if this bothered me enough, I could lift weights to develop muscle tone. I also dislike my neck; it’s not long enough. Unfortunately, short of brass neck coils (which border on self-harm), there’s nothing I can do. It’s not worth brooding over. (That being said, when contemplating any major change, especially ones involving surgery or substantial amounts of money, ask, “Is this change for me alone or am I seeking outside approval?” The essence of self-care is the self; it’s for you and you alone.)

11. Adopt a healthy habit (or quit a bad one) 

This idea embodies delayed-gratification self-care vs. instant-gratification self-care (i.e. sipping a mug of tea or gazing at the stars). And while both types of self-care are important, the rewards associated with a healthy habit are life-changing (vs. “mildly pleasant”).

According to research, there are five lifestyle habits associated with a low risk of illness and longer life expectancy. If you’re serious about self-care (and want more bang for your buck), adopt one (or all) of the following practices:

Eat a healthy diet

Exercise regularly

Maintain a healthy body weight

Drink alcohol in moderation (or not at all)

Don’t smoke

A healthy lifestyle is the foundation of self-care!

Share your favorite strategies for self-care in a comment!


 

Cassie Jewell, M.Ed., LPC, LSATP

Where Can I Find Help?

Where can you find the help you need? While there are plenty of resources out there for mental health and recovery, they’re not always easy to find… or affordable. (Plus, the Internet is full of scams!) This article is a starting point for getting help when you aren’t sure where to turn. This post offers practical guidelines; all of the resources in this article are trustworthy and reliable… and will point you in the right direction.

This post is not comprehensive; rather, it is a starting point for getting the help you need. There are plenty of resources out there for mental health and recovery, but it is not always easy (or affordable) to find help. The resources in this post are trustworthy and reliable… and will point you in the right direction so you can find help.

If you need treatment for mental distress or substance use, but are not sure how to find it…

If you have insurance, check your insurer’s website.

For substance use and mental health disorders, you can access the SAMHSA treatment locator. You can find buprenorphine treatment (medication-assisted treatment for opioid addiction) through SAMHSA as well.

Consider using Mental Health America’s interactive tool, Where to Get Help. NeedyMeds.org also has a locator to help you find low-cost mental health and substance abuse clinics.

Additionally, you could contact your local Mental Health America Affiliate for advice and/or referrals.

If you cannot afford therapy…

EAP (employee assistance programs) frequently offer free (time-limited) counseling sessions.

At campus counseling centers, grad students sometimes offer free or low-cost services.

You could look into community mental health centers or local churches (pastoral counseling).

In some areas, you may be able to find pro bono counseling services. (Google “pro bono counseling” or “free therapy.”) You may also be able to connect with a peer specialist or counselor (for free) instead of seeing a licensed therapist.

As an alternative to individual counseling, you could attend a support group (self-help) or therapy group; check hospitals, churches, and community centers. The DBSA peer-lead support group locator tool will help you find local support groups. Meetup.com may also have support group options.

Additional alternatives: Consider online forums or communities. Watch or read self-help materials. Buy a workbook (such as The Cognitive Behavioral Workbook for Depression: A Step-By-Step Program) from amazon.com. Download a therapy app.

Lastly, you could attend a free workshop or class at a local church, the library, a college or university, a community agency, or a hospital.

If you’re under 18 and need help, but your parents will not let you see a counselor (or “do not believe in therapy”)…

Some, but not all, states require parental consent for adolescents to participate in therapy. Start by looking up the laws in your state. You may be able to see a treatment provider without consent from a legal guardian. If your state is one that mandates consent, consider scheduling an appointment with your school counselor. In many schools, school counseling is considered a regular educational service and does not require parental consent.

Self-help groups, while not a substitute for mental health treatment, provide a venue for sharing your problems in a supportive environment. (If you suffer from a mental health condition, use NAMI to locate a support group in your state. If you struggle with addiction, consider AA or NA.)

Alternatively, you could join an online forum or group. (Mental Health America offers an online community with over 1 million users and NAMI offers OK2Talk, an online community for adolescents and young adults.)

You could also contact a Mental Health America Affiliate who would be able to tell you about local resources and additional options.

If you are in crisis, call the Boys Town Hotline at 1-800-448-3000 or the National Suicide Prevention Hotline at 1-800-273-TALK. Alternatively, you can text HOME to 741741 to text with a trained crisis counselor.

Lastly, consider talking with your pastor or a trusted teacher, reading self-help materials, downloading a therapy app, journaling, meditation or relaxation techniques, exercising, or therapy podcasts/videos.

If a loved one or friend says they are going to kill themselves, but refuses help…

Call 911. If you are with that person, stay with them until help arrives.

If you are thinking about or planning suicide…

Call the National Suicide Prevention Lifeline or Veterans Crisis Line. Alternatively, you can text HOME to 741741 to text with a trained crisis counselor. Call 911 if you think you might act. 

If you are grieving…

Check local hospitals and churches for grief support groups; some areas may have nonprofits that offer free services, such as Let Haven Help or Community Grief and Loss Center in Northern Virginia.

Additionally, a funeral home or hospice center may be able to provide resources.

If you are a veteran, you and your family should be able to access free counseling through the VA.

The Compassionate Friends offers support after the loss of a child. Call for a customized package of bereavement materials (at no charge) or find a support group (in-person or online).

GRASP is a grief and recovery support network for those who have lost a loved one through substance use. You can find suicide support groups using the American Association of Suicidology’s directory or the American Foundation for Suicide Prevention’s support group locator.

Hello Grief provides resources and education for children and adolescents who are grieving.

There are also online communities, forums, and support groups, including groups for suicide survivors such as Alliance of Hope and Parents of Suicides – Friends and Families of Suicides.

If you are a victim of sexual assault or domestic violence…

If you are sexually assaulted, call 911 or the National Sexual Assault Hotline at 1-800-656-4673 (or live chat). Find help and resources at National Sexual Violence Resource Center.

For male survivors of sexual abuse: MaleSurvivors.org

For domestic violence: The National Domestic Violence Hotline

For gender-based violence: VAWnet

For teen dating abuse: LoveIsRespect or Break The Cycle

LGBTQ: National Coalition of Anti-Violence Programs for LGBT Communities

If you’re a victim of sex trafficking…

Access Coalition to Abolish Slavery and Trafficking or call National Human Trafficking Hotline at 1-888-373-7888 (or text 233733).

If you’re a victim of stalking…

If you believe you are in immediate danger, call 911. Find help and info at Stalking Resource Center and Stalking Awareness Month.

If you can’t stop gambling…

Call or text the National Problem Gambling Helpline at 1-800-522-4700. Access screening tools and treatment at National Council on Problem Gambling. Attend a Gamblers Anonymous Group or other support group for problem gambling.

If you or a loved one has an eating disorder…

If you want to approach a loved one about his or her eating disorder, start by reading some guidelines (such as Helping Someone with an Eating Disorder from HelpGuide.org).

Contact the National Eating Disorders Helpline at 1-800-931-2237. (Alternatively, there’s a “live chat” option.) For support, resources, screening tools, and treatment options, explore the National Eating Disorder Association site.

Find support groups, recovery tools, and local treatment centers at Eating Disorder Hope.

Attend an Eating Disorders Anonymous meeting (in-person or online). You may also want to consider an Overeaters Anonymous meeting.

If you are engaging in self-harm and can’t stop…

Call 1-800-DONT-CUT or attend an online support group, such as Self Mutilators Anonymous.

Read personal stories, learn coping skills, and access resources at Self-injury Outreach and Support.

Join an online community like RecoverYourLife.com.

Try one of these 146 things to do instead of engaging in self-harm from the Adolescent Self Injury Foundation.

If you’re concerned about the drinking or drug use of a friend or family member, but they don’t want help…

If you’re considering staging an intervention, know that there’s little to no evidence to support the effectiveness of this tactic. 

Instead, read guidelines for approaching the issue (like What to Do If Your Adult Friend or Loved One Has a Problem with Drugs or How to Talk about Addiction). Learn everything that you can about addiction. Explore treatment centers in the area; if your loved one changes their mind, you’ll be prepared to help.

Explore Learn to Cope, a peer-led support network for families coping with the addiction of a loved one. Alternatively, you could attend Al-Anon or Nar-Anon.

Keep in mind that it’s almost impossible to help someone who doesn’t want it. You can’t control your loved one or force them into treatment. Instead, find a way to accept that there’s no logic to addiction; it’s a complex brain disorder and no amount of pleading, arguing, or “guilting” will change that.

If a friend or family member overdoses on heroin or other opioid…

Call 911 immediately.

How to recognize the signs of opiate overdose: Recognizing Opiate Overdose from Harm Reduction Coalition

You can receive free training to administer naloxone, which reverses an opioid overdose. Take an online training course at Get Naloxone Now. You can purchase naloxone OTC in most states at CVS or Walgreens.

For more information about how to respond to an opioid overdose, access SAMHSA’s Opioid Overdose Prevention Toolkit (for free).

If you want to quit smoking…

In addition to talking to your doctor about medication, the patch, and/or nicotine gum, visit Smoke FreeBe Tobacco Free, or Quit.com for resources, tools, and tips.

Call a smoking cessation hotline (like 1-800-QUIT-NOW) or live chat with a specialist, such as LiveHelp (National Cancer Institute).

Download a free app (like QuitNow! or Smoke Free) or sign up for a free texting program, like SmokefreeTXT, for extra support.

Attend an online workshop or participate in a smoking cessation course; your insurance provider may offer one or you may find classes at a local hospital or community center. You could also contact your EAP for additional resources.

If you or a loved one have a hoarding problem…

Read guidelines for approaching a hoarding issue with someone such as Hoarding: How to Help a Friend.

Learn more about hoarding and find help (support groups, treatment, etc.) at Hoarding: Help for Hoarding.

If your therapist is making unwanted sexual remarks/advances…

Contact the licensing board to file a complaint. Each state has a different licensing board. Additionally, contact the therapist’s professional association (i.e. American Counseling AssociationAmerican Psychological Association, etc.) Provide your name, address, and telephone number (unless filing anonymously). Identify the practitioner you are reporting by his or her full name and license type. Provide a detailed summary of your concerns. Attach copies (not originals) of documents relating to your concerns, if applicable.

Read NAMI’s How Do I File a Complaint against a Mental Health Care Facility or Professional?

If you want to take a confidential online assessment for mental health or substance use disorders…

Free and anonymous screenings: Screening for Mental Health, Inc. or Depression and Bipolar Support Alliance Mental Health Screening

For additional sites, self-help guides, literature, etc., check out the resource page.

If you know of a great resource, post in the comments below!


Cassie Jewell, M.Ed., LPC, LSATP

We Only Get One Body in Life

“We only get one body in life, so it makes sense to treat it well by fueling it with nutritious foods.” An interview with Dr. Lisal Folsom, who discusses optimal health, nutrition, and sustainable weight loss.

Interview: We Only Get One Body (An Endocrinologist’s Thoughts On Health and Sustainable Loss)

On a typical day, what are your patients’ complaints and how do you resolve them?

As an endocrinologist, I care for patients with all types of gland and hormone disorders. The most common reasons patients come to see me include diabetes (both type 1 and type 2), concerns about growth and puberty, thyroid dysfunction, hirsutism (unwanted hair growth), polycystic ovarian syndrome, and adrenal disorders. I also provide gender-affirming hormone therapy for transgender individuals. Depending on the patient’s symptoms and diagnosis, I may order lab tests and/or radiology studies such as thyroid ultrasounds or bone age xrays as part of my evaluation. Once we have a diagnosis, I work with the patient to create a personalized plan for treatment and follow up.

What about common questions or concerns?

Regardless of the reason they’ve come to see me, many patients are concerned about fatigue and weight gain. Everyone loves to blame these symptoms on the thyroid gland, but there are many other possible contributors to both fatigue and weight gain, including lack of quality sleep, sleep apnea, suboptimal eating habits, and infrequent exercise.

How does diet impact health?

A balanced diet and good nutrition are essential for optimal health. The only way to nourish and fuel our bodies is through food, and multiple studies have shown the benefits of good nutrition on health.

People who eat a diet composed of fruits and vegetables, whole grains, and lean proteins have lower blood pressure, better cholesterol, and decreased risk of obesity than those who follow a typical Western diet. There is a lot of research going on right now investigating the health effects of switching to a whole foods plant-based diet. A study comparing gut bacteria found that individuals following vegan and vegetarian diets had a more diverse selection of microbes in the intestines, which can lead to better health. Another study published in Clinical Nutrition this year found that people with high cholesterol had improvement in their cholesterol numbers when they followed a whole foods plant-based diet. Their cholesterol worsened when they switched back to a diet containing animal products and refined carbohydrates.

We only get one body in life, so it makes sense to treat it well by fueling it with the healthiest, most nutritious foods.

What are the main risk factors for diabetes?

Type 2 diabetes is an acquired metabolic disease associated with insulin resistance and high blood sugars. Until relatively recently this was a disease of adults, but in the past few years more and more children have been diagnosed with type 2 diabetes as well, partly because of the increase in obesity.

Risk factors for developing type 2 diabetes include being overweight or obese, carrying extra weight in the abdominal area, lack of regular physical activity, a family history of type 2 diabetes, and being diagnosed with prediabetes. Gestational diabetes during pregnancy is also a risk factor for developing type 2 diabetes later on.

A person will not necessarily develop type 2 diabetes just by eating a lot of sugar, but a long-standing pattern of unhealthy eating, lack of exercise, and weight gain will certainly increase the risk of developing type 2 diabetes down the road.

Can diabetes be treated with lifestyle changes?

Lifestyle changes are vital in diabetes treatment! Medicines can help to lower blood sugar, but the underlying cause of type 2 diabetes is insulin resistance, which is exacerbated by weight and lack of regular activity. We know that people who exercise on a regular basis tend to have lower blood pressure, better cholesterol, and are more likely to be at a weight considered to be healthy, than people who don’t exercise often. Part of the reason for this is that exercise improves the body’s sensitivity to insulin. When we exercise, our bodies don’t have to work as hard to turn the food we eat into energy and fuel for our cells.

Studies have shown that people with type 2 diabetes who exercise after a meal have lower blood sugar levels than those who don’t. Exercise and a healthy diet are important for everyone, but these elements are especially crucial for people who are looking to improve their health.

Which is worse: Fat or sugar?

Ooh – tough question. I would say both and neither. Both fats and sugars come in healthy and unhealthy forms. Omega-3, polyunsaturated, and monounsaturated fatty acids help lower cholesterol and decrease the risk of heart disease. These healthy fats are found in nuts, peanut butter, avocados, flaxseed, and olive, canola, and soybean oils. Some eggs contain omega-3 fatty acids as well, depending on whether the chickens that laid them were given supplementation. Unhealthy fats include saturated and trans fats. These types of fats are found in fatty cuts of meat, poultry skin, fried foods, high fat dairy products, processed and prepackaged foods, and solid oils such as shortening and lard.

Healthy sugars include those occurring naturally in fruits and vegetables. A good rule of thumb is to try to choose foods that are as close to their natural state as possible. For example, when you eat an apple, rather than drinking apple juice, you get the added benefits of the fiber from the apple, and vitamins from the skin. These added health benefits of eating whole fruits and vegetables allow the sugars to be absorbed more gradually by your body, and are lost when foods are processed.

What is one food you’d never eat and why?

Cracklins. This southern delicacy consists of fried pieces of pork fat and skin, flavored with Cajun spices. Although I’m sure they’re very tasty, they’re also oozing with saturated and trans fats, contain almost 500 calories per serving, and are high in sodium. You could eat an entire avocado and two slices of whole wheat toast for fewer calories. This alternative snack is not only delicious, it also comes with the added benefits of healthy fats, whole grains, and fiber.

If given the opportunity, is there anything you’d change about the current dietary recommendations?

The current dietary guidelines are a good place to start. They recommend eating a variety of fruits and vegetables, making at least half of our grains whole, and limiting saturated and trans fats, added sugars, and sodium. I wish they went a little further though, by emphasizing the health benefits of whole rather than processed foods, and offering alternative options for people looking to follow a plant-based diet. There are some really great dairy alternatives out there, including nut milks (almond, cashew, macadamia), soymilk, plant protein products, and tofu. Many of these are made without added sugar, and are fortified with calcium and vitamin D, so the nutritional content is quite similar to the animal-based versions.

What are your thoughts on the obesity epidemic in America?

Obesity is a growing problem in our country, and it’s going to keep getting worse unless we as a society make some major changes. Obesity is a multifactorial disease, with many different levels of influence. Personal dietary choices have a role of course, but so does the environment in which people live. If a family lives in a food desert, and the only place to buy groceries is the convenience store where one banana and a 6-pack of ramen noodles each cost $1, parents are veritably forced to choose the less healthy, but inexpensive and filling options to feed their children. Many children in the U.S. eat both breakfast and lunch at school through the federally subsidized National School Lunch Program. This program is underfunded, and as such is unable to provide the highest quality, most nutritious food for the children who need it most.

There are so many barriers to optimal health that exist at societal and cultural levels; it’s going to take a lot of work to tackle obesity. It’s possible, but change will need to happen from the top down.

What advice do you give to patients who are trying to lose weight?

At the end of the day it’s all about math: Energy in = energy out. If we put more calories into our bodies than we burn, our weight will go up. Alternatively, if we burn more calories than we eat, our weight will go down.

Metabolism plays a role, certainly, and we all know people who can eat a dozen donuts without gaining a pound, which is just not fair, but overall consistent, purposeful, portion control is the key to sustainable weight loss.

Exercise helps, but it’s really hard to burn enough calories by exercising to offset what we eat. A typical adult woman walking on a treadmill for 30 minutes burns around 150 calories. As a comparison, a pint of Ben & Jerry’s Chunky Money contains 1,160 calories. You would need to spend nearly 4 hours on the treadmill to burn off that pint of deliciousness, and nobody has time for that. It makes more sense to limit your total calorie intake through portion control and careful meal planning.

Everyone should have a treat now and then, just plan for them ahead of time and pay attention to the nutrition label including serving size.

What’s one thing you wish everyone knew about hormones?

It’s probably not your thyroid. Seriously though, endocrinology is an amazing branch of medicine. Since our glands make hormones that then flow into the bloodstream, they have effects on so many different parts of the body. Endocrinologists have to consider the entire person when making a diagnosis, and this makes the field both challenging and exciting.

As an endocrinologist, what are the most useful things you’ve learned?

Weight loss is hard, but possible. Diabetes sucks, but you are strong, so don’t let it take over your life. Everybody loves to talk about food. Patients and physicians work best as a team. Good health is priceless.


Interviewer: Cassie Jewell, M.Ed., LPC

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Dr. Lisal Folsom is a board-certified physician who specializes in endocrinology, diabetes, and metabolism. She also provides gender-affirming hormone therapy for transgender individuals. Dr. Folsom’s medical research has been published in the academic journals Endocrine Practice, The Journal of the South Carolina Medical Association, Current Osteoporosis Reports, Journal of Adolescent Health, and Endocrinology & Metabolism Clinics. She has been practicing for nine years.

Sleep Deprivation: What Dreams May… Cure?

What happens to your mind and body when you’re sleep-deprived? Poor-quality sleep is linked to a variety of health conditions, including obesity and heart disease. Poor sleep leads to cognitive impairment and poor judgment. A lack of sleep can even lead to schizophrenia-like symptoms! Learn why sleep is essential for health and well-being.

According to the American Academy of Sleep Medicine, about 10% of Americans struggle with chronic insomnia and up to 35% of Americans experience insomnia at least occasionally. I’m part of the 10%. I’ve spent countless nights tossing and turning, dreading the obnoxious sound of “quantum bells” (my cell phone alarm) as daylight slowly creeps in. Due to this, I’ve done quite a bit of research on the subject. (And as a clinician, it’s important for me to know the relationship between restful sleep and mental health so I can educate my clients.)

Sleep recharges us; it makes it possible for us to remember what we learned throughout the day.

We all know that basic sleep hygiene is essential (i.e. having a regular sleep schedule, refraining from watching TV or reading in bed, avoiding alcohol before bedtime, etc.) And if you struggle with insomnia, you’ve probably heard of sleep medications and supplements like Ambien, trazodone, or melatonin. We also know how vital sleep is to health and wellness. Sleep significantly impacts mood, energy levels, and overall well-being. Sleep recharges us; it makes it possible for us to remember what we learned throughout the day.

Knowing how crucial sleep is for both physical and mental fitness, I set out to explore what happens when we don’t get enough. What exactly does a lack of sleep do to a person? I sifted through the research to learn more about the impact of sleep deprivation. This post explores how sleep deprivation affects physical health, perceptions, memory, and critical thinking.

SLEEP AND YOUR PHYSICAL HEALTH

Sleep deprivation is associated with signs of aging

Sleep deprivation has been linked to aging skin. One study found that poor-quality sleepers had more fine lines, uneven pigmentation, and reduced elasticity.

It makes sense that chronic sleep deprivation is associated with signs of aging; sleep is needed for overall rejuvenation (mind and body), which includes skin cell renewal. For smooth and supple skin, high-quality sleep is essential.

Snoring and sleep deprivation are linked to obesity

A 2016 study looked at the relationship between sleep characteristics and body size/weight. Snoring was associated with having a higher BMI, a larger waist, and more body fat. (It should be noted that snoring doesn’t cause obesity; the two are simply related.)

Poor sleep quality and shorter durations of sleep were linked to larger body size and more body fat. The relationship between sleep and obesity is further explored in the next few paragraphs.

Sleep deprivation is related to weight loss and appetite

If you’re dieting, you’re more likely to lose body fat when you’re getting adequate sleep. Researchers studied participants who slept for either an average of seven and a half hours or five and a quarter hours per night over a 14-day period. Calorie consumption was the same; participants lost similar amounts of weight. However, when participants slept more, they lost more body fat; in fact, about half of the weight they lost was fat. Sleep-deprived participants lost only a pound of fat; the other five pounds were fat-free body mass. Furthermore, it was found that sleep helps with appetite control; this is due to ghrelin, a hormone that stimulates appetite and promotes fat storage. Sleep-deprived participants had higher levels of ghrelin.

If you’re watching what you eat, incorporate healthy sleep habits to maximize your efforts; adequate sleep is needed for optimal weight loss.

Sleep affects our food choices

Other studies have examined specific the ways sleep deprivation affects food choices and calorie intake. Sleep deprivation is associated with especially poor food choices the day following poor-quality or no sleep. One study found that sleep deprivation led to strong cravings for junk food. The researchers measured increased activity in the part of the brain that responds to rewards, but decreased activity in the “decision-making” part of the brain. Study participants choose unhealthy items (i.e. pizza, donuts) over fruits and vegetables.

Another study looked at total calorie intake; sleep-deprived participants consumed an extra 385 calories per day. They also ate higher-fat foods. Additionally, researchers found that a sleep-deprived person purchased items that were higher in calories when grocery shopping.

A 2016 study looked at the relationship between sleep deprivation and the consumption of high-calorie, sugar-sweetened caffeinated beverages in a sample of 18,000 adults. It was found that adults who averaged less than five hours of sleep per night were more likely to consume sugary drinks like soda or energy drinks than their well-rested counterparts. The researchers weren’t able to determine whether drinking caffeinated beverages caused people to sleep less or whether being sleep-deprived caused people to crave more sugar and caffeine; it’s likely that both are true.

Without high-quality sleep, it’s difficult to lose body fat.

Regarding obesity, sleep deprivation plays a significant role. A lack of sleep causes us to feel hungry. We crave junk foods and consume more calories. At the same time, sleep deprivation promotes fat storage while decreasing our energy levels. Without high-quality sleep, it’s difficult to lose body fat.

If you struggle with chronic insomnia, make an active decision to make healthy eating a habit; you’ll be less likely to submit to your cravings. Visit the grocery store only when you’re well-rested. Know that you may not feel like exercising; practice determination. Be mindful to counter some of the health risks associated with sleep deprivation.

Sleep deprivation is related to heart disease, hypertension, and stroke (especially if you’re a woman)

In addition to obesity, sleep deprivation is associated with heart disease, high blood pressure, diabetes, and stroke. A lack of sleep takes a toll on the heart. In a recent study, researchers looked at 24-hour shift workers. It was found that sleep deprivation led to a significant increase in cardiac contractility, blood pressure, and heart rate. Furthermore, study participants experienced thyroid changes and an increase in cortisol (the stress hormone).

Research also indicates that chronic sleep deprivation and disrupted sleep are linked to an increased risk of developing or dying from coronary heart disease or stroke. Diabetes and hypertension are associated with sleep deprivation as well.

A lack of sleep may impact women more than men. Researchers found that women who got less than eight hours of sleep per night were at a higher risk of heart disease and other heart-related problems when compared to men who got the same amount of sleep.

Chronic sleep deprivation is related to reduced immune function

Have you ever noticed that you heal slowly or get sick more often when you’re sleep deprived? According to research, chronic sleep deprivation is associated with reduced immune function. If you’re not regularly getting at least six to seven hours of sleep, you’re more susceptible to illness. Your immune system won’t be as effective at eliminating viruses and bacterial infections.

Chronic sleep deprivation is associated with bone loss

Sleep even affects your bones. One study found that chronic sleep deprivation was associated with a loss of bone mass (in rats, at least). The rats underwent sleep restriction measures for three months. A lack of sleep led to significant decreases in bone density, volume, and thickness.

SLEEP AND YOUR BRAIN

Sleep deprivation is associated with increased pain sensitivity

The first part of this post examined sleep’s impact on physical health; the next half will explore how sleep affects the mind, including the way we sense and perceive the world around us. Research indicates that sleep deprivation and/or disruption increase sensitivity to pain. Interestingly, in one study, stimulants like caffeine had the ability to “normalize” the pain sensation (meaning it would feel the way it would with adequate sleep).

Sleep and chronic pain seem to be intricately connected, but the relationship is not fully understood; up to 88% of individuals with chronic pain report sleep issues and nearly 50% of individuals with insomnia have chronic pain..

A lack of sleep affects the way you hear and process sounds

In addition to the sensation of touch, sleep deprivation affects the perception of sound. A lack of sleep impairs central auditory processing (CAP). CAP is crucial for aspects of hearing such as language comprehension, identifying sounds, and recognizing patterns.

In one study, participants took a longer time identifying sounds after being deprived of sleep for 24 hours. It appeared there was a “transfer delay” (from hearing to identifying and then interpreting). To be effective, CAP requires alertness and concentration.

Sleep deprivation affects the formation of memories

We know that sleep deprivation causes cognitive impairment; the brain can only store so much information before it must recalibrate. During sleep, memories are encoded; the brain “consolidates” memories by strengthening them and transforming them from short-term into long-term memories. Without sleep, long-term memories can’t form. Short-term memories are lost and/or altered. Even procedural memories are impacted by sleep deprivation. A lack of sleep leads to forgetfulness and an inability to retain new information.

Sleep affects the way we interpret emotions

Sleep deprivation impairs your ability to interpret facial expressions. A recent study found that a lack of sleep made it difficult for participants to recognize the facial expressions of happiness or sadness. Interestingly, the ability to detect anger, fear, surprise and disgust was not affected. This suggests we’re biologically wired to recognize the emotions related to survival. The researchers hypothesized that the brain preserves functions that perceive life-threatening stimuli while sacrificing functions associated with empathy, bonding, and friendship.

“Real life” implications: If you’re majorly sleep-deprived, you could misinterpret the intentions of others, negatively impacting relationships with co-workers, family, friends, and others. Furthermore, you could read people wrong or miss important social cues; you might not respond appropriately or you could seem lacking in empathy.

When someone is sleep deprived, they’re slower to adopt another’s perspective

In addition to perception and memory formation, sleep deprivation impacts decision-making skills and thoughts, including the ability to accurately assess a situation.

If you have chronic insomnia, you might experience interpersonal problems.

In 2015, researchers hypothesized that sleep deprivation would impair the capacity to recognize sarcasm. Study results didn’t support the hypothesis, but the research generated an unexpected outcome. It was found that someone who was sleep-deprived was slower to adopt another person’s perspective. Implications? If you have chronic insomnia, you might experience interpersonal problems.

Sleep deprivation affects our moral judgment

Sleep deprivation affects moral judgment. In one study, participants were sleep deprived (awake for 53 continuous hours) and then faced with moral dilemmas. They had difficulty solving the dilemmas and making appropriate judgments. Other studies support this as well; a lack of sleep is related to decreased moral awareness. When you’re faced with a tough decision, especially one that involves ethics or morals, be sure to get adequate sleep. You can’t always trust your moral compass.

Sleep deprivation is linked to impaired decision making

Moral decisions are taxing if you’re sleep deprived… the opposite is true with risky ones. Sleep deprivation alters areas in the brain that assess positive and negative outcomes; sensitivity to rewards is enhanced while attention to negative consequences is diminished.

If you haven’t slept, tough decisions can wait.

Researchers found that when gambling, sleep-deprived individuals were more optimistic about their odds of winning. Another study found that sleep deprivation made it difficult for study participants to come to a quick decision when pressured. Sleep-deprived participants also made more mistakes. If you haven’t slept, tough decisions can wait.

A lack of sleep affects optimism

If you’re not getting enough sleep, you could lose your ability to remain positive-minded. Research indicates that individuals with insomnia have lower rates of self-esteem and optimism. In 2017, researchers found that sleep-deprived study participants were less likely to focus on positive stimuli. An inability to think positively is also a symptom of depression.

A lack of sleep can lead to schizophrenia-like symptoms

Sleep deprivation can lead to perceptual distortions, cognitive disorganization, and anhedonia (an inability to feel pleasure).In a 2014 study, participants experienced psychosis after staying awake for 24 hours. The sleep-deprived individuals reported attention deficits and being more sensitive to light, color, and brightness. They exhibited disorganized speech, which is a common symptom of schizophrenia. Participants also reported an altered sense of time and smell. Some of them actually believed they were able to read thoughts; others noticed an altered body perception. Implications? If you miss a night (or two) of sleep, don’t be surprised when you hear voices or when your reality is somewhat altered.

Conclusion

In conclusion, sleep deprivation, especially when it’s chronic, is detrimental to your health. Based on my review of the research, poor-quality sleep can adversely impact your skin, your weight, your cardiovascular system, your immune system, and your bones. (It should be noted that I barely skimmed the surface of an immense body of scientific data on sleep.)

Sleep is also related to brain health. Sleep deprivation impairs sensory perceptions, memory formation, the ability to assess your environment, moral awareness, critical thinking skills, and mood. Sleep deprivation can even induce psychosis.

If you’re like me (the one out of 10 Americans with chronic insomnia), in addition to practicing good sleep hygiene, go ahead and Google “CBT for sleep.” Research suggests that for some, CBT is more effective and longer-lasting than sleep medication. Do a little bit of research. CBT is not a quick fix for insomnia, but it’s worth a try; and your health and wellness are definitely worth it!

Cassie Jewell, M.Ed., LPC


  • References
  • Alexandre, C., Latremoliere, A., Ferreira, A., Miracca, G., Yamamoto, M., Scammell, T. E., &, Woolf, C. (2017). Decreased alertness due to sleep loss increases pain sensitivity in mice. Nature Medicine, 23(6), 768–774. http://doi.org/10.1038/nm.4329
  • American Academy of Sleep Medicine. (2009, June 16). Cognitive Behavioral Therapy Is An Effective Treatment For Chronic Insomnia. ScienceDaily. Retrieved February 21, 2018 from www.sciencedaily.com/releases/2009/06/090609072709.htm
  • American Academy of Sleep Medicine. (2007, March 2). Sleep Deprivation Affects Moral Judgment, Study Finds. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2007/03/070301081831.htm
  • Cappuccio, F., Cooper, D., D’Elia, L., Strazzullo, P., &, Miller, M. (2011). Sleep duration predicts cardiovascular outcomes: A systematic review and meta-analysis of prospective studies. European Heart Journal, DOI: 10.1093/eurheartj/ehr007
  • Chapman, C., Nilsson, E., Nilsson, V., Cedernaes, J, Rångtell, F., Vogel, H., Dickson, S., Broman, J., Hogenkamp, P., Schiöth, H., &, Benedict, C. (2013). Acute sleep deprivation increases food purchasing in men. Obesity, DOI: 10.1002/oby.20579
  • Deliens, G., Stercq, F., Mary, A., Slama, H., Cleeremans, A., Peigneux, P., &, Kissine, M. (2015). Impact of acute sleep deprivation on sarcasm detection. PLoS ONE, 10(11). e0140527. http://doi.org/10.1371/journal.pone.0140527
  • Diering, G., Nirujogi, R., Roth, R., Worley, P., Pandey, A., &, Huganir, R. (2017). Homer1a drives homeostatic scaling-down of excitatory synapses during sleep. Science, DOI: 10.1126/science.aai8355
  • eLife. (2016, August 23). How sleep deprivation harms memory. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2016/08/160823125219.htm
  • Finan, P., Goodin, B., &, Smith, M. (2013). The association of sleep and pain: An update and a path forward. The Journal of Pain: Official Journal of the American Pain Society, 14(12), 1539–1552. http://doi.org/10.1016/j.jpain.2013.08.007
  • Gharib et al. (2017). Transcriptional signatures of sleep duration discordance in monozygotic twins. Sleep, DOI: 10.1093/sleep/zsw019
  • Greer, S., Goldstein, A., &, Walker, M. (2013). The impact of sleep deprivation on food desire in the human brain. Nature Communications, 4 DOI: 10.1038/ncomms3259
  • Havekes, R., Park, A., Tudor, J., Luczak, V., Hansen, R., Ferri, S., Bruinenberg, V., Poplawski, S., Day, J., Aton, S., Radwańska, K., Meerlo, P., Houslay, M., Baillie, G., &, Abel, T. (2016). Sleep deprivation causes memory deficits by negatively impacting neuronal connectivity in hippocampal area CA1. eLife, 5 DOI: 10.7554/eLife.13424
  • Johns Hopkins Medicine. (2017, February 2). Sleep deprivation handicaps the brain’s ability to form new memories, mouse study shows: Chemical recalibration of brain cells during sleep is crucial for learning, and sleeping pills may sabotage it. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2017/02/170202141916.htm
  • Khatib, H., Harding, S., Darzi, J., &, Pot, G. (2016). The effects of partial sleep deprivation on energy balance: a systematic review and meta-analysis. European Journal of Clinical Nutrition, DOI: 10.1038/ejcn.2016.201
  • Killgore, W., Balkin, T., Yarnell, A., &, Capaldi, V. (2017). Sleep deprivation impairs recognition of specific emotions. Neurobiology of Sleep and Circadian Rhythms, 3(10) DOI: 10.1016/j.nbscr.2017.01.001
  • King’s College London. (2016, November 2). Sleep deprivation may cause people to eat more calories. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2016/11/161102130724.htm
  • Knutson, K. (2012). Does inadequate sleep play a role in vulnerability to obesity? American Journal of Human Biology, 24(3), 361. DOI: 10.1002/ajhb.22219
  • Liberalesso, P., D’Andrea, K., Cordeiro, M., Zeigelboim, B., Marques, J., &, Jurkiewicz, A. (2012). Effects of sleep deprivation on central auditory processing. BMC Neuroscience, 13(83). http://doi.org/10.1186/1471-2202-13-83
  • Mitchell, M. D., Gehrman, P., Perlis, M., &, Umscheid, C. A. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: A systematic review. BMC Family Practice, 13(40). http://doi.org/10.1186/1471-2296-13-40
  • Perelman School of Medicine at the University of Pennsylvania. (2017, July 17). You’re not yourself when you’re sleepy. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2017/07/170717120048.htm
  • Petrovsky, N., Ettinger, U., Hill, A., Frenzel, L, Meyhofer, I., Wagner, M., Backhaus, J., &, Kumari, V. (2014). Sleep deprivation disrupts prepulse inhibition and induces psychosis-like symptoms in healthy humans. Journal of Neuroscience, 34(27): 9134 DOI: 10.1523/JNEUROSCI.0904-14.2014
  • Prather, A., Leung, C., Adler, N., Ritchie, L., Laraia, B., &, Epel, E. (2016). Short and sweet: Associations between self-reported sleep duration and sugar-sweetened beverage consumption among adults in the United States. Sleep Health, DOI: 10.1016/j.sleh.2016.09.007
  • Radiological Society of North America. (2016, December 2). Short-term sleep deprivation affects heart function. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2016/12/161202100943.htm
  • Universität Bonn. (2014, July 7). Sleep deprivation leads to symptoms of schizophrenia, research shows. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2014/07/140707121415.htm
  • University Hospitals Case Medical Center. (2013, July 23). Sleep deprivation linked to aging skin, study suggests. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2013/07/130723155002.htm
  • University of Arizona. (2017, March 23). Sleep deprivation impairs ability to interpret facial expressions. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2017/03/170323132524.htm
  • University of California – Berkeley. (2013, August 6). Sleep deprivation linked to junk food cravings. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2013/08/130806145542.htm
  • University of California – San Francisco. (2016, November 9). Shorter sleep linked to sugar-sweetened drink consumption: Treating sleep deprivation could potentially help reduce sugar intake. ScienceDaily. Retrieved March 8, 2018 from www.sciencedaily.com/releases/2016/11/161109112553.htm
  • University of Chicago Medical Center. (2010, October 5). Sleep loss limits fat loss. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2010/10/101004211637.htm
  • University of Warwick. “Lack Of Sleep Could Be More Dangerous For Women Than Men.” ScienceDailywww.sciencedaily.com/releases/2009/07/090701083523.htm
  • University of Warwick. (2011, February 8). Sleep deprivation: Late nights can lead to higher risk of strokes and heart attacks, study finds. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2011/02/110208091426.htm
  • University of Washington Health Sciences/UW Medicine. (2017, January 27). Chronic sleep deprivation suppresses immune system: Study one of first conducted outside of sleep lab. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2017/01/170127113010.htm
  • Washington State University. (2017, December 20). Seeing gene influencing performance of sleep-deprived people. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2017/12/171220153055.htm
  • Washington State University. (2015, May 7). Sleep loss impedes decision making in crisis, research shows. ScienceDaily. Retrieved February 21, 2018 from www.sciencedaily.com/releases/2015/05/150507165432.htm
  • Whitney, P., Hinson, J., Jackson, M., &, Van Dongen, H. (2015). Feedback blunting: Total sleep deprivation impairs decision making that requires updating based on feedback. SLEEP, DOI: 10.5665/sleep.4668
  • Wiley. (2013, September 5). Sleep deprivation increases food purchasing the next day. ScienceDaily. Retrieved March 6, 2018 from www.sciencedaily.com/releases/2013/09/130905113711.htm
  • Wiley-Blackwell. (2012, April 17). Lack of sleep is linked to obesity, new evidence shows. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2012/04/120417080350.htm
  • Xiao, Q., Gu, F., Caporaso, N., &, Matthews, C. (2016). Relationship between sleep characteristics and measures of body size and composition in a nationally-representative sample. BMC Obesity, 3(1).
  • Xu, X., Wang, L., Chen, L., Su, T., Zhang, Y., Wang, T., &, Zhang, Y. (2016). Effects of chronic sleep deprivation on bone mass and bone metabolism in rats. Journal of Orthopedic Surgery and Research, 11(87). http://doi.org/10.1186/s13018-016-0418-6

4 Key Statements That May Change Your Life

Therapy can lead to “light bulb” moments; everything suddenly clicks. This is a short list of 4 statements that “clicked” with my clients and inspired change.

Upon learning I’m a therapist, people often ask for advice. “What do you think I should do about making a change regarding [insert any imaginable life situation here]?”

I hate to disappoint, but I don’t have all the answers. Contrary to popular belief, a counselor won’t tell you how to fix your problems.

Keep in mind that you’re the expert on you. When you combine your knowledge with a therapist’s expertise on human behavior, a collaborative partnership is formed. The process of change begins. You hold the answers, but they’re locked. The process of therapy unlocks the mind.

There have been times in counseling sessions when something I say “clicks” with that person. They experience a moment of clarity or have a sudden realization.

The following list is four key statements that “clicked” with my clients (and for me as well!)

Four Key Statements that May Change Your Life

1. “Say what you mean.”

How many times have you provided an explanation using partial truths? For example, you cancel on a friend, claiming a migraine. Your head may hurt, but at the same time, you’re embarrassed to go to the bar with her. She can’t seem to go out without getting obnoxiously drunk. Another example would be a wife who tells her husband, “I’m fine,” when she’s not. In both examples, truth is avoided.

When you don’t say what you mean, you deprive yourself. You’ll feel frustrated, and you may lose the chance to explore deeper issues. Your communication becomes second-rate. And if you find yourself saying what you think someone wants to hear, that’s not communicating; the point is to understand each other, not to mislead or appease.

Saying what you mean is freeing and it allows you to live an authentic life.

2. “Just say, ‘okay.’”

This is about not engaging with that one person who pushes your buttons (or with your own irrational thoughts).

I’ll use myself as an example. I once received a stern email from my boss, instructing me to complete a task ASAP… a task I finished three days ago. Initially, I panicked, second guessing myself. But after double checking my work and finding it complete, I silently fumed to myself. Does my supervisor think I sit around doing nothing all day? (Or maybe he thinks I’m incompetent?) Why wouldn’t he check before sending an email? I drafted and then rewrote my response several times. I asked a co-worker to look it over and she laughed and asked, “Why didn’t you just tell him, ‘Okay’?” She was right. I had allowed my irrational self (and insecurities) to take over. The project was done, which is what mattered; there was no need for an emotionally-charged response. Another example would be a married couple who constantly fight. They argue to the point of shouting because neither wants the other to “win.”

If you link your self-concept to how others perceive you, the idea of admitting defeat threatens your identity. Instead of feeding into the argument, especially when you’re provoked, just say, “okay” and leave it at that. Furthermore, if there’s a toxic person in your life, for example, an ex that you co-parent with, don’t respond to a provoking text or to a barb. You gain nothing by proving you’re right (other than maybe a self-important spark of satisfaction). In the end, you’re still the loser because you took the bait and allowed someone else to orchestrate your emotions.

Don’t sacrifice your peace of mind; just say, “okay.”

3. “This is nothing you can’t handle.”

It may not seem like much, but this sentence can lay the foundation for change. A seemingly unsolvable problem is broken down into manageable solutions. A catastrophe becomes a challenge.

When faced with the impossible, we panic. Our emotional mind has all the control while our rational mind fades to the background. However, the rational mind can be coaxed from hiding with guidance.

The next time you feel helpless and are thinking, “This is impossible,” remind yourself it’s nothing you can’t handle. Once you’re in that mind frame, the solutions will come more easily.

4. “Always take ownership.”

This is about owning your actions, especially when you make a poor decision. You’re going to make mistakes. Don’t make excuses. Admit fault and apologize when needed.

I’ve counseled clients who made excuses for their wrongdoings, even their crimes. (“I wouldn’t have done it if it weren’t for [insert plausible reason here]”). By placing the blame on someone or something else, you stunt personal growth. You’ll continue to make the same mistakes, and it will never be your fault.

You can’t live an authentic life without taking ownership, nor will you gain the respect of others. Be authentic; take ownership of your mistakes (and achievements!)


If reading this list of key statements “sparked” something for you, think about the changes you want to make. Develop a change plan. And then take action!

Cassie Jewell, M.Ed., LPC

37 Things You Can Do for a More Meaningful Life

A unique list of 37 ideas for personal growth; simple (and fun!) ways to lead a a more fulfilling and meaningful life.

If we don’t strive to meet our goals and improve on a regular basis, we become stagnant. And if we aren’t growing and learning, our minds become lethargic.


According the Substance Abuse and Mental Health Administration (SAMHSA), there are eight dimensions of wellness:

1. Emotional—Coping effectively with life and creating satisfying relationships

2. Environmental—Good health by occupying pleasant, stimulating environments that support well-being

3. Financial—Satisfaction with current and future financial situations

4. Intellectual—Recognizing creative abilities and finding ways to expand knowledge and skills

5. Occupational—Personal satisfaction and enrichment from one’s work

6. Physical—Recognizing the need for physical activity, healthy foods, and sleep

7. Social—Developing a sense of connection, belonging, and a well-developed support system

8. Spiritual—Expanding a sense of purpose and meaning in life


Find additional SAMHSA links in the Links section of this site. SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation.


In order to maintain balance and live a meaningful life, it helps to have a variety of wellness strategies in your toolbox. The following list is comprised of 37 ideas for personal/professional development, self-improvement, and creating healthy habits.

37 Things You Can Do for a More Meaningful Life

1. Read one inspirational/motivational book per month or

2. Read one wellness article per week.

3. Take advantage of free classes offered at the library or through Coursera. (Coursera provides universal access to education by partnering with top universities and organizations.)

4. Take part in a new activity or event to step outside your comfort zone. (Examples: Join a book club, take a cooking class, attend a Meetup, etc.)

5. Make time for an old friend.

6. Develop an exercise routine, write it down, and then stick with it. No excuses!

7. Walk your dog (or borrow one from a friend!)

8. Complete household tasks and chores on a daily basis. Create a chore list. Don’t procrastinate!

9. Stay informed on the latest science and health news/research with sites like Science Daily.

10. Attend a workshop to learn about a topic you’re unfamiliar with.

11. Prioritize sleep hygiene.

12. Improve your posture. (And yes, there are apps for that!)

13. Read a non-fiction book.

14. Take a daily inventory; assess your attitude, productivity, etc. before going to bed.

15. Drink more water, green tea, and black coffee. (And drink less wine, beer, sugar-sweetened beverages, and soda!)

16. Practice active listening.

17. Overcome a fear.

18. Identify your “blind spots” by soliciting feedback from a trusted friend or loved one. They can help you to recognize areas for improvement by sharing their observations. (Example: You may not realize how often you complain until someone points it out for you.) Make a commitment to change.

19. Find a mentor (or be a mentor!)

20. Complete a 30-day challenge to improve your mental and/or physical health.

21. Live a meaningful life with daily meditation and mindfulness. Spend a few quiet moments alone every morning, drinking a cup of coffee. Or journal before going to bed. Reflect on your day and think about what you’re grateful for. Practice deep breathing exercises or listen to guided imagery scripts. Create your own unique ritual.

22. Dress up, style your hair, apply makeup, get a manicure/pedicure/facial, wear sexy shoes or your favorite jacket… Alternatively, you may prefer to put on your comfiest clothes, sweatpants or a fuzzy sweater. Whatever makes you feel good!

23. Be optimistic. Catch yourself if you start complaining and reframe your thoughts. Always assume positive intent.

24. Complete a task you’ve been putting off.

25. Watch a TED Talks.

26. Cook and enjoy a healthy meal.

27. Learn to juggle.

28. Learn a foreign language (or sign language).

29. Practice random acts of kindness, give a spontaneous gift, or help a stranger.

30. Create a vision board.

31. Volunteer.

32. Be a tourist in your hometown. (Free walking tours are often available in larger cities!)

33. Donate blood or plasma.

34. Memorize the lyrics to a song (or rap) of your choice.

35. Find a Pinterest project that interests you. Pin it and then do it!

36. Pick up trash in your neighborhood.

37. Write and mail “thinking of you” cards/postcards.


Additional Ideas: Run a 5K (or 10K!) Adopt an elderly pet that needs a home.


Comment with your best ideas for living a more meaningful life.

Cassie Jewell, M.Ed., LPC

30 Thirty-Day Challenges!!

A unique list of wellness-based thirty-day challenges.

There are plenty of 30-day challenges out there, but this post is unique in that all of the challenges listed are wellness-based. This is a list of 30 exciting ideas for thirty-day challenges.

30 Thirty-Day Challenges

Difficulty Level – Easy

1. Give one compliment per day

2. 30 days of flossing

3. Five minutes of mindful breathing every day

4. 30 days of gratitude journaling

5. Set sleep schedule for 30 days

6. 30 days of Matcha or green tea

7. Learn a new vocabulary word every day for 30 days

8. Daily act of kindness

9. Read a random Wikipedia article every day for 30 days

10. 30-day dog walk challenge

11. Write a daily poem or short story

12. No cursing for 30 days

13. Pray (or spend time in quiet reflection) every morning

14. Watch a TED Talks (or similar) every day

Difficulty Level – Medium

15. 30-day vegan challenge

16. 30 days of following a strict budget (no “wants,” only “needs”)

17. 30-day gym challenge

18. 30-day documentary challenge

19. 30-days of cleaning and organization; the decluttered home challenge

20. No fast food, no carryout, and no dining out for 30 days

21. Write a book chapter daily

Difficulty Level – Hard

22. 30-day art challenge (one drawing or painting per day)

23. 30-day Pinterest challenge (one Pinterest project a day)

24. No social media

25. 30 days of no caffeine, nicotine, alcohol, or other substances

26. No driving for a month

Difficulty Level – Nearly Impossible

27. No cell phone or Internet (except for work-related use); the 30-day unplugged challenge

28. One hour of daily exercise

29. 50 sits ups or crunches daily

30. Sugar-free challenge


Post your ideas for a 30-day challenge in a comment!

Cassie Jewell, M.Ed., LPC