Relationship between suicide and religious service attendance

A new study published in the May 6, 2020 edition of JAMA looks at the relationship between suicide and other "deaths of despair" and attendance at religious services among health professionals.

Briefly, this study sought to answer the question "Is frequent religious service attendance associated with a lower risk of deaths related to drugs, alcohol, and suicide (referred to as deaths from despair) among US health care professionals?"

The researchers looked at a group of  66,492 female registered nurses and 43,141 male health care professionals in the US. Data from these groups was examined covering a 15+ year time period. Among the female group there were 75 deaths of despair, and among the male group there were 306.

When the relationship between deaths of despair and religious service attendance was examined,  attendance at religious services at least once per week was associated with a 68% lower hazard of death from despair among women and a 33% lower hazard among men compared with those who never attend. The researchers state that these findings suggest that frequent attendance at religious services is associated with lower subsequent risk of death from despair.

To read the full article click here.

Three minutes to decrease COVID worry

Acceptance and Commitment Therapy (ACT) is a form of therapy based on acceptance and mindfulness combined with behavior change and commitment. It's a form of therapy that is taught/frequently utilized in my current residency program.

One of our faculty who facilitates the resident processing group is Tom Lavin. He wrote out a 3+ minute meditation using ACT theory. While it can be useful in dealing with a whole host of stressors, it can also be very helpful in dealing with COVID-related stress/anxiety/worry that many of us may be experiencing. We might be worried about the health risks for our loved ones or ourselves. We might be worried about the financial fallout. We might be struggling with isolation, or conversely spending more time with family/housemates than we usually do. Or even just getting enough of the basic supplies... (For more on Tom Lavin's resources click here). 

Here's the meditation (shared with permission): 

Accepting, Choosing-Committing, Taking Action 

Tom Lavin MFT, LCADC, ACATA

Accept what is, as it is

Slowly... take a few deep breaths...

Allow your thoughts and feelings to emerge and just be there...

the ones you like... and the ones you don’t like...

take few more deep breaths...

and just let your thoughts and feelings be there...

Take a few more deep breaths...

and let your thoughts and feelings be there...

—not judging them and not trying to make them go away...

Just let your thoughts and feelings be there.

Accepting your thoughts and feelings does not mean you like them

and it doesn’t mean you like the situation ...

Just let your thoughts and feelings be there...let the situation be there...

and then settle into accepting what is, as it is...

If you’re having a hard time accepting what is,

go ahead and accept that you’re having a hard time accepting what is...that

you really wish the thought or feelings or the situation were different...but

they’re not...so you’re willing to accept what is, as it is...

After accepting what is as it is, focus on what’s important to you-is there

something about this you want to change---do you want to change your

perspective? Or change the situation?

What do you want to change?

If you think you can make the change, develop and plan a strategy

to make the change you discern would be good...

...then...engage in NIKE Therapy---be willing to “ just do it”...

Be willing to take positive, assertive action....

However, if you can’t change the situation and you’re struggling with

your perspective..... let go............let go...........let go.....

Let it go for today.

Just let it be.

Let it go... and move on...

Say “Yes to Life”...

... and focus your attention on other people and activities you value.

Image from the Center for Stress and Anxiety Management

Face coverings and how to help health care workers if you sew

This past week the CDC made the strong recommendation for people to wear face coverings in public. For complete and up to date information on face coverings from the CDC, please click  here.   

In response to this recommendation, the State of Nevada sent out an email to all State employees explaining the different types of masks and their preferred use, as well as providing information on how to make your own mask. 

If you like to sew, you can make coverings for your local health care providers in addition to making them for yourself/family/friends/neighbors. I was so grateful when I went for my N95 fitting to find that people in the community had made hundreds of cloth coverings for our N95 masks so that we can extend the number of uses per N95. There was a big bin of cloth masks that we could chose from with lots of fun patterns. Additionally, it's really helpful to have a headband with buttons sewn behind the ears so that providers can hook their cloth mask onto the headband instead of behind their ears. No one had donated any, but I'm sure they would be greatly appreciated as well. 

The information below on cloth masks is adapted from the State of Nevada email. I hope you find it helpful.

• Can be worn anywhere but should be changed out and washed frequently;
• If you are able to make a cloth mask, it is recommended to make a few to change out between home, work and other places.

• The cloth mask for work should ONLY be worn at work.
• Maintain in a plastic zip-lock bag.
• Change the zip-lock bag at least once a week
• Only take home to be laundered, placed in a clean zip-lock bag and brought back to work.
• Placing a cloth mask over other masks will help keep the other masks clean and last longer.
• The cloth mask should be able to be laundered in hot water and machine dried without damage or change to the shape or integrity of the mask.
• Here are some  YouTube ‘How To’ videos for making a mask:
• How to make a fitted mask – much like an N95:

https://www.youtube.com/watch?v=fySsaOojEVM

• How to make a mask with a filter:

https://www.youtube.com/watch?v=iNX0cRrYj6U

• How to make a great mask if you can’t find supplies:

https://www.youtube.com/watch?v=v8HNYKvlaN8

• How to make a mask with a handkerchief/napkin: 

https://www.youtube.com/watch?v=nauxXkljAVs

Face masks should fit snugly but comfortably against the sides of the face and bridge of the nose. Ideally, they include layers of fabric, preferably with a filter. Ideally they will allow for breathing without restriction. They should also only be touched when putting them on or taking them off. 

Please stay safe, stay home, and wash your hands.

Prayers for health care workers

As the impact of COVID-19 spreads, it is hitting close to home as the list of health care professionals that have died in service to others grows. Medscape keeps an updated list of health care workers who have died from COVID-19. I posted the link of Facebook previously, but it is worth sharing again. Unfortunately and sadly, it was updated again this morning as more names had to be added. For the most up to date list click here. 

Right now I feel the force of my two vocations, medicine and ministry, colliding. It is only through prayer and faith in God's sustaining strength that I can put my fears aside to serve those hospitalized with psych issues on my weekends on call. And it is through prayer that I respond to the growing list of those who have already died while serving others. Below are three prayers from Grace Cathedral that I find beautiful. 

Please, think about your physician or a health care worker that you know and offer one of the prayers below. We will all appreciate it more than you will ever know...

For Those Who Are Sick and Those Who Minister to Them

Gracious God, source of life and health: Jesus came to our disordered world to make your people whole. Send your Spirit on those who are sick and all who minister to them; that when the sick enter your peace, they may offer thanks to your Great Name; through Jesus Christ our Savior. Amen.

For Health Care Providers

Give your blessing, gracious God, to those whom you have called to the study and practice of the arts of healing, and the prevention of disease and pain. Give them the wisdom of your Holy Spirit, that through their work the health of our community may be advanced and your creation glorified; through your Son Jesus Christ. Amen.

For Emergency Workers

God our strong deliverer: when those charged with the urgent mediation of your healing power feel overwhelmed by the numbers of the suffering, uphold them in their fatigue and banish their despair. Let them see with your eyes, so they may know all their patients as precious. Give comfort, and renew their energy and compassion, for the sake of Jesus in whom is our life and our hope. Amen.

God and COVID-19

This past week I've read alot of  "theological" statements positing ideas about God during this global pandemic. Some of them just made my head spin as the theology inherent in these statements is full of holes and presents an image of God that is the antithesis of my understanding and experience of God whose own self definition is love. For example,  I read a statement from a physician a few weeks ago that said he didn't care about the lack of personal protective gear that our profession faces right now because God "won't let that happen to us." I read another statement that linked the timing of the spread of the virus to Lent as a way to increase our suffering and bring us closer to Christ. Goodness gracious.

The fact is that people have argued for thousands of years about where God is when bad things happen. And the bottom line is that there is no good, comprehensive answer.

James Martin, a Jesuit priest, wrote an opinion piece for the New York Times last week. In this piece he raised the following points (to read the full article click here):

• When we address the "problem of suffering" a distinction must be made between  natural suffering (such as hurricanes, cancer, and yes, this virus) and suffering that results from the actions of individuals. 
• All explanations for natural suffering in the end are "wanting in some way." Most common explanations include that suffering is a test (which Martin states is an approach that can make God out to be a monster) and that suffering is punishment for sins. 
• The confusion for believers comes down to the "inconsistent triad" which he summarizes as "God is all powerful, therefore God can prevent suffering.But God does not prevent suffering. Therefore, God is either not all powerful or not all loving. "
• The most honest answer to why COVID-19 is killing people is we don't know.
• Jesus' fully divine and fully human nature, biblical teachings on sickness and  healing,  and  of course prayer can bring comfort to Christians at this time.
• Those who do not consider themselves Christians can also view Jesus' life and actions as a model for care of the sick, that we should allow our heart to be "moved by pity" in our response to how we care for others during this crisis. 

Over the years I've thought alot about natural suffering. I see my patients who through no fault of their own have dopamine imbalances in their brains and thus live their lives with schizophrenia. I look at the ravages of the Paradise Fire and other natural disasters. And now this virus, the ultimate impact that we don't yet know.

While my beliefs essentially align with the above, I've often wondered about what role free will plays.  In seminary our theology professor wrote out several different areas that different theologians view as a continuum for ways of conceptualizing God. For example, some see God as a master clock maker, who brought the world into being and continues to control every aspect. The other end of this continuum is God created the world and then stepped back, letting creation evolve--a more hands off approach. The professor presented at least a dozen of these different areas, but one that especially intrigues me is free will vs. determinism. Do we have the ability to make our own choices, or is God determining every step? (For a full discussion of free will click  here). In my own thoughts, I've often wondered if nature itself has free will. What if free will did not only apply to people but to the natural order?  Can a virus' mutation be explained by the free will of the natural order? Can ultimate neurological function be explained by  the free will of  the developmental process? I am far from a theologian and will leave it for deeper spiritual thinkers to ponder, but it is something I've always been curious about. Maybe we limit the concept of free will if we only apply it to humans...

For now dear readers, stay calm, wash your hands, stay at home,  pray if so inclined, and care for each other with a heart driven by love...

Calming activities during the time of COVID-19 and the best banana bread recipe ever...(yes, they are related)

In last week's post I shared some coping mechanisms for worry. One of the mechanisms to use when worry translates into tension/anxiety is to engage in activities that calm you and distract you from your anxiety producing thoughts. In that post I suggested several activities. Activities such as: 

• Yoga:  for some now free yoga classes click this link to  Core Power Yoga
• Fitness:  Planet Fitness is live streaming a daily workout at 7 PM ET on their Facebook page, to join in click here. Orange Theory (my absolute favorite gymn ever) has daily at home work outs. For the March 22 video click here. 
• Journaling
• Prayer: for a prayer in the time of COVID-19 from the Anglican Church in Ireland, click here
• Art projects: Michael's has a page that lists several make at home projects. They are also currently offering 30% off supplies for on line or curb side pick up. Click here for more information. 

This past week I found myself turning to one of my go-to coping mechanisms--stress baking. We have three generations together right now isolating in my home, and I've found myself turning to baking as a distraction when my worries start to become overwhelming.  This morning I made banana bread--it's a family recipe that my grandmother gave me when I got married. If you find baking calming and you have bananas that are starting to brown, consider heading to the kitchen. You could even make a double batch and share with someone else, even a neighbor you haven't met. 

Ethel's Banana Bread

2 cups mashed bananas (usually about 3-4)

3 eggs

1 cup oil

1 teaspoon vanilla (not mandatory if you don't have it)

2 cups flour

1 cup sugar (can use less if desired)

1 teaspoon baking soda

1/4 teaspoon salt 

Optional ingredients: 

grated lemon or orange peel 

dried or fresh fruit cut in small pieces (about a handful--I use cranberries or blueberries)

chopped nuts (about 1/2 cup)

1 teaspoon cinnamon 

Wash your hands thoroughly. 

Preheat oven to 350 degrees. 

Mix the sugar into the oil  and let sit a few minutes, stirring occasionally. Then add bananas, eggs, and vanilla. Mix well.  Add  flour,  soda and salt to the mixture. Stir to combine. Stir in any of the optional ingredients if desired. 

Grease (or use cooking spray) a 9x5 loaf pan. It comes out best if you line the pan with greased/sprayed wax-paper. Bake for about 50 minutes. Insert a knife into the center and if it comes out without batter stuck to it, it is done. (I like to leave the very middle a little gooey). 

Enjoy!

Ways to cope with worry during a pandemic

The topic of this week's post is physical and mental health. 

Each day the news about COVID-19 becomes more worrisome. The spread, risks, and ripple effects  are alarming, and certainly cause for worry. And some worry is a good thing--it can drive us to make the hard changes that prevents/slows the spread of this new virus. But there is such a thing as too much worry---and too much worry can take a toll on both our mental and physical health. 

A lot of my time right now is focused on learning and implementing cognitive behavioral therapy techniques with my patients. In this week's post I want to share some cognitive behavioral strategies that can help people who might be worrying a little too much. The information is adapted from the American Academy of Family Physicians. 

On the left side of the chart below are some problematic thoughts/beliefs that people can have about worry. In the middle of the chart are some facts that counter that thought. In the third column are some strategies/behaviors you can turn to if you catch yourself falling into one of the problematic thoughts. 

PROBLEMATIC THOUGHT/BELIEF  ABOUT WORRY	COUNTERING FACTS	SUGGESTED COPING STRATEGIES
If I'm worried it is a warning.	Worry rarely saves us from anything. Most things we worry about are unlikely events. The bad things that happen to us are rarely anticipated through worry and rarely allow us any control. A compelling worry is still just a thought that will pass.	Challenge your distorted risk assessments: “Am I overestimating the risk?” “Yes, it feels likely, but how likely is it really?” Remind yourself about the transient nature of worries: “What will this situation be like in year,  or even next month?”
I need to seek re-assurance for my worries.	Frequently seeking reassurance (e.g., searching the Internet, checking your body/temperature constantly, repeated consultations with health care professionals) often stimulates more worry and doubt. The brief relief provided by reassurance only perpetuates the worry cycle.	If you repeatedly seek reassurance from others, encourage them to gradually withhold the reassurance that only perpetuates the problem. Stop “investigating” on line.  Getting the facts from trusted sources is fine, but spending hours reading information on questionable web sites is less than helpful. Checking your temperature if you feel feverish is important, but doing so incessantly should be avoided.
I have to avoid thinking about my worries.	Trying not to think about a particular thing is the problem, not the solution. What we resist persists. We think about what we are striving not to think about. Do not try to eliminate your worries. Worried thoughts can be accepted as background noise without being actively engaged.	Learn mindfulness meditation. It is simple, but not easy. Learning to be in the moment, focusing on your breathing and accepting the contents of your thoughts, can gradually ameliorate worry as you become more skilled.
I need to give my worries immediate attention	This only perpetuates the worry cycle. Strive to experience your worries “on the clock” rather than whenever they intrude and upset you. You can learn to have worries on your schedule rather than having them intrude on you all day.	This only perpetuates the worry cycle. Strive to experience your worries “on the clock” rather than whenever they intrude and upset you. You can learn to have worries at your bidding rather than having them “chase” you all day.  Some people find it helpful to keep a small box handy to "put their worries in" until they want to give them their attention.
If I worry I can  control what worries me and the future will be certain	More worrying will not yield control or certainty. If a worried thought is truly a signal, it should dictate certain actions. If a worry does not call for action (other than reassurance seeking), it is likely to be merely noise, not a signal.	More worrying will not yield control or certainty. If a worried thought is truly a signal, it should dictate certain actions. If a worry does not call for action (other than reassurance seeking), it is likely to be merely noise, not a signal.
My worries are leading my body to feel tense and anxious.	When you give credence to your worried thoughts, your body will respond with tension, anxiety, and somatic symptoms. When you accept worries as “just thinking,” your body will respond accordingly.	Relaxation and diaphragmatic breathing skills can help decrease body tension.  Discover what calms you, (examples include massage, yoga, exercise, music, a hot bath, journaling, prayer, giving your time to someone or something).
If I worry it is a sign of weakness or lack of faith	Worries are not the litmus test of strength or religious faith. All people are prone to worry. However, unhealthy habits perpetuate worry, and healthy habits can diminish worry.	Give a worried thought your full attention for five minutes, but then do something physical or interpersonal instead. Exercise and social contact (while not seeking reassurance) usually make worry much less compelling.