3 Foolproof Ways to Prevent Work Burnout, Backed by Science

Over-working leads to burnout, here’s a better way to get things done.

Our culture is obsessed with productivity. But research shows that stressing ourselves out over an ever-expanding to-do list actually works against us—no matter how “productive” we may feel. After all, we’re seeing 50% burnout rates across industries.

Not only does workaholism double the risk of depression and anxiety, it actually lowers productivity and decreases work performance, according to research by Steven Sussman at the University of Southern California. It also leads to sleep problems and shortened attention spans, both of conspire to get in the way of our ability to do good work. Workaholism is bad for employers as well: it leads to stress-related accidents, absenteeism, higher employee turnover, lower productivity and higher medical costs.

So why have we gotten caught up in a frantic approach to productivity? As a Stanford University research psychologist who has spent years looking into this literature, I believe the problem lies in our constant focus on the future – we believe we always have to look ahead in order to succeed and be happy. This belief leads us to forego personal happiness in the present and spend our days hunched over our computers, grinding our teeth and reassuring ourselves that the eventual payoff will be worth it.

But the truth is that nonstop focus on our work leads to the opposite of what we want: we are stressed, tired and never satisfied because there’s always something more to be done. Two simple changes could make us much better off.

1. Detach When You’re Not Working

First, detaching from work can actually make us more productive. Sabine Sonnentag, a professor of organizational psychology at the University of Mannheim in Germany, has found that people who do not know how to detach from work during their downtime experienced increased exhaustion over the course of one year and became less resilient in the face of stressful work conditions. By contrast, gaining some emotional distance from highly demanding work tends to help people recover from stress faster and leads to increased productivity.

“From our research, one can conclude that it is good to schedule time for recovery and to use this time in an optimal way,” Sonnentag shared with me. Recommended activities include exercise, walks in nature, and total absorption in a hobby that’s unrelated to work—whether that’s shooting hoops with friends, doing some woodcarving in the garage or learning to make dim sum. Positively reflecting about your job after work hours can also help replenish you, according to research by Sonnentag and Wharton Professor Adam Grant. In other words, thinking about the good sides of your work at the end of your workday – in particular about the ways in which you are benefitting others – results in higher well-being and happiness. If your work directly benefits others (e.g. you are a firefighter or a nurse), this exercise will be straightforward. If, however, you don’t feel that your work product benefits others substantially, you can still think about how your work is impacting others in a positive way. For example, it is benefitting your family. Or your attitude at work is benefitting your colleagues. Research shows that, when we are engaged in any kind of prosocial or kind action, we become happier.

2. Calm Down Rather than Amping Up

Our addiction to caffeine and other stimulants is another big issue. In the name of productivity, we have learned to keep our adrenaline levels high with copious amounts of coffee. Caffeine is a drug – albeit a socially accepted one. It is a stimulant. When we drink coffee, it raises cortisol (the “stress” hormone) above its natural levels.  Cortisol is naturally occurring in our body – it helps us wake up in the morning and have energy to start the day. However, raising it to unusual levels through coffee is the reason we sometimes feel so jittery after consuming caffeine.

This means we wind up depending on anxiety to fuel ourselves to get through our overscheduled days. Other people may rely on stimulants like sugar, energy drinks and even potentially addictive drugs like Adderall to help themselves stay up and focus for long hours.

Then, over-stimulated and unable to calm down when we come home, we turn to depressants like alcohol, sleeping pills or anti-anxiety medication to achieve balance. The constant back-and-forth between stimulant-induced anxiety and depressant-induced drowsiness places an enormous burden on our already exhausted nervous system.

Cutting back on stimulants and cultivating calmness in your life – through yoga, walks in nature, and tech-fasts, for example – can help you turn down the dial on your adrenaline-filled life. By balancing these calming activities with the more high-intensity demands of your life, you will end up managing your energy better, having more emotional intelligence and making better decisions.

3. Breathe

Research that I led with veterans (arguably some of the most stressed individuals in our society when they return from war) shows that learning conscious breathing (sudarshan kriya yoga) can help significantly reduce our stress and anxiety levels—sometimes in minutes. Breathing is among the most neglected solutions to stress, since it mostly happens on its own while we’re not paying attention to it.

But research suggests that you can change how you feel using your breath. By taking deep breaths into your abdomen and lengthening your exhales so they are longer than your inhales helps your nervous system relax – your heart rate and blood pressure may even decrease. Having a more relaxed nervous system will actually help provide you with more energy. Instead of wearing yourself out quickly with adrenaline, by remaining calm and engaging your parasympathetic nervous system, you will be able to restore yourself and manage your energy throughout the day without crashing.

There is little evidence that leading an adrenaline-fueled life makes you more productive. However, there is plenty of evidence to show that a chronically stressful lifestyle damages your physical health and your cognitive faculties. So if you’re really interested in becoming a more accomplished and happier person, stop driving yourself up the wall with productivity hacks—and commit to learning how to take a breather.

Emma M. Seppälä Ph.D. Based on a section of her new book, The Happiness Track: How to Apply the Science of Happiness to Accelerate Your success (HarperOne, 2016)

Alternate Nostril Breathing:

Place the index and middle finger of the right hand on the center of the eyebrow, and place the thumb on the right nostril, and the ring finger and pinky on the left nostril. The left hand rests on the lap, palm facing up. Take a deep breath in and, closing the right nostril with your thumb, breathe out through the left nostril. Then take a deep breath in through the left nostril, close the left nostril with your ring finger and pinky at the end of the inhale, and exhale through the right nostril. Take a deep breath in through the right nostril and, closing the right nostril with the thumb, exhale on the left side, and start over. Do this with your eyes closed for about five minutes. Notice the effects on your body and mind.

Fear v. Anxiety

Most of us make some distinction between fear and anxiety. Sometimes it’s merely a matter of linguistics. We say we have a fear of something (flying, aging) and anxiety about something (flying, aging).

Sometimes we distinguish the two by our bodily experience. I’m sure you’re aware that the neurobiology of fear is different than the neurobiology of anxiety. The sudden re-arrangement of your guts when an intruder holds a knife to your back (fear), is different from the mild nausea, dizziness and butterflies in your stomach as you’re about to make a difficult phone call (anxiety).

Anxiety is also the word of choice to describe lingering apprehension, or a chronic sense of worry or tension, the sources of which may be totally unclear.

But the notion that “fear” always connotes something bigger and stronger than “anxiety” breaks down in real life experience.

You can have a short-lived fear response to the bee buzzing around your face, and you can wake up at three in the morning awash in anxiety that won’t let you get back to sleep.

In everyday conversation, we use the language of emotions that we’re comfortable with and that fits our psychological complexion. I’ve worked with clients who don’t report feeling anxious or afraid. “I’m incredibly stressed out…” is their language of choice. “Stressed” is the code word for “totally freaked out” for people who are allergic to identifying and sharing their own vulnerability.

Whatever your emotional vocabulary, no one signs up for anxiety, fear and shame, or for any difficult, uncomfortable emotion. But we can’t avoid these feelings, either.

I am convinced that the more we can look these uninvited guests in the eye, with patience and curiosity, and the more we learn to spot their wisdom as well as their mischief, the less grip they will have on us.

Only when we experience our emotions as both potential stumbling blocks and wise guides–not either/or–can we begin to live more fully in the present and move into the future with courage, clarity, humor, and hope.

-Talkspace

Margaret Cho Wants You to Embrace Your Darkness

Using creativity to cope and connect

Margaret Cho has been finding ways to entertain us for decades. From her stand-up routines, such as The Notorious C.H.O.; to her books, such as I’m The One That I Want; to her roles in films such as Face/Off, Cho continues to come up with new ways to explore and share her artistry.

A major reason why Cho continues to be so prolific is the same reason why she is so beloved by her fans — she is willing to tackle and speak out on difficult issues. Cho has been an advocate for LGBT rights, has opened up about her having experienced sexual abuse, and about her sexuality, as well as her consequent struggles with an eating disorder, addiction, depression and suicide. In doing so, Cho has given voice to people who feel alone and invisible in their struggles with social and emotional issues.

And with her new album, American Myth, Cho is continuing her message: Don’t run away from your darkness — embrace it.

Cho explains how this is a central approach to her life and art. She told me, “People should be conscious that pain and suffering are essential to living. We need it as much as we need happiness and joy and pleasure. There would be no contrast in your existence if the bad and dark parts didn’t exist.”

For Cho, this stance is personal. One of the painful issues with which she has struggled over the years is depression. People who struggle with depression — even only sub-clinical depressive symptoms — may experience significant loss of physical, social and role functioning. And the loss of functioning associated with depression appears to be comparable to or worse than that of other chronic medical issues.

“I think I’ve always had it. It’s something that sounds familiar when people talk about their experience of depression,” Cho explained. “But I’ve never been diagnosed or medicated or anything. It’s not weeks; it’s more just like it’s parts of days.”

Cho describes her depression as feeling like existential dread, also referred to as existential angst. “There’s always been this existential dread that I’ve had, not knowing what the future is going to bring,” Cho explained. “And not knowing how you may have done something in the past that’s upsetting, or regret something that you’ve done.”

Like many others who experience depression, Cho also experiences rumination, which is to compulsively and repeatedly think about something. Rumination can be useful if one is attempting to deliberate over possible solutions to a problem. But it can also take the form of obsessing and amplifying a problem without arriving at a solution.

“It becomes something amplified in your mind to obsess over. The tiny slights that build up – like someone doesn’t email or text you back,” she explained. “Something that you obsess on, and then you realize that the other person has no idea that you’re going through this crazy thing. And it’s just strange how certain facts or details about your life become amplified.”

Managing one’s negative experience can be difficult enough, but Cho felt that while she was growing up there were many social signals that she and her feelings didn’t matter. This first came with observing the underrepresentation of Asian-Americans in popular culture. Research suggests that even subtle forms of racism can result in negative psychological consequences.

In Cho’s case, she described the feeling of invisibility — like she was not there and she didn’t matter — that can arise from these forms of racism.  “I think you feel betrayed and shocked when you realize that you’re not what’s being represented or you don’t feel included. It’s just this strong feeling of invisibility. And it can be very hard to explain to other people.”

-Michael Friedman, PhD, Brick By Brick

Challenging Irrational Thoughts

Sometimes we tend to believe our own automatic negative thoughts instead of challenging them and paying attention to the evidence. For example, I am always checking my partner’s phone because I am suspicious that he is cheating on me. I can’t sleep at night because I’m worrying about him being with someone else. My thoughts are completely dominating my emotions and I am not focusing on the evidence in front of me:

1. He frequently demonstrates his love for me with his words and actions

2. He does not have a history of cheating on me or anyone else.

3. He has never broken a promise to me.

4. He has solid values and morals.

5. He’s never been flirtatious with other women and only pays attention to me when we’re out.

So that is an example of taking a step back, looking at the facts, and challenging your own irrational thoughts to make sure that you’re not just going along with them and letting them dictate your emotions. With practice, this becomes easier and easier and you might find that you are much more able to see things realistically rather than anxiously. Does this make sense? What do you think about this coping strategy? Is it something that could be applied to your life to help you manage your worried thoughts a little bit better?

-Ivanna Colangelo, LMFT

20 Rules to Live By

14. Be kind, not nice.

1. Bring your sense of humor with you at all times. Bring your friends with a sense of humor. If their friends have a sense of humor, invite them, too. Remember this when going to hospitals, weight-loss centers, and funerals, as well as when going to work, coming home, waking up, and going to sleep.

2. If it’s worth crying over, it’s probably worth laughing at. Cultivate a sense of perspective that permits you to see the wider and longer view of the situation; this will help you realize that although your situation is upsetting, it might also one day become a terrific story.

3. Other people don’t care what you’re wearing.

4. Don’t be a sissy. This is especially important if you are a woman. Girls can be sissies, but behaving like a simpering, whining, fretful coward as an adult is unacceptable no matter what your gender happens to be. If you are anxious, scared, and feeling powerless, you don’t need to change your behavior; you need to change your life.

5. Don’t lie. Cheat the devil and tell the truth.

6. There is one exception to the rule above: Never say a baby looks like a sausage wearing a hat. The parents will not forgive you. This is a situation in which telling the truth is not wholly necessary. If it’s not possible to tell the whole truth for fear of causing undue pain, just say the baby looks “happy.”

7. Never use the passive voice. Do not say, “It will get done.” Say, “I’ll do it” and then offer a solid, unwavering deadline. Always make your deadline.

8. The pinnacle is always slippery; no peak is safe. Only plateaus offer a place to rest. Are you ready to stay on a plateau or are you climbing? Decide and pack your bags accordingly.

9. As we age, love changes. As a youth, you fall for an unattainable ideal. When you’re more mature, you fall in love with a person: “Sure, he has only one eye in the middle of his forehead,” you’ll rationalize, “but he never forgets my birthday.”

10. Power is the ability to persuade stupid people to do intelligent things and intelligent people to do stupid things. This is why power is dangerous.

11. Sherlock Holmes said, “Work is the best antidote to sorrow, my dear Watson.” Listen to Mr. Holmes.

12. Everybody wants a shortcut to love, prosperity, and weight loss, although not necessarily in that order. Apart from being born into an adoring family, getting good genes, and inheriting the mineral rights, however, there are no short cuts. The rest of us have to work at it.

13. Help the dramatically self-pitying to understand that they are not, by definition, sympathetic or interesting. Encourage them to address topics other than themselves.

14. Be kind, not nice. Kindness is both intentional and meaningful. Acts of kindness requires generosity, emotional and otherwise. Perfunctory and superficial niceness is, too often, mere window dressing.

15. Only poor workers blame their tools. It’s not the fault of the computer, the school, the train, the government, or poor cell phone reception. Take responsibility.

16. You know how sometimes you don’t think you’re asleep—you’re half listening to a conversation or the television—only to discover you were unconscious? One part of your head would swear it’s awake, but when you actually snap out of it, you realize you were wholly elsewhere? Sometimes that happens in life. Sometimes the only way you know you’re truly in love, in the entirely wrong profession, being a moron at parties, or a great poet is when you snap out of it.

17. You can always stop what you’re doing.

18. You should either be doing something useful or you should be playing. You should not be thinking about playing while at work or thinking about work when you’re out having fun. Compartmentalizing your life is not inevitably a bad thing. It’s easy to waste pleasure by feeling guilty and waste potentially effective time by feeling resentful.

19. Be aware that a safety net, if pulled too tight, easily turns into a noose. Don’t trade independence for security without being aware of the consequences.

20. Someday you will die. Until then, you should do everything possible to enjoy life.

-Gina Barreca, PhD
Excerpted from IF YOU LEAN IN, WILL MEN JUST LOOK DOWN YOUR BLOUSE? published by St. Martin’s Press (March, 2016)

What Is Therapy? — The Complete Definition of Psychotherapy

Therapy [psychotherapy] is the process of working with a licensed therapist to develop positive thinking and coping skills and treat mental health issues such as mental illness and trauma. Answering the question of “What Is Therapy?,” however, goes far beyond this basic definition.

The definition of psychotherapy depends on the therapist, type of therapy and time period. By exploring these three factors and their combinations, we defined what therapy was, what it is and what it might become. These pieces form the complete definition.

By reading a thorough answer of “What is Therapy?,” you should be able to pick which part of therapy and which kind of therapist is most appealing to you. Understanding what therapy is could be the first step toward trying something that will help you live a happier life.

How Do Therapists Define What Therapy Is?

Every therapist defines therapy in at least a slightly different way. By looking at the aspects they stress, you can see a more detailed picture of what therapy is and whether the therapist’s approach aligns with your goals.

Here are some definitions we gathered by surveying our therapists at Talkspace and reaching outside our network:

  • A commitment to yourself and to opening yourself up to someone else; being willing to trust someone enough to let them into your life and learn from each other — Alaina Brubaker, Talkspace Therapist
  • A way of changing your perspective on how to handle a situation — Noor Pinna, Talkspace Therapist
  • A communication process of increasing clarification and understanding pertinent to specific experiences related to such terms as discomfort, dissatisfaction, disappointment, discontent, disenchantment, and other dispositions that are perceived as problematic — Ken Fields, Talkspace Therapist
  • A dynamic process that occurs in a safe and contained relational frame wherein destructive patterns of being are identified and replaced with healthy and productive ones — Paul Hokemeyer, Marriage and Family Therapist
  • Empathy, a nonjudgmental attitude and the creation of a safe space in which nothing the client wants to explore is off-limits and everything is on the metaphorical table — Kristen Martinez, LGBT Therapist
  • Learning how to overcome your personal or relational struggles by developing long-term tools — Jennine Estes, Marriage and Family Therapist
  • The art and science of engineering self-improvement and growth in clients via a strong therapeutic relationship and evidenced-based therapies — Michael Zito, Therapist, Ph.D.
  • Helping clients break free of old ideas, patterns and wounds that are restricting their happiness and contentment; coaching them through life passages, teaching skills and techniques for self-awareness, relationships and success — Tina B. Tessina, Therapist, Ph.D.

What Is Therapy (Based on Each Type)?

If you asked a psychoanalytic therapist to define psychotherapy, the answer would be a far cry from one a cognitive behavioral therapist would offer.

All forms of psychotherapy exist to improve clients’ mental health, but the definition for each type stresses a different primary purpose. The best type for you will be the definition that most closely resembles your reasons for considering going to therapy.

If there isn’t any one type that appeals to you or seems like enough to help you, consider a therapist who uses multiple approaches or does not identify with a single approach.

Note: The following list includes the most widely practiced types of therapy. A complete list would be too long.

Client-Centered Therapy: you determine the course of the session; the therapist helps build self-esteem and problem-solving abilities but does not guide the session

Cognitive Behavioral Therapy [CBT]: challenging negative patterns about yourself and the world to alter unwanted behaviors or treat disorders such as depression

Dialectical Behavior Therapy [DBT]: stressing acceptance and change while learning behavioral skills (mindfulness, distress tolerance, interpersonal effectiveness, emotion regulation) that help clients enhance motivation, overcome challenges, improve mental health or treat a disorder (often borderline personality disorder)

Existential Therapy: working with a therapist to find meaning in life and confront the “givens” of human existence: isolation, meaninglessness, mortality and freedom

Family-Focused Therapy [FFT]: working with family members and a therapist to understand how their behavior impacts your bipolar disorder or overall mental health

Gestalt Therapy: gaining an awareness of emotions and behaviors in the present rather than focusing on the past; improving self-awareness and personal responsibility

Interpersonal Therapy [IPT]: improving communication patterns, relational abilities and the way you see yourself to better manage and express emotions, treat mental illnesses such as depression and improve mental health

Psychodynamic Therapy: understanding the influence of the past and subconscious processes on present behavior

What Was Therapy Before Freud?

To fully understand what something is, you need to explore its past, present and possible future. This timeline will give you a richer understanding of what psychotherapy is and how it evolved.

Before Freud and other early psychologists such as Wilhelm Wundt, philosophy was the closest thing to therapy. It was the only field that explored human behavior and mental health.

“Psychology is an offshoot of philosophy,” psychologist Bart Rossi told Talkspace.

Rossi cited schools of philosophy such as rationalism and empiricism. He also said philosophers including Immanuel Kant contributed to the development of therapy.

One of the best examples of philosophy informing psychotherapy is existential therapy, which is derived from existential philosophy. Existential psychotherapist Irvin Yalom, who shaped the field of modern existential therapy, said existential philosophers such as Nietzsche inspired his work.

What Was Therapy During Freud’s Time and the 20th Century?

Because Freud was a psychiatrist, early psychotherapy was mostly about reducing symptoms. It followed a medical model rather than the wellness/medical model we see today. Therapy was for “patients” with diagnosable mental illnesses, not “clients” who see a therapist for various reasons.

“I think in the past, therapy was centered around ‘fixing’ what was ‘wrong’ with people,” said therapist Kristen Martinez. “Certain people thought they were the healthy ones, and psychotherapy focused on getting ‘unhealthy’ people to be healthy like them.”

What Is Therapy Now?

Modern psychotherapy tends to balance a wellness and medical model. Therapists want to reduce symptoms in people dealing with mental illness, but they focus more on the person.

CBT changed the definition of therapy, according to Rossi. It is now more behavior-focused and does not use the dynamic approach as often.

The advent of online therapy has also appended what therapy is. Although earlier definitions of therapy did not explicitly describe it as occurring only in-person, it needed to happen in an office because the Internet did not exist.

Earlier definitions also implied therapy could only take place in “sessions” where the therapist and client scheduled a meeting or phone call. Because of technology and approaches such as the asynchronous texting Talkspace offers, therapy does not require sessions.

What Will Therapy Become?

The basic definition of therapy seems here to stay, but there are trends that will expand the answer to the question of what therapy is.

Read: 3 Trends in Therapy You Need to Watch For

Here are some trends that might evolve the definition of psychotherapy:

  • More technological advances in online therapy
  • Virtual reality
  • Integration of medical care
  • More focus on the therapeutic relationship
  • More cultural consideration
  • New CBT approaches

Now that we’ve discussed what therapy is, take a moment to think about what it can do for you. The titular question is also an opportunity to improve your mental health and live a happier life.

-Joseph Rauch, Staff Writer at Talkspace

When changing careers isn’t a realistic option

  • Try to find some value in what you do. Even in some mundane jobs, you can often focus on how what you do helps others, for example, or provides a much needed product or service. Focus on aspects of the job that you do enjoy—even if it’s just chatting with your coworkers at lunch. Changing your attitude towards your job can help you regain a sense of purpose and control.
  • Find balance in your life. If your job or career isn’t what you want, find meaning and satisfaction elsewhere: in your family, hobbies, or after work interests, for example. Try to be grateful for having work that pays the bills and focus on the parts of your life that bring you joy. Having a vacation or fun weekend activities to look forward to can make a real difference to your working day.
  • Volunteer—at work and outside of work. Every boss appreciates an employee who volunteers for a new project. Undertaking new tasks and learning new skills at work can help prevent boredom and improve your resume. Volunteering outside of work can improve your self-confidence, stave off depression, and even provide you with valuable work experience and contacts in your area of interest.
  • Make friends at work. Having strong ties in the workplace can help reduce monotony and avoid burnout. Having friends to chat and joke with during the day can help relieve the stress of an unfulfilling job, improve your job performance, or simply get you through a rough day.
  • Consider the following steps to planning a career change. Even if it’s something that you’re unable to act on at present, having a plan for someday in the future (when the economy picks up, the kids have grown up, or after you’ve retired, for example) can help you feel energized and hopeful, and better able to cope with the difficulties of the present. Simply sending out resumes and networking can make you feel empowered. Also, making a career change can seem far more attainable when there’s no time pressure and you break down the process into smaller, manageable steps.

-Talkspace

How Therapy Can Help in the Golden Years

Marvin Tolkin was 83 when he decided that the unexamined life wasn’t worth living. Until then, it had never occurred to him that there might be emotional “issues” he wanted to explore with a counselor.

“I don’t think I ever needed therapy,” said Mr. Tolkin, a retired manufacturer of women’s undergarments who lives in Manhattan and Hewlett Harbor, N.Y.

Though he wasn’t clinically depressed, Mr. Tolkin did suffer from migraines and “struggled through a lot of things in my life” — the demise of a long-term business partnership, the sudden death of his first wife 18 years ago. He worried about his children and grandchildren, and his relationship with his current wife, Carole.

“When I hit my 80s I thought, ‘The hell with this.’ I don’t know how long I’m going to live, I want to make it easier,” said Mr. Tolkin, now 86. “Everybody needs help, and everybody makes mistakes. I needed to reach outside my own capabilities.”

So Mr. Tolkin began seeing Dr. Robert C. Abrams, a professor of clinical psychiatry at Weill Cornell Medical College in Manhattan. They meet once a month for 45 minutes, exploring the problems that were weighing on Mr. Tolkin. “Dr. Abrams is giving me a perspective that I didn’t think about,” he said. “It’s been making the transition of living at this age in relation to my family very doable and very livable.”

Mr. Tolkin is one of many seniors who are seeking psychological help late in life. Most never set foot near an analyst’s couch in their younger years. But now, as people are living longer, and the stigma of psychological counseling has diminished, they are recognizing that their golden years might be easier if they alleviate the problems they have been carrying around for decades. It also helps that Medicare pays for psychiatric assessments and therapy.

“We’ve been seeing more people in their 80s and older over the past five years, many who have never done therapy before,” said Dolores Gallagher-Thompson, a professor of research in the department of psychiatry at Stanford. “Usually, they’ve tried other resources like their church, or talked to family. They’re realizing that they’re living longer, and if you’ve got another 10 or 15 years, why be miserable if there’s something that can help you?”

Some of these older patients are clinically depressed. The National Alliance on Mental Illness reports that more than 6.5 million Americans over age 65 suffer from depression. But many are grappling with mental health issues unaddressed for decades, as well as contemporary concerns about new living arrangements, finances, chronic health problems, the loss of loved ones and their own mortality.

“It’s never too late, if someone has never dealt with issues,” said Judith Repetur, a clinical social worker in New York who works almost exclusively with older patients, many of whom are seeking help for the first time. “A combination of stresses late in life can bring up problems that weren’t resolved.”

That members of the Greatest Generation would feel comfortable talking to a therapist, or acknowledging psychological distress, is a significant change. Many grew up in an era when only “crazy” people sought psychiatric help. They would never admit to themselves — and certainly not others — that anything might be wrong.

“For people in their 80s and 90s now, depression was considered almost a moral weakness,” said Dr. Gallagher-Thompson. “Fifty years ago, when they were in their 20s and 30s, people were locked up and someone threw away the key. They had a terrible fear that if they said they were depressed, they were going to end up in an institution. So they learned to look good and cover their problems as best they could.”

But those attitudes have shifted over time, along with the medical community’s understanding of mental illness among seniors. In the past, the assumption was that if older people were acting strangely or having problems, it was probably dementia. But now, “the awareness of depression, anxiety disorders and substance abuse as possible problems has grown,” said Bob G. Knight, a professor of gerontology and psychology at the University of Southern California, and the author of “Psychotherapy With Older Adults.”

A report by the Substance Abuse and Mental Health Services Administration found that about half of all Americans ages 50 to 70 will be at high risk for alcohol and marijuana abuse by 2020, compared with less than 9 percent in 1999.

In years past, too, there was a sense among medical professionals that a patient often could not be helped after a certain age unless he had received treatment earlier in life. Freud noted that around age 50, “the elasticity of the mental process on which treatment depends is, as a rule, lacking,” adding, “Old people are no longer educable.” (Never mind that he continued working until he died at 83.)

“That’s been totally turned around by what we’ve learned about cognitive psychology and cognitive approach — changing the way you think about things, redirecting your emotions in more positive ways,” said Karl Pillemer, a gerontologist and professor of human development at Cornell, and author of “30 Lessons for Living.”

Treatment regimens can be difficult in this population. Antidepressants, for instance, can have unpleasant side effects and only add to the pile of pills many elderly patients take daily. Older patients may feel that they don’t have the time necessary to explore psychotherapy, or that it’s too late to change.

But many eagerly embrace talk therapy, particularly cognitive behavioral techniques that focus on altering thought patterns and behaviors affecting their quality of life now. Experts say that seniors generally have a higher satisfaction rate in therapy than younger people because they are usually more serious about it. Time is critical, and their goals usually are well defined.

“Older patients realize that time is limited and precious and not to be wasted,” said Dr. Abrams. “They tend to be serious about the discussion and less tolerant of wasted time. They make great patients.”

After her husband died two years ago, Miriam Zatinsky, a retired social worker who is now 87, moved into an independent living facility at Miami Jewish Health Systems. It was a difficult transition to make late in life.

“It was really strange to me, and I couldn’t seem to make any friends here,” Ms. Zatinsky said. “I really couldn’t find my way. I was having a terrible time.”

The medical director for mental health at the facility, Dr. Marc E. Agronin, a geriatric psychiatrist and the author of “How We Age,” told her that her problems were not unusual for someone in her situation, and encouraged her to make some friends. He prescribed Xanax to help with anxiety, which she said she rarely takes, and he put her in touch with a social worker, Shyla Ford, whom Ms. Zatinsky saw once a week until Ms. Ford moved (Ms. Zatinsky now has a new social worker she talks to). They strategized on how she could reach out. And slowly, she did.

“Sitting at the table for dinner, you talk to people,” said Ms. Zatinsky, who has become president of her building.

Typically, 15 to 20 sessions of talk therapy are enough to help an older patient, unless he or she is struggling with a lifetime’s worth of significant problems. Still, even long-term issues can be overcome.

After a debilitating depression in which she spent three months unable to get out of bed, Judita Grosz, 69, of Pembroke Pines, Fla., decided to see Dr. Agronin, who prescribed medication. (She also tried group therapy but didn’t like it.) He also practiced some cognitive behavioral techniques with her — for instance, requiring her to get dressed every day for a minimum of 15 minutes.

Eventually, she began to feel better. “I learned to adjust my thinking, and I don’t get as anxious as I used to,” said Ms. Grosz, who has since begun making and selling jewelry. “I found out at this age that I am artistic and creative and innovative and smart. I just woke up to the fact that I have a mind of my own. Talk about a late bloomer.”

Dr. Agronin, who still meets with Ms. Grosz monthly, said, “You might not be able to gain a magical insight and wrap up their entire life in therapy, but you might be able to accomplish one or two small but meaningful goals.”

Sometimes, what older patients really need is help putting a lifetime in perspective.

“Things can be seen differently from the perspective of old age that relieve some guilt and challenge assumptions that you’ve had for decades,” Dr. Abrams said. “ ‘Maybe it wasn’t too terrible after all; maybe I shouldn’t blame myself.’ Maybe some of your worst mistakes weren’t so egregious, and maybe there were unavoidable circumstances you couldn’t control.”

Mr. Tolkin still stops by Dr. Abrams’s office for a monthly checkup.

“Everybody has a certain amount of heartache in life — it’s how you handle the heartache that is the essential core of your life,” Mr. Tolkin said. “I found that my attitude was important, and I had to reinforce positive things all the time.”

He said he wishes he had tried therapy years ago. But he adds: “I can’t go back. I can only go forward.”

-Abby Ellin

Self-Esteem versus Narcissism

The distinction between self-esteem and narcissism is of great significance on a personal and societal level. Self-esteem differs from narcissism in that it represents an attitude built on accomplishments we’ve mastered, values we’ve adhered to, and care we’ve shown toward others. Narcissism, conversely, is often based on a fear of failure or weakness, a focus on one’s self, an unhealthy drive to be seen as the best, and a deep-seated insecurity and underlying feeling of inadequacy.

-HelpGuide.org