Why You Shouldn’t Believe Everything You Read in the Newspapers about Medical Studies

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One of my favorite journals is called PLOS ONE.  This is a journal which supports open access. That means anyone can access any article in this Journal without paying a fee. Medical studies published in this journal are accessible to anyone.

Most of you probably don’t realize but when you see a medical study quoted in a newspaper article, you can’t actually access the original study on the Internet without paying a hefty fee, usually $20-$40! If you have access to a medical library then you may be able to access the article but for most people the original articles are off-limits without paying large fees.

Plos.org is an organization that supports open access publication of scientific articles.

That’s why I admire them.

Back to my main story. A recent study in PLOS ONE looked at how often medical research results are replicated, meaning does a second or third similar study show the same results.

The researchers in this study looked at 4723 studies that were included in 306 meta-analysis articles. (A meta-analysis is a study where you combine the results of many other research studies in order to get an overview of findings.)   The researchers divided the studies into lifestyle related studies which looked at things like drinking coffee or smoking cigarettes and non-lifestyle studies such as genetic markers for Alzheimer’s. There were 639 lifestyle studies and 4084 non-lifestyle studies.

The question is of the studies that were picked up by newspapers, how many of them were replicated by subsequent studies?  The answer is only about half of the studies held up when tested again in another study. The other thing that was interesting in this article was that when studies failed to replicate, newspapers never reported that failure. Interesting examples included studies that linked a specific gene to depression, schizophrenia, or autism. None of these studies replicated successfully, which you think would be big news and would be reported by many newspapers, but the truth is that not a single newspaper article reported these failures to replicate.

This shows that newspapers don’t have much genuine interest in good science reporting. Good science reporting always involves being skeptical of new and different results, as well as following up on attempts to replicate those results.

So, what does this mean about science results reported in popular media? What it probably means is that if the finding is new and exciting and different, you probably should be highly skeptical of it being true. And the more esoteric the finding is (such as genetic markers) the more skeptical you should be.

For instance, a recent study that was funded by drug companies looked at whether the statin class of medications have side effects or whether these side effects are just a placebo effect. I’ll write more extensively about this study later, but the study’s findings–that only when people knew they were taking statins did they experience side effects– should probably be viewed very skeptically since many other studies have shown side effects from statins and many clinical reports have confirmed the side effects. (And of course any study that is funded by the manufacturer of a drug should be viewed highly skeptically.)

The bottom line is this: finding the truth is hard, and science is no shortcut. Only findings that have been repeated and replicated in numerous studies should be believed.

How to Overcome Obsessive Compulsive Disorder (OCD) Using Exposure and Response Prevention and Cognitive Behavioral Therapy: Part One

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What is Obsessive Compulsive Disorder (OCD)?

obsessive-compulsive disorder

Check? Check? Check?

OCD is a chronic psychological illness where a person has disturbing and recurring thoughts (obsessions) and compulsive behaviors that they repeat over and over.

OCD is at its core an anxiety disorder. The obsessive thoughts trigger intense anxiety, which the person attempts to ameliorate or reduce by either having compulsive behaviors or compulsive thoughts.

Typical obsessions that people have include:

  • thoughts about harming other people or being aggressive towards other people,
  • inappropriate sexual thoughts and feelings,
  • fear of germs or other types of contamination such as chemical contamination,
  • thoughts about symmetry and order,
  • taboo thoughts about religion or other “hot” issues.

Some typical examples of compulsive behaviors include:

  • Checking behaviors where the person repeatedly checks to see if the stove is turned off or a door is locked
  • Excessive cleaning, hand washing or showering
  • Counting behaviors
  • Arranging things in a particular and precise way
  • I’ve also written about hoarding, which is another type of compulsive behavior.

Some compulsive behaviors are actually thoughts, such as saying a particular prayer to yourself over and over.

There’s an excellent article on OCD at the National Institutes of Mental Health page.

A common type of OCD that I treat in my practice is germ phobia. The typical obsessive thought in these cases is that touching something such as the floor will transfer dangerous germs onto the person’s hands, which will then be transferred either to them or to someone they care about, causing great harm. These people are typically very fearful of public bathrooms and will avoid touching the doorknobs in them. In order to cope with perceived contamination, they will typically wash their hands many times a day, sometimes up to 30 to 50 times. When they cannot wash their hands they will use alcohol gel to sterilize their hands. Often the handwashing is so extreme that the person’s hands will look profoundly chapped and red.

When they feel particularly contaminated they will often take very long showers, washing and re-washing their body very carefully multiple times. These showers can take 30-60 minutes in some cases.

Exposure and Response Prevention Treatment (ERP) for Contamination OCD

OCD that is accompanied by clear rituals such as handwashing is easily and effectively treated using a Cognitive Behavioral Approach that focuses on something called Exposure and Response Prevention (ERP). Let me describe a hypothetical case. (This is a hypothetical case that may include composite aspects of clients I have treated, with all identifiable client information changed.)

Susana came to me because she had developed a very severe case of contamination OCD. Her primary fear was that by touching something that might have germs, she would transfer these germs to her children, husband, or even to strangers, and that they would sicken and die. As a result of these fears, she would wash her hands more than 50 times a day, and take showers that lasted more than an hour during which she would scrub up and wash down three or four times.

She also had developed almost complete avoidances of many situations. Public restrooms terrified her, so she could not leave the home for long periods of time. She was afraid of contaminating her car, which then might contaminate people she loved, so she avoided driving. Work was out of the question since she was spending hours a day on OCD rituals.

The first step was to thoroughly evaluate her OCD. I gave her multiple questionnaires that evaluated the frequency of obsessive thoughts, compulsive behaviors, and avoidant behaviors. The same questionnaires also evaluated the level of anxiety and distress caused by both the obsessions and the compulsions. This gave us a good baseline set of numbers that described the state of her OCD. As part of the same evaluation, I obtained detailed information about all of the things that she was avoiding doing.

The next step was to do some Cognitive Behavioral Therapy (CBT) on her belief systems about germs and contamination. This consisted primarily of a set of conversations where I asked open-ended Socratic-style questions about her beliefs. She showed a variety of common OCD distorted thoughts and beliefs.

Common Thought Distortions in Contamination OCD

  • All germs are lethal and deadly: This distortion is basically the belief that every microorganism causes serious or fatal diseases. It’s actually not true. We are surrounded by bacteria, and most of them are harmless or even beneficial. The most common kind of harmful germs or viruses are the common cold and the flu. Neither these illnesses are particularly dangerous although they are unpleasant. More dangerous germs such as HIV or tuberculosis are extremely rare in developed nations, and the virus that causes HIV is extremely fragile and cannot survive for more than a couple of minutes on most surfaces.
  • Germs live forever on any surface: This is the belief that once a germ attaches itself to a surface it will stay there forever and be capable of infecting you. In reality, most surfaces are fairly inhospitable for bacteria and viruses, and the microorganisms become inactivated fairly quickly, usually within minutes or at most an hour.
  • Things transfer at 100% potency: The law of transfer says that with each transfer the potency of what is being transferred becomes less and less. So if you touch something that has germs on it, your hand will have some germs transfer. If you then touch something, such as a computer keyboard, fewer germs will transfer. Then when someone else touches the keyboard, even fewer germs will transfer to them. The more transfers the less is transferred.
  • Humans have no immune system: This is the belief that every germ or virus that one contacts will cause illness. Humans actually have a very robust immune system. Every day our immune system kills off a variety of germs and viruses we get exposed to. Unless we are exposed to many germs or viruses, our immune system usually does a good job of resisting illness.

The Treatment: Using Exposure and Response Prevention

We did some experiments to test her beliefs. One experiment I like to do is the chalk dust experiment. I have the patient touch some chalk dust, and then they touch my hand, and then I touch my keyboard of my computer, and then I have them touch the keyboard with a clean hand. Thus they graphically see that each transfer moves less and less chalk dust to the next item.

We spent a few sessions discussing and correcting the misconceptions about germs and illness. This began the process of getting ready to start the essential part of the treatment, Exposure and Response Prevention. (ERP)

To prepare for ERP we first made a laddered list of things that would be scary for her. The list went from fairly easy tasks which were a little scary, to tasks that would be terrifying. We rated the anxiety on a 0-10 scale.

I asked her to pick a task that would be somewhat challenging but not terrifying to start with. She picked a task with moderate fear attached to it, touching the floor of my office (which is a carpeted floor.) I also told her that anything that I would ask her to do I would also do with her.

I had her rub both hands on the carpeted floor. Then I asked her to just sit with her anxiety. Initially, her level of anxiety was 10 out of 10. I asked her to narrate her thoughts. “My hands are covered with dangerous germs,” she said.

Over 15 minutes or so her anxiety began to diminish. It went down to about a 7. I noticed that she was holding her hands in the air, so I asked her to put them on her lap. This increased her anxiety briefly, but after a few minutes he anxiety came back down to a 7.

Over another 20 or 30 minutes, her anxiety came down even further. Now it was only a level 4. I asked her to describe her thoughts. “Your carpet probably isn’t really covered with very many germs, and therefore my hands probably don’t have very many germs on them,” she said.

Then I asked her to do something a little bit more challenging – to rub her hands on her face. This made her anxious, but she did it, and after a few minutes of higher anxiety the anxiety subsided again.

By the end of our official face-to-face session, her anxiety level was a 3 out of 10. I asked her if she had any alcohol gel or cleanser in her purse, which she did, and I asked her to leave that in my office. Then I asked her to spend at least another 30 minutes in my waiting room to see if the anxiety level would come down even further, without washing or cleansing her hands. At the next session, she told me that the anxiety level had come down to a level 2, which amazed her given that she had started at 10. I had asked her not to wash her hands for several hours which she did.

At the next session, we tackled another item on her list, the ATM. She was afraid to touch ATMs with her fingers, and either used the back of her knuckles or used alcohol gel after touching the ATM. So we went next door to the local banks ATM, and I had her repeatedly touch the keys with her fingertips. This brought her anxiety level up to about 7, so we kept repeating the task until the anxiety began to subside. Once again I asked her not to wash or use alcohol gel.

A few sessions later after using exposure and response prevention on a variety of other issues, we tackled the top of her list – the public restroom! For many contamination OCD patients, this is the ultimate challenge. We went next door to the building’s restroom, where I put a sign on the door, Closed for Maintenance. Next, I modeled touching the doorknob, the sink, and she did the same. We went back to my office and once again she sat with her anxiety until it came way down.

Once her anxiety had dropped we went back into the restroom and did a harder task. First I modeled touching the toilet seat, and then she touched it. Not surprisingly this raised her anxiety very high. Once again we went back to my office and she sat with that anxiety. We discussed the nature of what toilet seats are made of, and how long germs could live upon them. Gradually her anxiety diminished to about a level of 5, which was a large drop for her.

Between sessions, I asked her to practice these tasks on her own. I explained that the key was to sit with the anxiety for a long enough time for it to subside naturally without any hand cleaning or sterilization. She practiced on a daily basis and made rapid progress on the items we had done together and some other items that were also on her feared list.

By this point, she had lowered her hand washing from 40 or 50 times a day to only several specific situations. After using the toilet, before preparing food, and after preparing food. She had stopped using alcohol gel completely.

A few months later she began to look for work for the first time in several years, as her OCD was virtually completely resolved. I continued to see her intermittently over the next few years, and her OCD continued not to be a problem, although there were some other non-OCD challenges.

In Part Two of this article, I will discuss the use of medications for the treatment of OCD, Thought OCD, Checking OCD, and Health OCD.

 

Why We Suck at Saving Money, and Suck Even Worse at Saving Time

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Two recent articles in the New York Times got me thinking about why most of us really suck at saving money and more importantly why we suck at utilizing our time well. These are two separate but very connected issues. They are connected because after all we all know that time is money and money is time.

Both money and time seem like nonrenewable resources. Time actually is a nonrenewable resource. Although we don’t know exactly how much time we have, it’s a pretty good bet that most of us have between 70 and 90 years on this planet. And we each have 16 to 18 hours of conscious time each day. Just like oceanfront property, we can’t manufacture more time, we can only better utilize the time we have.

Money also seems like a nonrenewable resource for most of us. But it’s not really. In fact, thinking that money is a nonrenewable resource is probably one of the main reasons why people don’t use time better.

The first New York Times article, How to Pinch Pennies in the Right Places, gave a theoretical thought experiment. If you could save $10 on a $50 set of headphones, would you drive 30 minutes across town to get a better price at a different store? (Answer this before reading on.)

Or, if you could save $15 on a $400 television would you drive 30 minutes across town?

Research done by Daniel Kahneman and Amos Tversky in 1981 suggests that most people were more willing to drive across town to save money on the headphones than on the television. You save 20% on the headphones and only 3.75% on the television. But we don’t spend percentages, we spend dollars, and actually you’d be saving more money ($15) on the television than on the headphones ($10).

The same article discussed other research that suggested that consumers were willing to spend 20 minutes extra to save $3.75 on a $10 pen, but needed a savings of at least $278 on a $30,000 car to be willing to invest the same 20 minutes extra.

This of course is crazy! In the example of the pen people value their time at $11.25 per hour. But in the example of the car people are unwilling to make an investment of time that would pay them $834 per hour!

But we all fall prey to different versions of this. How much time do we waste surfing Amazon in order to save a few bucks on a product? Or to find a product that has 4 stars instead of 3 ½ stars?

This article also pointed out that people on the lower income level are less likely to fall prey to the percentage saved fallacy, because they care about each and every dollar. But I think the article misses a more important point – which is the real way to have more money!

Saving $10 or $15 on a purchase really doesn’t matter compared to lowering recurrent expenses. For instance, how much money do you spend each month on the following items: cell phone service, Internet service, cable or satellite TV, coffee drinks at your local café, restaurant meals, rent or mortgage, car payments? How much money did you spend on your last car? Spending $120 per month on cable TV comes out to $14,400 over 10 years. Nice late-model used cars can be had for $10,000-$15,000, yet many people drop $50,000 on a new car. Even just saving $30 on a less expensive cell phone plan means that you will save $3600 over 10 years.

(A number of years ago I looked at my recurrent expenses and realized that I was spending a lot of money on two business landlines, and on cable TV. I spent some time doing research and ended up purchasing a couple of Ooma telephone systems that when connected to the Internet provided completely free telephone service. I also put an antenna on my roof and switched to free over-the-air HDTV. The time invested was probably about 4 hours for all of the research and installation. But I saved almost $300 per month, without giving up anything I really cared about other than perhaps Monday night football (which is on cable TV only). My one-time four hour investment has paid me more than $10,000 in savings, which is roughly $2500 per hour! And I continue to save money each month.)

But the article also misses a more profound point, how to earn more money. People focus too much on saving money and not enough on earning more money, through work, entrepreneurship, education and training, and investment. In this era of the Internet there are 1 million ways to earn more money. And improving your education and training can help you earn more money in your current employment as well as well. Improving income opportunities lasts for life, while getting a good “deal” only lasts for a day! Or, if you can afford to invest money, then focusing your time on investing more successfully can yield huge benefits in total dollars. I know people that have spent the time to learn about investing in residential real estate, and who will retire with very nice incomes from the time they invested in acquiring and managing these properties.

Which brings me to the 2nd New York Times article, What Should You Choose: Time or Money? This is a fascinating and profound article. It summarizes research performed by Hal Hirschfield, Cassie Mogilner, and Uri Barnea which asked the question what do people choose, time or money? About 65% of their participants chose money over time, showing a small preference for money versus time. This in itself is not surprising or even particularly interesting. What’s more interesting is that those who chose time rather than money reported higher levels of happiness, even when the researchers controlled for participants’ amount of leisure time and income and money.

Realistically speaking, we are all in the business of balancing time against money. How we do this has significant implications in terms of our well-being and happiness. Research suggests that we should tilt in the direction of saving and valuing time rather than money if we want to maximize our happiness. There is ample research suggesting that experiences create more happiness than material possessions. And experiences take time (and sometimes money), while material purchases take money (and sometimes time.)

What can we learn from this research?

  1. When possible, tilt your decisions in favor of time rather than money. Don’t buy a cheaper house which requires you to spend many hours a week commuting. Don’t spend very much time in order to gain small savings in money.
  2. If you are going to invest time in order to save money, calculate your hourly “pay”, and only invest the time if the hourly salary is high. For instance, if it will take me 30 minutes to save 20 bucks, I’m earning $40 per hour. But if it takes me 30 minutes to save $5, then I’m earning $10 per hour. Try to be rational about these decisions and don’t pay any attention to the percentages saved, only to the dollar values and the time values.
  3. Time invested in saving money on recurrent expenses such as cable or satellite TV, car insurance, cell phone service, Internet service, etc. will always pay you a higher salary rate per hour. A few hours invested in researching less expensive alternatives and switching can save hundreds of dollars a month indefinitely which adds up to a very good return on your time invested.
  4. When you get excited about “getting a deal”, always calculate the true cost of the deal in time and in hassle. This will prevent you from driving across town to get a small savings or from spending too much time spent on the Internet looking for deals. (I am as guilty of this as most people, although I’m much more likely to spend time online rather than time in my car, even though both waste time.) Ask yourself whether on your deathbed you will be telling your grandchildren about this deal that you got. Remember that in the grand scheme of life, time is worth more than money. (See this classic parable about the poor fisherman and the entrepreneur.)
  5. Finally, remember that life is not just about time and money, it’s really about meaning and values. Spending money doesn’t really benefit you unless it ties into your core values and improves meaning in your life. That’s why even getting a multiplicity of small “deals” doesn’t really matter in the grand scheme of things. What matters more is whether you spend money to support your core values. That’s why grandparents sometimes pay for their grandchildren’s college, even though it’s an expensive proposition. And that’s why taking your family on a really fun vacation is a good investment as it leads to experiences and memories that potentially last a lifetime. (My siblings and I will always remember magical experiences from our family trips – playing telephone tag in the elevators of the Caesar’s Palace in Las Vegas, riding donkeys along a precipitous cliff in Grand Canyon, screaming “beep beep” on a narrow, twisting road in Spain when our rental car horn failed.)
  6. And even time should be evaluated in terms of meaning and values. Here in Silicon Valley a lot of people retire early. This isn’t always a good thing however. What I’ve seen is that they often end up spending time doing things that don’t really add to their happiness. For instance, they will design and build a custom house, usually quite large, which eats up several years of their life playing at general contractor and quality control inspector.
  7. Just as spending money intelligently is challenging, it’s even more challenging to spend time well. I struggle with this all the time. But I try to continually improve how I spend my time, for instance trying to focus more on writing these blog articles rather than watching television or reading a novel.

This article ended up being a lot longer than I expected, but I think these are profound and important issues for all of us to think about and to improve. Now it’s time for me to have some fun!

Depression Often Misdiagnosed, and Untreated

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The New York Times had an interesting article about how depression is often misdiagnosed in the US, and how most people who actually have depression don’t get treatment.  They reference a research study just published in the JAMA Internal Medicine.Depression

This research study performed by Mark Olfson, Carlos Blanco, and Steven C. Marcus, looked at responses from 46,417 people on the Patient Health Questionnaire-2 (PHQ-2) which is a brief screening tool for depression. A score of over 3 indicates depression on this scale.

What did they find? They found that approximately 8.4% of all adults studied had depression, but only 28.7% had received any depression treatment in the previous year! That means 71.3% of the people who suffer depression got no treatment for this depression.

Of those who were being treated for depression, about 30% actually had depression based on the screening, and another 22% had serious psychological distress. That means that of the people in the study who were being treated for depression roughly 48% neither suffered depression nor did they suffer serious psychological distress, indicating inaccurate diagnoses by the treating professionals.

There were some interesting correlates of depression. About eighteen percent of those in the lowest income group suffered depression, while only 3.7% of those in the highest income group suffered depression. It pays to be rich!

Depression was more common in those who were separated, divorced, widowed, or who had less than a high school education. None of this is terribly surprising.

How did depression sort out by age?

In the 18 to 34-year-old group 6.6% suffered depression. In the 35 to 49-year-old group 8.8% suffered depression. Ten percent of the 50 to 64-year-old group suffered depression. Of those over 65, only 8.3% suffered depression. So at least in this sample the 50 to 64-year-old group was slightly more likely to suffer depression, and contrary to what many people think, the youngest adults were somewhat less likely to suffer depression.

Of those who were married only 6.3% suffered depression. Of those who were separated, divorced, or widowed, 13.3% suffered depression. Divorce is bad for mental health, with almost a doubling of rates of depression.

Most of the patients who were treated for depression were treated by general practitioners (73%), with roughly 24% receiving treatment by psychiatrists and 13% receiving treatment by other mental health specialists. (There was some overlap, that’s why the numbers add up to more than 100%.)  This may explain the rather poor diagnosis and treatment of depression because general practitioners although competent and intelligent, are very busy and typically only have a few minutes to spend with each patient, not enough to do a good job diagnosing and treating depression.

CONCLUSIONS ABOUT DEPRESSION FINDINGS

What can we conclude from this research?

  1. Almost 10% of the adult population suffers from depression. Of those people who have depression less than 30% of them will get any treatment for depression.
  1. You are more likely to suffer depression if you are in the lowest income group, divorced, separated or widowed, or have no high school education. If you are married you have half the probability of being depressed.
  1. Many adults receive depression treatment even though they don’t really meet the criteria for depression. In this study, almost half of the people receiving treatment for depression were neither depressed nor were they even particularly distressed.
  1. Rates of depression by age groups were relatively equal, with the youngest age group having the least depression and the middle-aged group (50 to 64) suffering somewhat more depression. Married people are suffer half as much depression as divorced, separated, or widowed people.
  1. Most people received depression treatment from their general practitioner or internal medicine doctor, with a smaller number receiving treatment from a psychiatrist, and even a smaller number receiving treatment from psychologists. This also meant that most people who receive depression treatment were treated using medication, and very few people received psychotherapy, even though most studies comparing medication to cognitive behavioral therapy for depression have shown that therapy performs at least as well as medication and probably better over the long term, with less relapse.

Reading between the lines of this study, it suggests that many people who feel depressed would benefit from receiving an accurate diagnosis from a clinical psychologist, and might very well also benefit from receiving cognitive behavioral therapy for depression rather than medication. Even if medication is indicated, a psychologist could recommend it to the patient’s general practitioner, and then monitor more closely the results.

The study also suggests that many people receive antidepressant medication who actually are not depressed, which needlessly exposes them to side effects and also fails to provide the correct treatment for what troubles them.

And finally, since only about 30% of those who suffer depression received any treatment for it, if you feel depressed, be sure to pursue treatment for depression. Get an accurate diagnosis and then get treatment, ideally with a psychologist or therapist who practices cognitive behavioral therapy. If you want more information about depression, I’ve written extensively about it with a complete list of depression articles.

Forgiveness and Happiness Researcher Fred Luskin Says Turn Off Your Smartphone If You Want to be Happy

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Earlier this year I had the good fortune to spend several morning hours listening to Stanford professor and researcher Fred Luskin talk about happiness. Dr. Luskin is a psychologist who has done groundbreaking research on forgiveness over many years. He’s the author of many books, and frequently lectures about forgiveness. I often recommend his book Forgive for Good: A Proven Prescription for Health and Happiness to clients suffering from anger and hurt.

But this morning he was discussing happiness. He came into the room with no pretense. His hair was wild and curly, partly dark and partly gray. He was wearing a puffy black down jacket, a T-shirt, running tights, and sneakers. Clearly a man comfortable with himself, and not trying to impress.

He started off by doing something quite outrageous. He asked the audience of 30 people to turn off their cell phones. Not to lower the volume, or turn off the ringers, but to actually shut down their cell phones. This clearly caused some discomfort among the audience. He explained that the reason he wanted people to turn off their cell phones is so that they would truly focus on the present and to listening to him. He cited a statistic that people check email on average 79 times a day. Each time they check their email they get a burst of adrenaline and stress. Clearly this is not conducive to genuine happiness.

He pointed out that you can’t really be happy unless you can sit still and relax. “We are all descended from anxious monkeys,” he said, and clearly most of us do not know how to sit still and relax. “Happiness is the state of ‘enough’ “, he said, “and is not consistent with wanting more.”

He pointed out that wanting what you have equals being happy. And that wanting something else than what you have equals stress.

He talked about the beginnings of his career, when clinical psychology was focused on unhappiness and problems. There was no science of happiness. Now there is a huge area of research and writing on happiness called Positive Psychology.

He shared some simple techniques for enhancing happiness. One simple technique revolved around food. When you’re eating don’t multitask. Give thanks for the food, and really focus on tasting and savoring that food. One technique I have often used is to close my eyes while I savor food, which greatly intensifies the taste.

Another simple practice is whenever you are outside, take a few moments to feel the wind or sun on your skin.

He also talked about phones and how we use them. We are completely addicted to the little bursts of dopamine and adrenaline that we get each time we check our email or we get a text. And rather than be present in most situations, we simply look at our phones. Go to any outdoor cafe and look at people who are sitting alone. Most of them are looking at their phones rather than experiencing the surroundings or interacting with other people. Even sadder, look at people who are with others, either at a cafe, or a restaurant. Much of the time they too are lost in their smartphones.

He discussed how happiness is not correlated with achievement. Nor is it correlated with money once you have an adequate amount to cover basic needs. What happiness seems to be most correlated with is relationships. If you like yourself and connect with other people you will tend to be happy.

He reviewed  the relationship between impatience, anger, frustration, judgment and happiness. He pointed out that whenever we are impatient or in a hurry all of our worst emotions tend to come out. When someone drives slowly in front of us we get annoyed. When someone takes too much time in the checkout line ahead of us, we get angry.

I really liked his discussion of grocery stores. He pointed out what an incredible miracle a modern American grocery store really is. The variety of delicious foods that we can buy for a relatively small amount of money is truly staggering. But instead of appreciating this, we focus on the slow person in the line ahead of us, or the person who has 16 items in the 15 item express line. What a shame!

He pointed out we have a choice of what we focus on, and this choice greatly influences our happiness. We all have a choice to focus on what’s wrong with our lives, or what’s right with our lives. And we have a choice of whether to focus on how other people have treated us poorly, or how other people have treated us well. These choices of focus will determine how we feel.

We also have the choice of focusing on what we already have, or focusing on what we do not have and aspire to have. For instance, let’s imagine that you are currently living in a rental apartment. The apartment is quite nice, although there are things that could be better. The kitchen could be bigger, and the tile in the bathroom could be prettier.

Perhaps you imagine owning a house, and you feel badly about renting an apartment. Rarely do we appreciate what we have. Having a place to live is clearly infinitely better than being homeless. And even a flawed apartment is still home.

All of us need to work on learning to emphasize generosity, awe, and gratitude in our lives if we want to be happy. Generosity means kindness and acceptance in contrast to anger and judgment. Awe is the ability to be astounded by the wonder and beauty in the world. Gratitude is appreciation for all the good things in your own life and in the world.

He cited one interesting study where researchers observed a traffic crosswalk. They found that the more expensive cars were less likely to stop for people in the crosswalks. Thus wealth often correlates with a lack of generosity and a higher level of hostility. Other data shows that there is very little correlation between wealth and charitable giving, with much of the charitable giving in the USA coming from those of modest means.

He also talked about secular changes in our society. He quoted a statistic that empathy is down 40% since the 1970’s. At the same time narcissism has increased by roughly 40%. This has a huge negative impact on relationships.

I was impressed by this simple but profound message of Dr. Luskin’s talk. Slow down, smell the roses, turn off your phone, focus on relationships, appreciate what you have, and become happier.

It’s a simple message, but hard to actually do.

I’m off to go for a hike in the hills, without my phone!