New research by a Fordham psychologist shows that more than one-third of college students report being emotionally distressed by the pandemic and that LGBTQ+ students, students of color, and women experience higher levels of stress and anxiety.

The findings were published in a paper titled “Constant Stress Has Become the New Normal: Stress and Anxiety Inequalities Among U.S. College Students in the Time of COVID-19,” published in the Journal of Adolescent Health in December and co-authored by Fordham assistant professor of psychology Lindsay Till Hoyt, Ph.D. The first part of the paper’s title is a direct quote from one of the study participants.

The study incorporates quantitative and qualitative data that was collected from more than 700 college students who were recruited on Instagram. It began back in April with a baseline survey of 707 students from 374 colleges across the U.S., including Fordham. More than 500 students returned for a follow-up survey in July.

The very first question on the survey was direct: “Tell us how the pandemic is affecting you personally, just in your own words.” Without specific prompting, 27 participants responded to that question by citing specific mental health disorders, such as anxiety.

For the paper, researchers in Hoyt’s virtual lab, called the youth Development, Diversity, and Disparities (3D) Lab,  examined the stress symptoms reported as well as inequalities found across gender, sexual orientation, race/ethnicity, and income.  Young women, in particular, reported higher stress levels than young men, said Hoyt, a developmental psychologist whose work primarily focuses on how “macro-level stressors get under the skin and influence the health and well-being” of adolescents and young adults.

Difficult to Be Living Back Home 

Some of the survey responses illustrated the problem with specific examples.

“As a daughter of immigrants, moving home is treated as a vacation by my parents, so I am tasked with several home duties and taking care of my siblings,” said a respondent who identifies as a high-income cisgender Asian woman.

And while women were more likely to report symptoms of stress, Hoyt clarified that cisgender men could well be internalizing their pain in other ways, such as increased use of alcohol or other substances.

Gender-diverse students, she said, reported worse outcomes than their cisgender, heterosexual peers.

“Many of the gender diverse and transgender students talked about a lot of stress from not feeling accepted or comfortable at home.”

A respondent who identifies as a multiracial middle-income lesbian said that being back at home was difficult.  “As a member of the LGBT+ community, it was especially hard to leave all my support at school and come back to a homophobic household where I have to remain in the closet,” she wrote.

Hoyt noted that the pandemic had thrown many of these young people off track socially. Students often come into their own at college, she said, once they find a good support network and like-minded friends.

“With COVID all of a sudden that came crashing down and they were going back to their hometowns and their families,” she said. “I think most people would say the findings align with what you would expect, such as the gender difference, but what we also found, because we had longitudinal data at two time points, is that it does seem like that the inequalities in stress and anxiety are widening, with students from traditionally marginalized groups facing greater burdens.”

Researchers for the paper came from both coasts: Co-authors include Alison K. Cohen, Ph.D., an instructor of epidemiology and population health at Stanford University in California, as well as two Fordham psychology graduate students: master’s candidate Brandon Dull and Ph.D. candidate Neshat Yazdani. Doctoral candidate Elena Maker Castro contributed from the University of California Los Angeles.

Black and Multiracial Students Showed Increase in Anxiety from April to July

Hoyt said that after the death of George Floyd and the resulting national protests, the team integrated questions on the Black Lives Matter Movement for the follow-up questionnaire conducted in July. They asked how the movement affected their stress and their civic engagement. She noted that in the April survey that white students had the highest levels of perceived stress and anxiety. But early analysis of the July survey revealed that Black and multiracial students—from across sociodemographic groups—were the only students to show an increase in anxiety from April to July.

“I think the data is reaffirming things that we know about inequalities and this is just one of many studies that will underscore that, but I also think what we’re going to learn will be about their resilience, that’s definitely what we’re seeing in the qualitative responses,” said Hoyt.

Hoyt said she is also interested in how civic engagement can be a “protective factor.”

“When something really stressful is happening in your environment, civic engagement can be empowering,” she said.

Much of the follow-up data still needs to be analyzed, but Hoyt had to slow the pace of the work while she underwent treatment for a rare form of cancer. She generally disengaged from work and the news so as to concentrate on her care and her family, particularly her toddler. But she soon found outside forces too great to ignore.

“I went off social media when I first was undergoing all this, but then during the election, I couldn’t help myself and I had to go back on Twitter, and I’ve posted about the cancer there,” she said. “I’ve learned it’s good not to be ashamed of having any disease, including cancer. Lots of people are dealing with it during this pandemic, so I am completely comfortable sharing.”

Despite Hoyt being on leave during her illness, many of the master’s and doctoral candidates continued analyzing data for the study, which is ongoing. A third survey was conducted during the fall semester that also incorporated questions about the election.

Hoyt said she’s been moved by the students’ strength in the face of adversity. She’s been particularly impressed with the students who are research assistants on this project.

“I always tell them they’re the experts on this study and they give such great feedback because this is a study about them, their generation,” she said.

 

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More than 63 percent of college students reported experiencing overwhelming anxiety within the last year, according to the American College Health Association’s 2018 National College Health Assessment. And almost 42 percent of surveyed students said they felt so depressed that it was difficult to function.

“Anxiety and depression are the most common presenting problems in our office as well,” said Jeffrey Ng, Psy.D., director of counseling and psychological services (CPS) at Fordham. “Student utilization of on-campus mental health services has been trending upwards for the past 10 years nationally, including at Fordham.”

But there are many different ways to combat anxiety and depression, both on one’s own and with help from loved ones and professionals. Ng offered some suggestions for students struggling with their mental and emotional health and those who care about them:

Practice self-compassion. “Students often have perfectionistic and unrealistic demands and standards for themselves—standards that they likely wouldn’t apply to others,” Ng said. “We encourage our students to try to be as kind to themselves as they would to someone you love or care about.”

Exercise. “Engage in physical activity or exercise,” Ng said. “Physical activity and exercise are incredibly effective for reducing mild to moderate anxiety and depression.”

Practice digital and social media literacy. “Social media constantly exposes and bombards us with airbrushed or curated versions of people’s lives. When we compare ourselves to what we see on social media, we may get the sense that ‘we’re not good enough or doing enough.’ This can contribute to lower self-esteem, which can increase our vulnerability to mental health problems,” he said. “We encourage our students to try to be more intentional, thoughtful, and discerning about how they perceive and relate to social media.”

Don’t forget the essentials. “Attend to basic needs like sleeping, eating, and playing,” Ng said. “Having social relationships and social interactions—those are basic needs as well.”

Remember that there are multiple routes to healing. “It’s important for students to remember that there are many, many different pathways or routes for healing and feeling better. Acceptance from our parents (as in Govindan’s case) is just one of those paths,” Ng said. “Unconditional acceptance is obviously very important for our mental and emotional health, but for some students, they may unfortunately never experience that level of acceptance from their parents. So it’s especially important for them to recognize that there are multiple pathways and possibilities for healing.”

Normalize vulnerability. “One of the most important things we can do to support our students is to normalize vulnerability, imperfection, and struggle as part of the human experience,” Ng said.

Seeking help. One local resource is Fordham’s Counseling and Psychological Services Center, with offices on the Rose Hill, Lincoln Center, and Westchester campuses. To make an appointment, students can call or simply stop by. During non-business hours, students can reach out to public safety or residential life staff for emergencies.

Off-campus, 24/7 resources include the National Suicide Prevention Lifeline, 1-800-273-TALK (8255) and, for those who would rather type than talk, the Crisis Text Line.

“It’s important for our students to recognize that help-seeking is a sign of strength and maturity rather than weakness,” said Ng.

Marija Kundakovic, Ph.D., assistant professor of biology, spearheaded a study that was published in Nature Communications, the third highest-ranked multidisciplinary science journal in the world, earlier this summer. Kundakovic and her colleagues found that chromatin, a microscopic cell component, changes its shape during the ovarian cycle—especially when females experience a drop in estrogen. This changes how our genes behave. Because this occurs inside the brain area implicated in anxiety and depression, it may mediate women’s vulnerability to increased risk for these disorders. 

Now, thanks in part to the research conducted by Kundakovic’s team, scientists are closer to figuring out which molecules should be targeted with drug treatments, particularly for women with anxiety or depression. 

“This is really important for us to show at the molecular level—the molecular basis of this is what we now, with our study, are starting to understand,” Kundakovic said.

Part of the reason why this study is important is that it focuses on the female brain. Tell me more about that. 

The majority of neuroscience experimental studies were done on males. It’s been like that for decades. We know very little about the female brain, and this is particularly a problem for the disorders that are more frequent in women than men, like depression and anxiety. So this is why we basically don’t understand anything about the mechanism that tells us why this sex difference exists. 

Our study was designed to try to understand how—at a molecular level—these fluctuating sex hormone levels might increase the risk of anxiety and depression in women.

Why is there such a stark difference between men and women regarding their risk for anxiety and depression?

When you look at boys and girls before puberty, there’s really no difference in risk for depression. This risk really becomes two times higher in females when they get their first period —when the hormones start fluctuating. And then around perimenopause, this difference becomes even more profound because there are more extreme fluctuations. You can have very high or very low sex hormones. And then after menopause, when women achieve these very stable, low sex hormone levels, the sex difference becomes almost nonexistent. So this really tells us that this is not about low or high hormones, but the fluctuations in hormones that might be increasing women’s vulnerability to anxiety and depression.

What’s an extreme example of hormone fluctuations? 

Postpartum depression, a period when you have very high progesterone and estrogen (sex hormones), and then a drop after pregnancy. It often triggers a serious depression. There are a lot of lines of evidence showing that this drop in sex hormones, particularly estrogen, may increase the risk for anxiety and depression.

There’s another interesting phenomenon. Women who are depressed and on antidepressant treatments often report that just before their period, they experience worsening of their symptoms. The symptoms seem to be in control with the treatment, but all of a sudden, in this particular period, their symptoms worsen.

All these human findings are consistent with our findings in mice (women experience the menstrual cycle; female mice experience a similar process called the estrous cycle), showing that a drop in estrogen during the estrous cycle leads to increased anxiety levels in females.

You studied brain cells from both female and male mice, and also included female mice in different stages of the estrous cycle. What did you find? 

DNA is six-and-a-half feet long in a single cell. You have to package it very nicely so you can put this huge piece of DNA into every cell. The way this is accomplished is through a special structure called chromatin. 

This is important to package our DNA, but not only for that. By opening and closing chromatin, you can turn genes on or off. You have to have this open structure for some factors to bind and to turn the genes on. If this is closed, you can’t do that. People use libraries as an analogy. You can have a huge library. There are certain books you can’t even access. But if something’s accessible, you can potentially read it. That’s how our genome works as well. 

What we show—and this is really the biggest discovery of this study—is that as hormones fluctuate, they’re actually changing the organization of chromatin. This changes gene expression. 

Can you provide an example that explains these chromatin changes? 

Serotonin is a neurotransmitter—a chemical in the brain that has been implicated in anxiety and depression. What we show in our study is that the genes that are important for serotonin function, their expression, and their chromatin organization changes with the estrous cycle. Basically, now we are providing a possible molecular mechanism for why we could have those changes in anxiety levels across the ovarian cycle. 

What’s the difference between chromatin in male and female mice? 

In terms of how many open chromatin regions we have, the numbers are pretty similar. What is different is which regions are open or closed. They change with the estrous cycle, and they differ between males and females, meaning some genes that were closed will open up. And some genes that were open will close. What we didn’t expect is that we would find as many differences across the estrous cycle as we see when we compare chromatin in males and females. 

Women and men currently have the same treatment for anxiety and depression. But might your study results lead to the development of sex-specific treatments for these disorders? 

Yes. We are starting to understand what are the players involved, what are the mechanistic factors—like receptors, regulators of chromatin—that are leading to this opening and closing. It may help us identify a candidate that we could possibly target with drugs. 

Many women take birth control. How can that affect sex hormones and treatment? 

We don’t know enough about that. There are different contraceptives. I think we need more studies in humans to understand how exactly contraceptives would affect this. 

What implications does this research have for transgender people? Or is there not enough data yet? 

That’s another important question that I’m getting more nowadays. What we’re talking about here are biological changes that are induced by hormones. When we talk about transgender people, you might think about certain hormonal treatments that they are receiving. Our brain, even in adulthood, is responsive to these hormones. But sexual differentiation of the brain is very complicated, and it starts very early during life. So as you said, I think we would need more information and funding to try to understand how exactly this would affect transgender people. 

This interview has been edited and condensed for clarity.

In her early years at Fordham, she struggled with an abusive relationship, a falling out with friends, and a breakup with a different boy she loved. She started school as a chemistry major on the pre-med track—but she wasn’t happy.

In the fall semester of her junior year, Govindan decided to take her life. On a cold day in October 2017, she sat at a Starbucks a few blocks away from Fordham’s Lincoln Center campus, drafting suicide letters to her family. Then she got a life-changing phone call from her mother.

Govindan’s parents—a pediatric anesthesiologist and a bank vice president who pulled themselves out of poverty in India—had refused to let her pursue stand-up comedy, something she had loved since middle school. But after hearing the pain in her daughter’s voice, her mother changed her mind.

“She [had]told me, ‘Indian girls don’t become comedians. They become doctors and scientists and biologists and engineers,’” Govindan, a Fordham College at Rose Hill senior, said at a Fordham event last fall. “But this time around, she said yes. And to me, that just meant so much because what she was telling me is, I don’t care what we think. I don’t care what other Indian families think. What matters to me right now the most is your happiness.”

Now, Govindan is a young comedian who has performed around the world, from Ireland to Houston, Texas. At the age of 21, she was invited to apply as a writer for a TV show. And after receiving therapy, she’s determined to destigmatize mental illnesses through candid discussions on social media.

“Happy #WorldSuicidePreventionDay,” she wrote on social media. “What ultimately ended up helping me was seeking out therapy and medication and investing in a hobby I found happiness in (comedy!!!).”

Last year, Govindan applied for a fall production internship at the Emmy Award-winning show Full Frontal with Samantha Bee—and got it. She transcribed news and TV clips, answered phone calls, and went out on coffee runs. In conversations with senior colleagues, Govindan said, she received “uncensored advice” that will help her develop as a stand-up comedian. And, thanks to one of those mentors, she was able to meet one of her biggest idols—Hasan Minhaj, an Indian-American comedian who co-created and hosts the Netflix series Patriot Act.

“Every day as I continue to pursue stand-up comedy,” Govindan said, “I thank the heaven and the stars that on that cold, crisp day in October of 2017, I chose my own happiness instead of choosing to end my life.”

Finding Humor in the Darkness

Govindan’s jokes begin with observations. If she makes a friend laugh, she said, she’ll record what she said in her phone. Those notes might make it to the official notebook that she brings and refers to on stage—the book that holds all her organized sets.

One of those stand-up sets is about her experience with being suicidal. When Govindan performs the set, she speaks about a much more private notebook—the place where she wrote why she should stay alive. One reason: never being able to taste another Cheez-it cracker again. Another: never knowing what would happen in the season finale of her favorite TV show Brooklyn Nine-Nine.

“Probably my favorite reason—and perhaps the most ridiculous reason—was Kylie Jenner,” she recalled. “I was like, I can’t die without knowing whether or not Kylie Jenner is pregnant.”

More seriously, comedy gave her a reason to live. 

“Every time I was emotionally distressed, every time I went to this dark place, I would open up my notebook and force myself to write a comedy set,” she said. “I think that’s really what carried me through the darkness of it all … Being able to find the humor in everything.”

College Comedy and Beyond

Govindan’s first stand-up comedy show was a five-minute slot on December 2017 at Carolines on Broadway—a place where legendary performers like Jerry Seinfeld got their start. Since then, she has performed nearly 40 times in New York City; her home state of Texas; and Ireland, where she studied abroad for a semester. She says her shows usually run from five to 10 minutes, and her audience size is around 40 people.

In each show, she segues into bits and pieces of her own life: her identity as an Indian-American, dating, her struggles with mental illness, her experiences with therapy.

“I’m there to make you laugh—not talk about my own life,” she said. “But I also put enough of myself and my own truths in there that I feel good at the end of the day about what I’ve done … that I feel like I’ve been authentic with myself.”

Govindan reflected on two of her past shows this January. In the first one, she bombed. No one laughed except for her two high school friends, she said. Later that night, she performed the same seven-minute set somewhere else. But this time was different. She recalled two young Indian girls who came up to her and said, “We’ve never seen an Indian woman perform stand-up comedy live. Seeing you there, seeing you talk about the Indian-American experience, and seeing everyone else laugh just felt … amazing.”

In a few months, Govindan will graduate from Fordham with a degree in psychology; industry knowledge from classes in sitcom writing, documentary television, and screenwriting; and several internships under her belt. She says she’ll pursue a full-time job in either comedy writing or entertainment marketing. And she dreams of someday hosting her own late-night talk show. She’s even picked out a name for it—The Low Down. But in the end, she says, what matters most is the impact she has on the people around her.

“I hope I can be that salvation for someone else,” Govindan said. “If I can be that reason—if I can be the light at the end of the tunnel for anyone else, in the same way that stand-up comedy was for me—then I will be doing my job.”

Guidance for Students Experiencing Anxiety or Depression

Govindan isn’t alone in her struggles with depression and mental health. More than 63 percent of college students reported experiencing overwhelming anxiety within the last year, according to the American College Health Association’s 2018 National College Health Assessment. And almost 42 percent of surveyed students said they felt so depressed that it was difficult to function.

“Anxiety and depression are the most common presenting problems in our office as well,” said Jeffrey Ng, Psy.D., director of counseling and psychological services (CPS) at Fordham. “Student utilization of on-campus mental health services has been trending upwards for the past 10 years nationally, including at Fordham.”

But there are many different ways to combat anxiety and depression, both on one’s own and with help from loved ones and professionals. Ng offered some suggestions for students struggling with their mental and emotional health and those who care about them:

Practice self-compassion. “Students often have perfectionistic and unrealistic demands and standards for themselves—standards that they likely wouldn’t apply to others,” Ng said. “We encourage our students to try to be as kind to themselves as they would to someone you love or care about.”

Exercise. “Engage in physical activity or exercise,” Ng said. “Physical activity and exercise are incredibly effective for reducing mild to moderate anxiety and depression.”

Practice digital and social media literacy. “Social media constantly exposes and bombards us with airbrushed or curated versions of people’s lives. When we compare ourselves to what we see on social media, we may get the sense that ‘we’re not good enough or doing enough.’ This can contribute to lower self-esteem, which can increase our vulnerability to mental health problems,” he said. “We encourage our students to try to be more intentional, thoughtful, and discerning about how they perceive and relate to social media.”

Don’t forget the essentials. “Attend to basic needs like sleeping, eating, and playing,” Ng said. “Having social relationships and social interactions—those are basic needs as well.”

Remember that there are multiple routes to healing. “It’s important for students to remember that there are many, many different pathways or routes for healing and feeling better. Acceptance from our parents (as in Govindan’s case) is just one of those paths,” Ng said. “Unconditional acceptance is obviously very important for our mental and emotional health, but for some students, they may unfortunately never experience that level of acceptance from their parents. So it’s especially important for them to recognize that there are multiple pathways and possibilities for healing.”

Normalize vulnerability. “One of the most important things we can do to support our students is to normalize vulnerability, imperfection, and struggle as part of the human experience,” Ng said.

Seeking help. One local resource is Fordham’s Counseling and Psychological Services Center, with offices on the Rose Hill, Lincoln Center, and Westchester campuses. To make an appointment, students can call or simply stop by. During non-business hours, students can reach out to public safety or residential life staff for emergencies.

Off-campus, 24/7 resources include the National Suicide Prevention Lifeline, 1-800-273-TALK (8255) and, for those who would rather type than talk, the Crisis Text Line.

“It’s important for our students to recognize that help-seeking is a sign of strength and maturity rather than weakness,” said Ng.

What helped him recover, it turned out, was emotions, in particular the sadness and grief he had buried. Once he learned to fully experience them and manage them, he eventually recovered—making friends, making changes in his life, and feeling alive again.

Hendel wrote an article about the technique she had used, and something happened. Published in The New York Times in 2015, it rose to the top of the most-emailed list, prompted a flood of appreciative emails, and drew the interest of a literary agent.

At his urging, she wrote a book that was published this month, titled It’s Not Always Depression: Working the Change Triangle to Listen to the Body, Discover Core Emotions, and Connect to Your Authentic Self (Random House and Penguin UK, 2018).

The book describes techniques developed more than 20 years ago by the psychologist and author Diana Fosha, Ph.D., to help people mentally engage with latent emotions and move past traumas that may be stubbornly holding them back.

So far, no one has written a book about these techniques for the general public, Hendel said.

Judging by the response, people are ready for one.

“Depression is a huge problem,” along with treatment-resistant depression, so it strikes a chord when readers learn that “it’s not always depression, that there’s something at the root of it,” she said.

Harnessing Core Emotions

The daughter of a former guidance counselor and a psychiatrist, Hendel grew up with the “mind over matter” idea that emotions are to be mastered “with intellectual insight,” as she puts it in the book.

But in 2004, after earning her master’s degree in social work at Fordham’s Graduate School of Social Service and preparing to earn her psychoanalysis certification, she learned of a different approach—accelerated experiential dynamic psychotherapy, or AEDP.

She saw Diana Fosha present AEDP at a conference and wanted to start practicing it as soon as possible. It calls for learning to viscerally experience core emotions—anger, sadness, joy—that are blocked by shame or other defenses. It reflects a view of emotions as biological forces that, when stymied, throw the body and mind out of balance. By showing people how to continually access these emotions, Hendel felt, AEDP could help them permanently heal.

The book is a jargon-free guide to AEDP techniques for anyone. “Basically, I just want to teach [readers]about emotions” and make them less scary and less mysterious, she said.

In the book, she tells of patients (with their consent) who are struggling with social anxiety, irritability, feelings of depression, and other troubles. Typically, patients are encouraged to notice any faint physical reactions—a tightness in the diaphragm, a clenching of fists, a tear in the eye—that signal core emotions linked to trauma, such as childhood neglect or a parent’s verbal abuse.

They learn to get comfortable with the experience of these emotions, exploring them with curiosity and compassion. The emotions may have been buried under shame, guilt, and anxiety during childhood—because of the emotions’ frightening power, and because it was less scary to blame themselves for what they were feeling than to find fault with the adults they were dependent on.

During therapy, a patient might imagine speaking to her childhood self and offering comfort, or rebuking whoever inflicted the trauma. Anger or harsh words may flow, along with copious tears, as with the patient anonymously described in Hendel’s New York Times article.

The goal is to unblock the emotions by growing comfortable with how they physically feel. Patients can also unblock positive core emotions like joy and excitement and gain confidence.

The Change Triangle, Hendel’s own visual model for the AEDP process, is centered on core emotions and the openhearted, authentic self they can help bring out when patients learn to access and control them.

Treatment times vary. Change can come quickly, or it can take years, Hendel said.

“What we’re ultimately trying to do is effect brain change,” she said. “People come to me that have been in traditional talk therapy, and they say, ‘I’m doing talking, I know everything, I have insight, but I still have the same feelings. The same things are triggering me again and again and again.’”

“That’s why AEDP is healing,” she said. “It changes the triggers.”

“It’s Not Always Depression”

The book’s title reflects a view that what seems like depression—“a word that we’ve put on a constellation of symptoms,” Hendel said—may in fact be a more specific problem that stems from an experience that can be addressed.

“The idea is that it’s not an end; [depression is]the beginning of a story,” she said. “It’s the tip of an iceberg, and what’s underneath it is the brain and the mind and why it’s reacting that way. And you change the brain through working at these deep levels of emotion.”

She hopes the book will help create broader awareness of how to manage emotions, something she considers to be a public health issue.

“Emotions, when they’re blocked, cause stress on the mind and body, and we can heal by releasing the emotional energy that’s blocked,” she said. “If we had a culture that taught emotion education from the get-go, we would have all these skills to manage emotions and work with our thoughts in a constructive way.”

Although most understand this time of year can bring stress as well as joy, we don’t always plan accordingly. We spoke with Dana Alonzo, Ph.D., associate professor of social work at Fordham’s Graduate School of Social Service, to get some suggestions.

Full transcript below

Patrick Verel: Is it cliché to say that the holidays are stressful, or do you get the sense that folks understand that it’s not going to be all smiles and good cheer this time of year?

Dana Alonzo: I think that what we tend to see is that people have a superficial or anticipatory recognition that this is going to be a stressful time, and, “I have so much to do. I’m going to be spending so much money. How do I find that perfect gift for someone?” And there’s lots of that kind of thinking about the stress, but it doesn’t end up translating into any real planning or prepping for how to manage it, so that by the time the holiday actually comes, I think people do end up feeling quite stressful.

Lots of people tend to think about the holidays as they see them on TV or in the movies or the way they always imagined they would be or wanted them to be. And when they end up in the room with their families, and it doesn’t match that expectation, it can be quite disappointing.

Patrick Verel: What advice do you give to someone who is actually dreading the holiday or having a tough time of it already?

Dana Alonzo: I think the first thing is to manager your expectations. If you don’t expect things to be perfect and put that kind of pressure on yourself, when things aren’t perfect it won’t be that surprising or disappointing. People who are experiencing stress this time of year because they’ve had a major loss in the recent past, planning a new tradition or beginning a new tradition can be really helpful.

So rather than focusing on not having that individual with you to share the things you would typically do with them, doing something different and starting a new tradition can be a really helpful way of managing some of those feelings of loss. I think that self-care is also very important. What tends to fall by the wayside is what you tend to do for yourself on a daily basis that keeps you going.

Patrick Verel: What are the best strategies for people to take?

Dana Alonzo: Going outside and taking a walk, sitting somewhere quiet for five to ten minutes by yourself and just allowing yourself to breathe deeply. Those are things that can be done anywhere. Research shows it’s really effective at allowing people to kind of take a break and reset themselves.

And I think that if you’re relying on things like a class at the gym, or going out with my friends, and then your friends are unavailable or you can’t afford the health club that month because you want to spend your money for presents for someone else. Those are not the best things, but something that you can just do for yourself, by yourself that doesn’t require any additional burden are the things to go to.

Haruka Minami, Ph.D., assistant professor of psychology, hopes to find out whether practicing mindfulness can help these individuals quit smoking, especially those with depression.

“Depressed individuals tend to smoke at higher rates; at the same time, depressive symptoms make it more difficult to quit,” said Minami. “Consequently, depressed individuals suffer from a higher rate of smoking-related diseases. Developing and implementing effective smoking cessation interventions for this vulnerable population is a public health priority.”

Minami is leading a treatment development study, together with her graduate and undergraduate students and colleague, Rivera-Mindt, at Montefiore Behavioral Health Center in the Bronx that provides smoking cessation treatment to depressed patients. This study uses a multi-pronged approach: in addition to providing no-cost nicotine replacement therapy and smoking cessation counseling, it asks participants to practice mindfulness with the aid of audio recordings.

Mindfulness is the act of “purposeful attention to the present moment, including sensations, thoughts, and feelings, in a non-judgmental way,” said Minami. “It also encourages openness, curiosity, and acceptance toward one’s experience.” This, Minami believes, can foster awareness and help smokers respond to cravings and other smoking triggers in a less impulsive and more reflective way.

“Smokers have learned to reach for a cigarette whenever they experience internal discomfort including craving, negative feelings, and stress.” she said. “We want to help them be more aware of their triggers, and be willing to experience discomfort without smoking.

“Taking a few minutes to be mindful of their internal experience throughout the day may help smokers respond to craving or stress with non-smoking strategies instead of reacting to them by smoking.”

This study does not take place solely in a clinic; it provides participants with smartphones to assess their mood, craving, and smoking behavior several times a day in real-time, a method known as ecological momentary assessment. This allows Minami to examine how changes over a matter of hours can influence smoking behavior in the context of an individual’s personal – as opposed to a clinic – environment.

These smartphones not only contain guided mindfulness audio recordings that participants can access at any time, but also prompts participants to blow into a device that measures carbon monoxide levels (akin to a smoking breathalyzer) and uploads results to a secure server in real time.

“This allows us to verify their smoking status without the need for participants to visit the clinic, thereby easing participant burden. We are also able to reward participants immediately for not smoking, a method called contingency management.”

This study is currently in the randomized controlled trial phase at Montefiore, and Minami is already impressed by some participant reactions in the pilot phase.

“Participants are enthusiastic about practicing mindfulness (sometimes more than 5 times a day!) and convey to us how helpful mindfulness practice is, not just in keeping them motivated to stay smoke-free, but in other aspects of their lives as well.”

In addition, the doctors and clinicians at the behavioral health center are excited and supportive of the study, said Minami. It fills a key need by providing patients with access to smoking cessation treatment.

“I hope this project will help improve cessation rates and further our understanding of protective and risk factors in this vulnerable population.”