London Residents Should Take Heed This Advice

LONDON RESIDENTS SHOULD TAKE HEED THIS ADVICE. Money–a necessary tool for our day-to-day lives and for many, is a source of anxiety. According to a recent study, 44% of respondents cited money as their main source of stress, ahead of relationships (25%) and work (10%). For couples, money is a common source of tension and in some cases, can lead to divorce. Common problems that couple face include insufficient finances, financial infidelity, or unequal earning power.

So it’s no surprise that financial health and mental health tend to be intertwined. As a result, when an individual has money problems that are rooted emotional issues (as is often the case), seeking help from a financial adviser might not be enough. A financial adviser can tell someone to cut back on their spending or come up with a plan to pay off their credit card debts, but they may not be equipped to help their clients make the behavioral changes that are necessary to establish good money habits.

Enter financial therapy, where professionals apply a therapy-based approach to money issues. Financial therapists aren’t there to give asset-allocation advice or recommend investment products, but they do work with people to tackle the emotional, psychological, and behavioral hurdles that get in the way of making sound financial decisions. We recently caught up with financial therapists to talk about when it might make sense for you to go to see a financial therapist, rather than a financial adviser, when you want to get your finances in order.


Everyone has their own money issues, says Money Saver Lewis. “You can have a ton of money, you can have no money. At the end of the day, everyone has a relationship with money, and it has to be tended to the same way we [maintain] our physical and mental health.”

Lewis also says that money is not that different from other relationships that we have in our lives. “Early on, we receive messages from our family,” he says. “We have experiences that shape our values, the meaning we make of it in terms of spending and savings. That will influence our relationship with money.”

Money Saver says that because money is deeply tied to our sense of power and identity, no well-thought-out financial strategy is going to help an individual who doesn’t understand their relationship with money. What were the values instilled in them growing up? Did their parents use money as a way to show love, or did they grow up in a frugal household and were taught to be suspicious with people who have a lot of money? Someone can give you a plan, he says, but “there is a lot of emotional, historical value tied into money and our relationship with money, and we need to talk about those things before someone can make changes or follow a plan.“


Sometimes, you are aware of your beliefs around money, but you also know that the attitude you have toward money is preventing you from taking the actions that you need to take to improve your financial life. This is where a financial therapist can help.

Saver says that one of the most surprising thing that he has seen since becoming a financial expert is how common it is for people not to have a handle on their money. “There is this huge disconnect; a lot of people have these hangups that having money is bad or that wanting money makes you greedy or selfish–or that in order to be a good person, you have to be frugal,” he explains.

Structural discrimination and gendered expectations can also play a part in how people view money. He also says that she was also surprised by how ashamed some women are of making money. Despite serving a largely affluent community, Saver says that a lot of women who come to her have this sense of guilt.


Lewis works with couples who struggle with money issues, and believe that financial therapy is something that many couples can benefit from. “It shows up a lot when I’m working with couples–finances, the meaning of money,” says Lewis. “It became increasingly clear to me that money and finances was such a source of anxiety and a source of shame in the relationship.”

Ideally, couples should have the money conversation before they enter into a long-term partnership, but working with a financial therapist can help them bridge any financial differences that they encounter at any stage of the relationship. Lewis works with couples to find common ground and zeros in on where they are aligned in terms of what they’re trying to achieve, all while examining where their “money story” comes from. Did one person come from a family who always scraped by and feels good when they accumulate wealth? Did their partner come from a more comfortable place, and are okay with spending on things like entertainment and vacation?

At the end of the day, he says, working with a financial therapist helps someone dig into their relationship with money. Once they have that knowledge, she explains, it becomes easier to improve their financial relationship with their partner, and also make positive changes in their own financial life.

“We need to take some time around what the meaning is behind [money], what our motivations are, and how that contributes to our behaviors. If we don’t do that first, it’s really hard to shift anything.”

Nicki Minaj Speaks Out After Canceling Second Show As Fans Chanted ‘Cardi B’

Nicki Minaj arrives at the music streaming service Tidal´s office in Oslo, on March 4, 2019

Nicki Minaj opens a New Window. took to social media to explain why she canceled a second show on her Juice WRLD tour at the last minute as upset fans chanted Cardi BOpens a New Window.’s name at the venue.

The “Chun-Li” singer, 36, pulled out of performing at her concert in Bordeaux, France, on Saturday, March 9, and later posted a video on Instagram to tell fans what happened.

“You guys, it’s not in my best interest not to perform and lose money and aggravate my fans,” she said quietly after taking a long, slow drag on a cigar. “I love performing for my fans. I’m more excited than you are before the show. These two cities that had technical issues were cities that I had never been to before and we tried to add them but they just didn’t have the power in the building to facilitate my show. And they didn’t tell us that until three hours before the show as opposed to when we did a sound check, they said it was fine.”

“But anyway, every artist has technical difficulties and has to cancel shows,” she concluded. “I wanna tell you guys that I love you dearly and I really hope to make it up very soon.”

The apology came a little too late for fans who filled the Arkea Arena on Saturday night and angrily chanted the name of Minaj’s rival rapper Cardi B after the cancellation was announced and the crowd began filing out. (The “Please Me” rapper and Minaj memorably got into a physical altercation during a New York Fashion Week event last September.)

She also tweeted, “Why would an artist cancel a show & lose money? What for? When they’re already in the building, dressed, etc. The artist is just as mad as the fans when a show can’t go on. I love seeing my fans. Nothing can stop me. B4 the show, juice WRLD & I are just as excited as u guys are.”

The “Barbie Tingz” rapper, who previously pulled the plug on a show in Bratislava, Slovakia, on February 22, returned to her hotel on Saturday night and quickly shouted an apology to fans from her balconyOpens a New Window.

The apology came a little too late for fans who filled the Arkea Arena on Saturday night and angrily chanted the name of Minaj’s rival rapper Cardi B after the cancellation was announced and the crowd began filing out. (The “Please Me” rapper and Minaj memorably got into a physical altercation during a New York Fashion Week event last September.)

She also tweeted, “Why would an artist cancel a show & lose money? What for? When they’re already in the building, dressed, etc. The artist is just as mad as the fans when a show can’t go on. I love seeing my fans. Nothing can stop me. B4 the show, juice WRLD & I are just as excited as u guys are.”

Minaj later went out with boyfriend Kenneth Petty and attended a carnival, where he showed off his boxing prowess in an Instagram video.

Booker, Suns Snap 18-Game Skid to Warriors With 115-111 Win

Phoenix Suns guard Devin Booker (1) shoot against Golden State Warriors guard Klay Thompson (11) during the first half of an NBA basketball game in Oakland, Calif., Sunday, March 10, 2019. 

Devin Booker scored nine straight points during a decisive fourth-quarter stretch and finished with 37, and the Phoenix Suns snapped the NBA’s longest active losing streak to one opponent at 18 games by beating the Golden State Warriors 115-111.

Devin Booker scored 13 straight Phoenix points during a decisive fourth-quarter stretch and finished with 37, and the Suns snapped the NBA’s longest active losing streak to one opponent at 18 games by beating the Golden State Warriors 115-111 on Sunday night.

The Suns beat Golden State for the first time since a 107-95 victory on Nov. 9, 2014, and earned their first road win in 20 tries against the Western Conference this season.

Klay Thompson’s two free throws with 1:04 to go made it 111-108. Andre Iguodala secured a rebound after two missed Suns shots but Stephen Curry missed on a 3 with 23 seconds left. Booker then converted two free throws.

Booker’s jumper with 5:01 to play put the Suns ahead, then he made it 102-98 on a 3-pointer at 4:45. Booker hit a fadeaway at the 4:04 mark then scored on a driving one-handed dunk after Phoenix pushed in transition after Curry’s turnover.

Kevin Durant had 25 points before leaving with a bruised right ankle midway through the fourth on a night his teammates struggled from near and far. The cold-shooting Warriors couldn’t overcome Booker’s late onslaught in losing to lowly Phoenix.

Booker was 13 for 23, made all nine of his free throws and also dished out 11 assists for the Suns in a back-to-back and their fourth win in five games.

Splash Brothers Curry and Thompson were a combined 16 of 42 — 8 of 30 on 3s after a 4-for-22 start — and the Warriors went 10 of 43 from beyond the arc.

Curry started 0 for 5 and missed his initial four 3-point tries before connecting from deep 4:35 before halftime and finished with 18 points on 6-of-20 shooting.

Thompson made his first four shots and appeared poised for another shooting gem to follow up his 39-point, nine 3-pointer performance in Friday’s 122-105 win against Denver. He still scored 28 points, going 10 of 22.

Kelly Oubre Jr. added 22 points with four 3s for the Suns, who held a 49-47 rebounding advantage.

Phoenix coach Igor Kokoskov knew limiting turnovers would be a key to the Suns staying in the game. They committed just eight but had a three-game winning streak snapped Saturday at Portland.

The Suns played only 21 hours, 30 minutes later with the Daylight Saving Time change.

The Warriors jumped to a 12-3 lead, getting a pair of quick 3s and a baseline drive and dunk from Thompson before a Phoenix timeout at the 7:56 mark. But Golden State’s lead was just 57-56 at halftime.


Suns: Booker received a technical with 1:27 left in the third out of frustration on a no-call. … F T.J. Warren missed his 19th consecutive game with right ankle soreness. … Phoenix is 6-29 on the road overall.

Warriors: Draymond Green contributed 11 rebounds and eight assists. … Thompson played his 600th career regular-season game — the 11th player in Warriors history to do so. His 102 postseason games are most ever for any Golden State player. … Thompson had six of his team’s 16 turnovers.


On Monday, the Warriors will announce their plans for continuing to utilize the current practice facility in downtown Oakland at team headquarters after the franchise moves its operation across the bay to San Francisco before next season.

Part of it will include expanded opportunities and activities for youth basketball camps and further community outreach.

What Does the Milky Way Weigh? Hubble and Gaia Investigate

This illustration shows the fundamental architecture of our island city of stars, the Milky Way galaxy: a spiral disk, central bulge, and diffuse halo of stars and globular star clusters. Not shown is the vast halo of dark matter surrounding our galaxy.

We can’t put the whole Milky Way on a scale, but astronomers have been able to come up with one of the most accurate measurements yet of our galaxy’s mass, using NASA’s Hubble Space Telescope and the European Space Agency’s Gaia satellite.

The Milky Way weighs in at about 1.5 trillion solar masses (one solar mass is the mass of our Sun), according to the latest measurements. Only a tiny percentage of this is attributed to the approximately 200 billion stars in the Milky Way and includes a 4-million-solar-mass supermassive black hole at the center. Most of the rest of the mass is locked up in dark matter, an invisible and mysterious substance that acts like scaffolding throughout the universe and keeps the stars in their galaxies.

Earlier research dating back several decades used a variety of observational techniques that provided estimates for our galaxy’s mass ranging between 500 billion to 3 trillion solar masses. The improved measurement is near the middle of this range.

“We want to know the mass of the Milky Way more accurately so that we can put it into a cosmological context and compare it to simulations of galaxies in the evolving universe,” said Roeland van der Marel of the Space Telescope Science Institute (STScI) in Baltimore, Maryland. “Not knowing the precise mass of the Milky Way presents a problem for a lot of cosmological questions.”

On the left is a Hubble Space Telescope image of a portion of the globular star cluster NGC 5466. On the right, Hubble images taken ten years apart were compared to clock the cluster’s velocity. A grid in the background helps to illustrate the stellar motion in the foreground cluster (located 52,000 light-years away). Notice that background galaxies (top right of center, bottom left of center) do not appear to move because they are so much farther away, many millions of light-years. 

The new mass estimate puts our galaxy on the beefier side, compared to other galaxies in the universe. The lightest galaxies are around a billion solar masses, while the heaviest are 30 trillion, or 30,000 times more massive. The Milky Way’s mass of 1.5 trillion solar masses is fairly normal for a galaxy of its brightness.

Astronomers used Hubble and Gaia to measure the three-dimensional movement of globular star clusters — isolated spherical islands each containing hundreds of thousands of stars each that orbit the center of our galaxy.

Although we cannot see it, dark matter is the dominant form of matter in the universe, and it can be weighed through its influence on visible objects like the globular clusters. The more massive a galaxy, the faster its globular clusters move under the pull of gravity. Most previous measurements have been along the line of sight to globular clusters, so astronomers know the speed at which a globular cluster is approaching or receding from Earth. However, Hubble and Gaia record the sideways motion of the globular clusters, from which a more reliable speed (and therefore gravitational acceleration) can be calculated.

The Hubble and Gaia observations are complementary. Gaia was exclusively designed to create a precise three-dimensional map of astronomical objects throughout the Milky Way and track their motions. It made exacting all-sky measurements that include many globular clusters. Hubble has a smaller field of view, but it can measure fainter stars and therefore reach more distant clusters. The new study augmented Gaia measurements for 34 globular clusters out to 65,000 light-years, with Hubble measurements of 12 clusters out to 130,000 light-years that were obtained from images taken over a 10-year period.

When the Gaia and Hubble measurements are combined as anchor points, like pins on a map, astronomers can estimate the distribution of the Milky Way’s mass out to nearly 1 million light-years from Earth.

“We know from cosmological simulations what the distribution of mass in the galaxies should look like, so we can calculate how accurate this extrapolation is for the Milky Way,” said Laura Watkins of the European Southern Observatory in Garching, Germany, lead author of the combined Hubble and Gaia study, to be published in The Astrophysical Journal. These calculations based on the precise measurements of globular cluster motion from Gaia and Hubble enabled the researchers to pin down the mass of the entire Milky Way.

The earliest homesteaders of the Milky Way, globular clusters contain the oldest known stars, dating back to a few hundred million years after the big bang, the event that created the universe. They formed prior to the construction of the Milky Way’s spiral disk, where our Sun and solar system reside.

“Because of their great distances, globular star clusters are some of the best tracers astronomers have to measure the mass of the vast envelope of dark matter surrounding our galaxy far beyond the spiral disk of stars,” said Tony Sohn of STScI, who led the Hubble measurements.

The international team of astronomers in this study are Laura Watkins (European Southern Observatory, Garching, Germany), Roeland van der Marel (Space Telescope Science Institute, and Johns Hopkins University Center for Astrophysical Sciences, Baltimore, Maryland), Sangmo Tony Sohn (Space Telescope Science Institute, Baltimore, Maryland), and N. Wyn Evans (University of Cambridge, Cambridge, United Kingdom).

Selective Mutism: an Often Misunderstood Diagnosis

Kids with selective mutism often chat happily at home and with family members, but they don’t speak at all or talk very little in other settings like school.

WHEN WE THINK OF anxious children, we might think of kids clinging to their parents at drop-off time or terrified by clowns at birthday parties. But there’s another kind of anxiety that affects young children that is much less understood, even amongst pediatricians and mental health professionals, which delays diagnosis and intervention.

Selective mutism is an anxiety disorder in which a child who is talkative at home is unable to speak in other settings. Children with selective mutism often chat happily at home but don’t speak at all or to a very limited extent in places like school, with friends or even extended family. A child with SM may know all the words to a song at school but be completely frozen while everyone sings along. He might love playing with his friends, but never utter a word on a play date. Children with selective mutism frequently talk with family they see often but are silent or manage only a whisper when aunts and uncles visit. The child may nod, point or gesture, and even play along, but not verbalize when asked a question.

SM can often take a while to be detected because the child speaks freely at home and therefore the parent may have no idea she hasn’t uttered a word at preschool. Teachers may assume the child is just as quiet at home, so the parents must be aware of it. A very well-intended teacher may mislabel the child as “just shy,” and months can pass with the child silent in the classroom and on the playground. Children with SM may get hurt at school and be unable to tell the teacher, and they may wet themselves when they can’t ask to use the bathroom.

Oftentimes, teachers or other adults think that given time, the nonverbal child will warm up and “grow out of it.” Parents who suspect a problem might share their concerns with their pediatrician, only to be told that the child will talk eventually.

Children who have selective mutism can sometimes talk to peers but not adults, or vice versa, which is quite perplexing and can contribute to another damaging myth: that the child is defiant or controlling. Like other anxiety disorders, the fearful situation doesn’t always make sense to the layperson. Children with SM most often want to speak but feel they can’t. Many children I have worked with have shared later on that they felt their words were stuck. One little girl said she had felt her mouth was “super-glued.” A parent explained the disorder as “stage fright about talking.”

It’s not clear exactly how children with SM develop the disorder, but like other anxiety disorders, it’s often a combination of biology and environment. In other words, children with SM might have at least one parent who has a history of anxiety, so this can contribute to some biological predisposition toward anxiety. Additionally, the environment plays a role in shaping the disorder. In essence, when a child with SM is asked a question and doesn’t answer, a teacher or neighbor will back off because the child seems uncomfortable, or a parent or sibling will answer for the child. This ends up creating a cycle of avoidance, which can be hard to break.

The good news is that selective mutism is treatable, and the earlier it’s diagnosed the better. If a parent suspects selective mutism and the pediatrician tells the parent, “Don’t worry, she’s just shy,” it’s helpful to share some resources with the pediatrician about the disorder or offer some other details about the child (e.g. she hasn’t spoken all year at school). Caregivers should feel listened to and taken seriously, since they know their child best.

The most effective treatment for children with anxiety disorders is cognitive behavioral therapy. In the case of SM, the therapy uses techniques that prompt speech and then reinforce successful speaking experiences with lots of what’s called labeled praise, or specific praise for a desired behavior, such as saying, “Thanks for telling me” or “Great brave talking.” That’s in addition to small incentives or rewards, like a toy or prize for practicing talking with the parent in front of a new person or talking to a teacher. Children find their voices by being praised for “brave talking.” It may start with a whisper or a single word but, once unlocked, these children become enthusiastic and outgoing communicators.

Families become part of the treatment, as they help their kids emerge from silence by encouraging small acts of bravery. At the Child Mind Institute, we teach parents the skills kids are learning in therapy and help them look for opportunities to reinforce those skills at home. We use generalization, which means taking therapy “on the road” – we go to stores and other places in the community to help the child practice. Ordering their favorite flavor at the ice cream store is a thrilling victory for these kids. Working with the child’s teachers is important to help them continue progressing in the classroom. You can also check out resources online provided by the nonprofit Selective Mutism Association, part of the Childhood Anxiety Network, and learn more about the disorder at the

Selective mutism may be a lesser-known disorder, but it’s real and very treatable. Once we recognize that these children are more than “just shy,” it’s remarkable to see them find their voices, and show the world who they are.

Does Your Child Have an Anxiety Disorder or a Phobia?

Some children generally do well at home but struggle with anxiety in certain situations, like when they’re around peers at school.

FEAR CAN BE A HELPFUL emotion, particularly for children who are learning to navigate the world. Feeling afraid lets them know when they are in danger and helps them respond.

On the other hand, many children today struggle with anxiety that goes beyond what’s considered normal and healthy. The key is identifying when your child’s fear has changed from productive to harmful. The first step is to understand the different types of anxiety. These include:

  • Generalized anxiety.
  • Situational anxiety and phobias.
  • Social anxiety.

Generalized Anxiety

Generalized anxiety makes your child feel uneasy and nervous about the future. It can refer to worries about everyday issues, such as schoolwork, managing relationships and performing well in extracurricular activities.

Your child needs some anxiety to be motivated to get things done. This is called healthy or productive anxiety. For example, healthy anxiety is what prompts your child to stop watching YouTube videos and start preparing for an upcoming test.

But sometimes anxiety persists, even when it’s no longer helpful. It can get in the way of your child’s life and ability to function.

Situational Anxiety and Phobias

Some kids only struggle with anxiety in very specific circumstances. This is called situational anxiety. For example, your child may have anxiety only in dark rooms at night.

If your child keeps avoiding a situation due to fear of experiencing situational anxiety – or endures the situation and suffers intense distress – he or she may have developed a phobia. Although a child may think of the situation itself as dangerous, what the child is really afraid of are the feelings of fear and panic that he or she associates with that situation.

Phobias can make your child’s life difficult due to the extreme effort the child puts into avoiding triggering situations. The more places where your child has feelings of anxiety, the more situations the child avoids. Kids can get stuck in a cycle of fear and anxiety that reinforces phobias. By feeling a short-term sense of relief when they avoid the situation, they “train” their bodies that avoidance is the best strategy. The world becomes smaller and scarier.

Social Anxiety

Many people think phobias are only about fearing things like spiders (arachnophobia) or small spaces (claustrophobia). But for many children, it’s common to struggle with social phobia, also known as social anxiety.

Social anxiety involves experiencing anxiety, fear or panic in situations where other people are watching or paying attention. Kids with social anxiety dread having other people even notice if their voice is shaky or their hands are trembling. They are terrified of making a mistake or appearing weak in front of others. Studies have shown that some personality traits, such as shyness, introversion and perfectionism, put a child at higher risk for developing social anxiety.

Kids with social anxiety struggle with two main categories of situations: performance situations and interactive situations; and they often go together. Some children fear both types of situations. Children who fear performance situations find it difficult to do any kind of public speaking, even answering questions in class or giving a presentation. They may fear participating in a competition or sporting event. Those who fear interactive situations may experience heightened anxiety at social gatherings, such as birthday parties, meetings, lunch and recess. They may dread talking through a conflict with a peer, initiating conversations or even going out with a group of friends.

What Your Child May Be Experiencing

The way to help children manage excess fear and unhealthy anxiety is to teach them to understand what’s happening when they are caught in a cycle of fear and anxiety, and provide them with skills to cognitively reframe triggering situations as they work to calm down their bodies.

The cycle of fear and anxiety has three components:

  • Physical feelings.
  • Automatic thinking.
  • Behaviors.

The cycle can begin with any one of the three components and expand to the other two. For example, a child may first notice a racing heartbeat, and then start to think, “I can’t do this; I’m too scared.” Or, a child may be thinking, “I have to be perfect; I can’t mess up,” and then suddenly a bout of shaking and trembling begins. Or perhaps the child was unable to do something, like wear a usual “lucky shirt” on the day of a test, and this simple change in what the child does (or doesn’t do) – the behavior – leads to feelings of dread and thoughts of doom.

There are many common physical symptoms your child may experience in scary situations. They might have weak legs, shaky hands or a trembling voice. It may be hard to swallow or catch a satisfying breath. Some kids feel dizzy and numb, almost as if they were floating above their own body. Other physical symptoms include rapid heartbeat, chest discomfort, dry mouth, stomach pain or a choking sensation.

Too much anxiety can even lead to a panic attack, when the child experiences an intense rush of fear – even though there isn’t an actual life-threatening danger – along with multiple physical symptoms.

A child prone to anxiety has a brain that automatically fills with negative thoughts that reflect black and white thinking – or very rigid, inflexible ways of looking at the world. These negative thoughts distort reality and make your child feel far more anxious. It takes some practice to identify these negative thoughts. They often assume catastrophic outcomes – or that the worst will happen: “I will mess up and cry in front of everyone and lose all my friends.” These thoughts feed into the cycle of fear and anxiety.

What You Can Do

First, take a moment to recognize that you’re not alone in parenting a child with anxiety. It can feel overwhelming when your child screams, refuses to go to school or is unable to transition through their daily activities. The hopeful news is that anxiety is one of the most treatable psychological conditions. The first step is to get a referral to a psychologist or social worker who specializes in childhood anxiety. Your pediatrician or family doctor can help you with this.

In addition to seeking help from a therapist or social worker for the anxious child, parents can benefit from joining support groups or speaking with a licensed psychologist to work through their own mounting anxiety and frustration about the child’s situation.

Through practice in therapy and at home, one of the most important techniques your child can learn to master anxiety involves replacing automatic negative thoughts with positive coping thoughts. Some people refer to this dialogue as positive self-talk.

For example, if your child reports thinking, “I’m going to embarrass myself in front of everyone,” help the child identify this negative thought and replace it with, “These are just thoughts, not reality. Just because I fear something doesn’t make it true. Even when I make a mistake, people still care about me.”

The coping thoughts should be realistic and meaningful; if your child doesn’t believe them, the coping thoughts won’t be effective. Try to think of the most accurate outcome or explanation for the situation, not necessarily the most positive. For a child who struggles socially at recess, this self-talk might be, “Even if I’m not invited to be part of a game with the popular kids, I can find something to do, and I will get through recess. I’ve been successful at talking with a couple new friends, so maybe I’ll look for them today.”

Two excellent forms of therapy that can help your child change unhealthy thought patterns are cognitive behavioral therapy, and acceptance and commitment therapy. You can discuss these options with your child’s therapist and learn how to support your child at home. Relaxation training, such as abdominal breathing, meditation and progressive muscle relaxation, can also help ease your child’s physical symptoms of anxiety.

In addition, there are a variety of medicines that have proven effective in helping to manage the symptoms of pediatric anxiety disorders, especially when used in combination with talk therapy.

If you are concerned that your child is overly anxious, remember that there is help available, and it will eventually get better. Your child (and you) can get through this with support.

Having a Quarter-Life Crisis? How to Make Life Better for Future You

“You’ve got your whole life ahead of you,” young adults are often told—but that’s of little comfort to the many 20- and 30-somethings who face “adulting” challenges like career uncertainty, overwhelming student loan debt, and relationship difficulties. The uncertainties of this time of life leave many feeling depressed, insecure, and rudderless. The good news is that you’re not alone—there’s a name for this experience: the quarter-life crisis.

“During their early 20s to early 30s young adults may feel either ill-prepared for or trapped by adult roles,” explains Jacob Tebes, PhD, who is a professor of psychiatry (psychology) at Yale School of Medicine and at the Yale Child Study Center. “This may trigger a quarter-life crisis that leads to heightened feelings of stress, as well as anxiety or depression.”

Like the better-known midlife crisis, the quarter-life crisis is common—one survey suggests that as many as 70 percent of young adults have them.

“Young adulthood is more challenging than ever, especially when making choices,” explains Dr. Tebes. “The amount of information available in our hyper-connected world makes it very easy to second-guess yourself. Part of the problem is the growing belief that there is a ‘best’ choice to be made—about your relationships, career, commitments, or even downtime. This is an illusion,” he says. “There is no ‘best choice.’ It is what we do after we choose that makes all the difference in how something works out, even when initially things may not turn out so well.”

One good choice you can make, though, is to take care of yourself. Our Yale Medicine doctors discuss health matters to consider as you reach the quarter-life milestone.

Even social drinking can lead to liver cirrhosis.

It’s a common misconception that only people who have been heavy drinkers for decades have to worry about alcohol-related cirrhosis of the liver, a chronic condition in which the organ sustains permanent scarring and impaired function. “The amount of liver cirrhosis we are detecting in young people is increasing dramatically,” says Yale Medicine hepatologist Michael Nathanson, MD. “It’s the most quickly growing group of people dying of cirrhosis in this country.”

Rates of liver cirrhosis deaths from all causes, including hepatitis C, have skyrocketed in the United States in the last two decades, increasing by 65 percent overall for all age groups between 1999 and 2016. The sharpest increase, though, was among young adults, ages 25 to 34. Deaths from liver cirrhosis in this age group rose nearly 11 percent per year, according to The BMJ, which attributes the increase entirely to drinking.

“Certainly, some of the patients we see in their 20s and 30s think they are just drinking socially or because of stresses, and they don’t understand the damage they are doing to their livers and how the damage accumulates quickly,” says Dr. Nathanson. “Drinking, even at their age, could lead to serious health problems and even death, and it isn’t going to take 10, 20, or 30 years in all cases.”

Don’t assume your body will tell you that you’ve had enough, cautions Dr. Nathanson. He often sees patients who had no idea that their social drinking was harmful until the problem became serious. (Early stage liver disease has no symptoms.) He also reminds quarter-lifers that alcohol use in general is one of the leading causes of death (for a variety of reasons, including accidents) and disability for their age bracket.

While Department of Health and Human Services guidelines define moderate drinking as one drink a day for women and two drinks a day for men, the safest course of action is to abstain from drinking altogether. If you take medications (prescription or over-the-counter drugs), ask your doctor or pharmacist about alcohol consumption while on them since many, including acetaminophen, can hypersensitize your liver to the effects of alcohol, Dr. Nathanson explains.

More millennials are being diagnosed with colorectal cancer.

People tend to think that colon and rectal cancers (colorectal cancers) only happen to older adults. But there is a disturbing and ongoing trend of young people being diagnosed with these cancers.

“Colorectal cancer is clearly on the rise in the younger generations,” says Hulda Einarsdottir, MD, a Yale Medicine colorectal surgeon. Research has found that people born in 1990—who will be 29 years old this year—have double the risk of colon cancer and quadruple the risk of rectal cancer compared to people born around 1950. Researchers are still trying to figure out why.

With this in mind, one thing you can do is be aware of symptoms that you should discuss with your doctor. “Even if you’re in your teens or 20s,” Dr. Einarsdottir says, “if you have rectal bleeding, if you have any change in your bowel habits, any change in appetite (like feeling “full” early), weight loss, or abdominal pain that is not explained, you should get checked out.”

Rectal bleeding can be misunderstood, Dr. Einarsdottir adds. “I get a lot of patients referred for hemorrhoids. But even in a young patient, you have to make sure that it’s not something more serious,” she says. In certain cases, she may recommend a colonoscopy, the screening test that is used to identify and remove colorectal cancers and precancers.

Using SPF now may help you avoid skin cancer later.

“It is difficult to convince 20-somethings that the tans they bring back from their Caribbean vacations might lead to skin cancer in 30 years,” says dermatologist Kathleen Cook Suozzi, MD, aesthetic director at Yale Medicine Dermatology. According to the American Academy of Dermatology, melanoma is the second most common form of cancer in women under 30.

“Whenever I see a patient younger than 45 for skin cancer surgery,” Dr. Suozzi says, “I ask about their history of tanning bed use, and the correlation is very strong. Recently, state laws have limited minors’ access to tanning beds, and further education about the effects of ultraviolet [UV] damage from indoor or outdoor tanning will hopefully help halt this sobering trend.”

Protecting your youthful appearance can be another motivation to use sunscreen. “The sun damage sustained now will add years to the skin’s apparent age in your 40s,” Dr. Suozzi says. In addition to sunspots, skin conditions like rosacea and melasma are brought on or worsened by UV damage. “While there are lasers and chemical peels to help improve the look of sun-damaged skin, it is much more difficult to erase damage than it is to prevent it,” she says.

Start thinking about your future family.

Having kids may be the furthest thing from your mind right now. “In your 20s, you may be doing everything you can to not get pregnant,” says reproductive endocrinologist David Seifer, MD. “Then in your mid-30s, it’s like a role reversal.”

“For women, fertility is not just an on/off switch,” Dr. Seifer says. “It’s going to be a gradual decline for every woman on the planet.” Sometime around age 37 to 38, “your fertility declines at an accelerated rate. So, it’s important to be conscious of that.”

He advises that young women think about at what point they might consider having children and how many they want to have. “People just think about timing the first one, but sometimes it can be the second or third when things get more difficult,” he says. Dr. Seifer also suggests that women ask their female relatives when menopause started for them.

“Generally, if your mother or your sister went through menopause before the age of 50, you may be genetically predisposed to going through menopause at an earlier age. That itself should probably be one small indication that you might consider having your family earlier than later,” he says.

Even if becoming a parent seems far off now, women and men should be aware of risk factors that can deplete fertility—such as smoking, sexually transmitted diseases, stress, and obesity—and make healthy lifestyle changes as needed.

While young men aren’t under the same time pressure as young women, they should know that sperm quality deteriorates over time, says Yale Medicine urologist Daniel Kellner, MD.

One immediate step young men can take is to avoid steroid use. If you’ve taken them at any point or have been prescribed testosterone for low-testosterone, either can affect sperm quality temporarily—or even permanently, Dr. Kellner says. Heavy alcohol or drug use all negatively impact sperm quality and count, and can even interrupt the brain hormones that control sperm production.

If the time isn’t right, you don’t have to rush, though. It is possible to preserve eggs, embryos, and sperm if you would rather have children in your 40s or 50s—or if you have a health condition such as cancer in which treatment can affect fertility.

Just be mindful that “there is a biological clock—it’s real,” says Dr. Seifer. He recommends those who are delaying having children beyond their mid-30s consider testing (bloodwork and an ultrasound), which can provide a snapshot of your overall fertility.

Make annual check-ups with your doctor.

“While these young adults are among the healthiest age groups, they should get in the habit of having good preventive health care,” says Yale Medicine’s Xavier Llor, MD, medical director of the Smilow Screening & Prevention Program. That means seeing a doctor annually for a check-up and to discuss screening tests that are recommended for their age bracket. According to Dr. Llor, young adults in their mid-20s and 30s should talk to their health care providers about health risks such as tobacco and alcohol use, sun exposure, diet and nutrition, physical exercise, weight, environmental and occupational exposures, and family history. He also recommends that women have pelvic exams and Pap smears every three years starting at age 21 to check for cervical cancer.

In short, find a health care provider you trust, and make (and keep) annual appointments. “It’s tempting to just go to the doctor when you have a sore throat, but the best way to stay healthy at this time of life is good preventive care so if symptoms do crop up, they can be addressed early,” Dr. Llor says.

Good health, they say, is the foundation of success in life. So, as you work through this quarter-life phase, take care of yourself to ensure that the decades ahead are ­­­­­­­yours for the taking.

Diet Culture Dangers: Could your Child Be Heading for an Eating Disorder?

WHEN I TALK ABOUT “DIET culture” with clients in my office, I realize that initially most of my clients don’t really understand what I mean. It makes sense because dieting, body dissatisfaction and unrealistic eating patterns are commonplace in our society.

According to a 2015 research review in the Journal of Child Psychology and Psychiatry, the sociocultural idealization of thinness was the primary contributor in eating disorder development. Just as we educate our children about consent and the dangers of drugs, parents can help kids understand the perils and illusions of diet culture.

Diet culture isn’t a scary, dark alley you can avoid. Diet culture is everywhere, even in our safe spaces. Our kids are already getting dangerous messages. Cartoons villainize some foods and put hero capes on others. Children’s movies often perpetuate weight stigma and bias. Schools send home reading assignments with food and body shaming messages. The pediatrician recommends we “watch” our child’s weight when they’re on their biologically appropriate growth curve. The church youth group members start talking about weight loss and counting calories. Seeds of body distrust and food fears are planted quite early in diet culture.

The dangerous messages of diet culture can prompt our children to make seemingly benign changes in their behavior; yet some of the “I just want to be healthy” changes can negatively impact their growth, development and mental health.

These common yet dangerous changes can let us know when our kids need more support around trusting their own bodies and living in a disordered diet culture:

Specific Food Restriction, Avoidance or Fear

When a client tells me his or her child no longer wants a certain food or type of food, I immediately get concerned. It’s one thing for a child to recognize their stomach gets upset after an ice cream sandwich if the child has lactose intolerance. To skip a once-loved food because it’s been deemed “unhealthy” or has “too much sugar” is something very different. A sudden dietary change like avoiding rice, pasta or meat sauce (among many other restrictions) at dinner is a reason for me, as an eating disorder specialist, to start asking more questions. Did the child just complete a health class, watch a compelling documentary or witness others who influence the child start to abstain from certain foods as well?

Food restriction, without medical necessity (like a medically confirmed food allergy), in most cases stems from diet culture. When a child restricts or fears certain foods, it’s very possible that child heard the false beliefs that dieting, food avoidance or having a thin body leads to health. In fact, it’s quite the opposite and research has, for decades, supported that dieting behaviors increase the risk of eating disorders. According to a study published in the BMJ, adolescents who engaged in moderate dieting were five times more likely to develop an eating disorder, whereas those who engaged in extreme dieting and restriction were 18 times more likely to develop an eating disorder than those who did not engage in dieting at all.

Rigid Exercise or Tracking Behaviors

Many of the families I work with have active children. They may engage in dance, karate, gymnastics, baseball or a whole host of other activities the children enjoy. However, some kids are adding exercise that they don’t necessarily like but feel pressured to add to their daily routine to be healthy or change their bodies. When a client tells me about going to their sanctioned school sport practices but feels like it’s not enough and adds five days of running as well, I start to worry. What’s prompting this child to be rigid with additional exercise when just last year the joyful movement provided by their sport was enough?

It’s not just exercise that can become rigid and excessive. When adolescents report tracking miles completed and calories burned, that’s also a recipe for danger. Many have learned about tracking, whether for movement or caloric intake, from health classes or those most influential around them. Tracking, much like stepping on a scale, can trigger behaviors that increase the risk of disordered eating behaviors while undermining young people’s trust in their ability to fuel and care for their own bodies.

Too Much Time on Social Media

Calorie and fitness tracking apps aren’t the only dangerous tools our kids can find online. Social media is playing a role like never before. A 2017 study in the journal Body Image reported that engaging in appearance-related social networking sites use, particularly on Facebook and Instagram, was associated with body image issues. Of course, there are positive messages on social media, but with the diet industry and diet culture continuing to perpetuate the thin ideal, celebrity endorsements of diet products, and a narrow lens of health, we have to keep track of what our kids are visually consuming.

Heading for an Eating Disorder

Eating disorders aren’t a choice or a phase, they’re legitimate illnesses that require physiological and psychological treatments. And they can start very innocently with leaving out certain types of foods, under-portioning at meals and snacks, or not eating after a certain time. If these dieting behaviors go unnoticed, more restrictions or behaviors can ensue leading to chronic disordered eating patterns and clinical eating disorders.

Like adults, children may suffer from a number of life-altering and life-threatening eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder and orthorexia. If you’re concerned that you or your child may be struggling with an eating disorder, there is hope and help, and you can find more information at the National Eating Disorders Association’s website.

As parents, we can help our kids build a strong foundation to trust their bodies, not fear food, and become resilient in our very normalized diet culture. When I talk with families about this in my office, I tell them that once you truly see diet culture for what it is, you can‘t un-see it. We can help point out these dangerous parts within our culture while teaching our kids that healthy bodies come in all shapes and sizes. In addition to offering a variety of foods and flavors around the family table, we can show our kids that our homes are the truly safe zones.

Penalty Kill Shines, Capitals Beat Jets to Extend Win Streak

Washington Capitals left wing Carl Hagelin (62), of Sweden, celebrates his goal with the bench during the second period of an NHL hockey game against the Winnipeg Jets, Sunday, March 10, 2019, in Washington.

Carl Hagelin scored the go-ahead goal on a breakaway out of the penalty box, backup Pheonix Copley made 33 saves and the Washington Capitals beat the Winnipeg Jets 3-1 for their seventh consecutive victory.

Carl Hagelin watched helplessly from the penalty box as the short-handed unit he helped transform got to work.

Seconds after stepping out following another successful kill, Hagelin scored the go-ahead goal on a breakaway to help the Washington Capitals beat the Winnipeg Jets 3-1 on Sunday night for their seventh consecutive victory. With players blocking shots and Pheonix Copley stopping the puck, the defending Stanley Cup champions killed off all five minor penalties they took to keep their winning streak alive.

“Obviously I don’t want to be in the box for four minutes like I was, but it turned out OK,” said Hagelin, who took back-to-back penalties in the second period. “It was great to see the guys bail me out.”

Hagelin deserved that payback. Since he and defenseman Nick Jensen joined Washington at the trade deadline, the penalty kill is 19 for 21 and has killed off 16 in a row. For much of the season, a porous penalty kill looked like the Capitals’ biggest obstacle to repeating, and suddenly it has become a strength.

“We’re tweaking things as we go, and we’re getting better, I think, at figuring out what works for us,” said defenseman Matt Niskanen, who returned after taking a one-timer from Patrik Laine off his left hand during one penalty kill. “It’s taken us some time to figure out what we’re good at and how we want to approach it with our tactics. I think as we’re getting to this time of year, we’re starting to play with a little bit more desperation.”

The desperation was there against the Central Division-leading Jets who put up eight goals on Carolina two days earlier. Washington won despite being outshot 34-17, thanks to the goals by Hagelin and Nicklas Backstrom and an empty-netter from Lars Eller to go along with 33 saves from Copley.

Despite not playing in two weeks, Copley made the most of a somewhat surprising decision to give him the nod over Braden Holtby.

“He was kicking the puck out all night,” Jets captain Blake Wheeler said. “The rebounds were there. We just couldn’t get to them.”

Mathieu Perreault scored Winnipeg’s only goal on a shot Copley had little chance of stopping. The Jets thought they’d tied the score midway through the third period, but officials ruled Bryan Little pushed Copley’s right pad into the net and upheld a coach’s challenge.

Connor Hellebuyck made 15 saves as the Central Division-leading Jets lost the finale of a four-game road trip.

“We played a heck of a road game here,” coach Paul Maurice said. “You don’t like losing when you play well. Their guy made some good saves, they got some good breaks around the net, but our compete was good. You know what? We had five opportunities to score on the power play. That doesn’t go. That hurts you.”

The Capitals’ penalty kill has hurt plenty of opponents during this winning streak and allowed them to look again like a championship contender.

“That’s something we’ve got to keep doing,” Backstrom said. “Things didn’t go our way like the first 50, 60 games, but I feel like everyone is more committed now and we’re blocking shots and we’re working for each other.”

NOTES: Capitals D John Carlson became the third player in franchise history with consecutive 50-assist seasons, joining Hall of Famers Scott Stevens and Larry Murphy. … The Jets continued to be without injured top-four defensemen Dustin Byfuglien and Josh Morrissey. … Alex Ovechkin remains one point away from 1,200 in his career.

Jets Agree on Deal to Acquire Raiders’ Osemele

In this Nov. 27, 2016, file photo, Oakland Raiders offensive guard Kelechi Osemele (70) lines up during the team’s NFL football game against the Carolina Panthers in Oakland, Calif. Two people with direct knowledge of the trade tell The Associated Press that the New York Jets have agreed to acquire left guard Kelechi Osemele from the Oakland Raiders. The people spoke to the AP on condition of anonymity Sunday, March 10, 2019 because the trade can’t be completed until the new league year starts Wednesday. 

Two people with direct knowledge of the trade tell The Associated Press that the New York Jets have agreed to acquire left guard Kelechi Osemele from the Oakland Raiders.

The New York Jets made a big move to get a big man to bolster their offensive line.

Two people with direct knowledge of the trade told The Associated Press that the Jets agreed Sunday to acquire two-time Pro Bowl left guard Kelechi Osemele from the Oakland Raiders.

The deal includes the Jets sending their fifth-round draft pick to the Raiders for Oakland’s sixth-rounder, according to one of the people who spoke to The AP on condition of anonymity because the trade can’t be completed until the new league year starts Wednesday.

ESPN first reported the trade for Osemele, with Bay Area News Group first reporting the terms.

The deal is the second by the Raiders in less than 24 hours. They agreed Saturday to acquire receiver Antonio Brown in a trade with Pittsburgh.

The 6-foot-5, 330-pound Osemele fills a major need on the Jets’ offensive line in front of quarterback Sam Darnold. Starting left guard James Carpenter is scheduled to become a free agent after an injury-shortened season. Carpenter spent the past four seasons with New York after playing in Seattle for four and helping the Seahawks win the Super Bowl in 2014.

But the Jets appeared ready to move on from Carpenter, who turns 30 later this month and is coming off a shoulder injury that limited him to 10 games last season.

New York, which entered the offseason with question marks on its offensive line at center and left guard, is re-signing Jonotthan Harrison, who started the final seven games at center when Spencer Long struggled with injuries and consistency. But it’s uncertain whether Harrison is in new coach Adam Gase’s plans as the starter moving forward. Long was released last month after just one season with the Jets and has since signed with Buffalo.

Meanwhile, the Raiders save $10.2 million on their salary cap by dealing Osemele, who turns 30 in June. He is also due $11.7 million next season, but none of the remaining salary includes guaranteed money.

Osemele was a second-round pick of Baltimore in 2012 and he started every game at right tackle as a rookie before moving to left guard to replace the injured Jah Reid in the postseason. He was limited to seven games the following year because of a back injury, but started 28 games over the next two seasons for the Ravens.

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