The Drama of the Anxious Child

2013-09-30

Childhood anxiety is on the rise at every level, from fear of monsters under the bed to severe anxiety disorders

When I was first studying psychology, thirty years ago, I learned that about 10-20% of children are born with a temperament that is highly reactive to anything new and unfamiliar. Some of these children go on in life to be anxious, timid, or shy (or, as we shy people like to say, “slow to warm up.”) A much smaller number of children, about 1-5%, were diagnosed at that time with a full-fledged anxiety disorder.

Nowadays, there are still 10-20% with that reactive temperament, but the number of children with a diagnosable anxiety disorder has skyrocketed, up to 25% according to the National Institute of Mental Health. A report from the National Institutes of Health adds, “There is persuasive evidence from a range of studies that anxiety disorders are the most frequent mental disorders in children and adolescents….” These new numbers must be viewed skeptically, of course, because of the trend towards looser and broader definitions of mental illness. Many commentators have linked this trend to the influence of pharmaceutical companies on diagnosis and prescription patterns.

Despite these caveats, however, I believe that childhood anxiety is indeed on the rise at every level, from fears of monsters under the bed to phobias and panic attacks to severe anxiety disorders.

Last year I gave a lecture on childhood anxiety to parents at a public elementary school. I heard about children who couldn’t be in a different room from their parents, even to use the bathroom, children who were too afraid of the water to swim or even take a shower, and children who were too afraid of making a mistake to function well in the classroom.

Of course, these were parents who chose to attend a lecture on childhood anxiety, but many teachers have told me that they now have a number of highly anxious children in every class. What struck me most in this group was that none of these children was in therapy, and none had received an “official” diagnosis of an anxiety disorder (though I did give out a few business cards).

In my practice I have seen more and more children who have too much social anxiety to go to school, too much stress about grades to enjoy life, and too much separation anxiety to achieve independence as they grow older. My colleagues report the same rise in fears, worries, and anxieties.

What’s going on?

Anxiety is an alarm system—we need a little jolt of it so we will look both ways before crossing the street, but we also need an all-clear signal when the danger has passed. I think our constantly wired world has drowned out the all-clear signal. We hear instantly about every disaster, and we are bombarded with graphic images that repeat on a loop—first onscreen and then in our minds.

Another way to think of anxiety is as a simple formula: Add up all the things that cause us stress, and then subtract all of our abilities to cope. The net result is our anxiety level. This formula makes it clear why childhood anxiety is on the rise. Schools are more competitive and stressful, children are more overscheduled, parents are worried about finances and safety, and our society is based on a win-lose model, where only a few children will be able to succeed. Meanwhile, coping mechanisms are disappearing: Children don’t get enough time outside, either experiencing nature or running around in their neighborhoods. Children don’t spend nearly enough time doing “nothing,” enjoying the downtime necessary to process all their new experiences. Instead, they are desperately engaged in a drive to never be bored. I think many parents have put themselves—and their children—into an anxiety-producing corner. They want their children to be academically successful and always happy and creative and socially/emotionally intelligent. It’s an impossible demand, and the inevitable result is anxiety and burnout.

In order to change this, we first need to look to ourselves. What are we doing to manage our own anxiety? I have lost count of the number of parents who tell me they don’t pressure their high-strung children. Let’s get real. I’ve been observing a strange mix of avoidance and pressure in today’s parents. They say things like, “You don’t have to swim (or go to birthday parties, or play soccer) if you don’t want to,” but at the same time they are distraught about their child not having a best friend or the right playdates in kindergarten.

As parents, we need to focus on the opposite of worry, anxiety, and fear. In terms of the body, that means relaxation, physical activity, roughhousing, and outdoor time. In terms of overprotectiveness, that means letting children have adventures that are scary, fun, and safe. In terms of specific phobias, the opposite is a gentle nudge towards facing the feelings and overcoming the fears. And for us parents, the opposite of worry is trust: trust in the power of development, trust in the resilience of children, and trust that the world is a good and safe place for our children to grow up.

Read more: http://ideas.time.com/2013/09/26/the-drama-of-the-anxious-child/#ixzz2gLtIYlNJ

5 tips for recovering from emotional pain

2013-09-19

By Guy Winch, Special to CNN

Editor’s note: Guy Winch holds a doctorate in clinical psychology and has a private practice in Manhattan. He is the author of “Emotional First Aid: Practical Strategies for Treating Failure, Rejection, Guilt, and Other Everyday Psychological Injuries.”

We sustain psychological injuries such as rejection and failure as we go through life just as often as we do physical injuries. But while we have access to ointments and bandages to treat cuts and sprains, we have no such tools to treat emotional pain.

In my book, I discuss the impact of seven common psychological injuries on our emotional well-being — rejection, failure, guilt, loneliness, rumination, loss and bouts of low self-esteem — and offer science-based treatments that ease the pain, accelerate healing and minimize long-term risks to our mental health.

Continue reading 5 tips for recovering from emotional pain →

Wealthy Selfies: How Being Rich Increases Narcissism

2013-08-22

The rich really are different — and, apparently more self-absorbed, according to the latest research.

That goes against the conventional wisdom that the more people have, the more they appreciate their obligations to give back to others. Recent studies show, for example, that wealthier people are more likely to cut people off in traffic and to behave unethically in simulated business and charity scenarios. Earlier this year, statistics on charitable giving revealed that while the wealthy donate about 1.3% of their income to charity, the poorest actually give more than twice as much as a proportion of their earnings — 3.2%.

“There’s this idea that the more you have, the less entitled and more grateful you feel; and the less you have, the more you feel you deserve. That’s not what we find,” says author Paul Piff, a psychologist at the University of California, Berkeley. “This seems to be the opposite of noblesse oblige.”

Continue reading Wealthy Selfies: How Being Rich Increases Narcissism →

The Key to Happy Relationships? It’s Not All About Communication

2013-08-20

By Francine Russo

If couples were paying any attention during the last few decades, they should be able to recite the one critical ingredient for a healthy relationship — communication. But the latest study shows that other skills may be almost as important for keeping couples happy.

While expressing your needs and feelings in a positive way to your significant other is a good foundation for resolving conflicts and building a healthy relationship, these skills may not be as strong a predictor of couples’ happiness as experts once thought.

Continue reading The Key to Happy Relationships? It’s Not All About Communication →

Urban Moms at Greater Risk for Postpartum Depression

2013-08-12

By Alexandra Sifferlin

Researchers are narrowing in on the host of factors that can contribute to postpartum depression, from genes to social connections. The latest work focuses on where a new mother lives.

The new study, published in the journal Canadian Medical Association Journal (CMAJ), looked at whether urban or rural locales played a role in postpartum depression rates.

More than 6,400 women who lived in a variety of different geographical areas, including urban, rural, semi-urban and semi-rural areas, participated in the 2006 Canadian Maternity Experiences Survey. (Rural living was defined as settlements with fewer than 1,000 people but more than 400 people per square kilometer. Semirural settings included up to 30,000 people, while semi-urban was defined as including 30,000 to 499,999 residents and urban areas included 500,000 people or more.) They also accounted for whether a woman commuted for work to urban places.

Overall, 7.5% of the women who had recently given birth in the weeks prior to the survey developed postpartum depression, but women from urban areas were at a greater risk, with a 10% rate, compared to 6% of women in rural areas, nearly 7% in semi-rural areas and 5% in semi-urban areas who developed the condition. The discrepancy is likely due to the disproportionate distribution of known risk factors such as social support and a prior history of depression that have been previously associated with postpartum depression. In the current study, for example, many of the city-dwelling mothers who developed postpartum were members of immigrant populations, which typically have weaker social support networks.

That could explain the counterintuitive result that a woman living among thousands of people in an urban setting, where post natal care and support may be more accessible than in less populated rural areas, can still experience social isolation that can contribute to feelings of helplessness and despondence. Paula Caplan, a clinical and research psychologist at Harvard University and author of “Don’t Blame Mother: Mending the Mother-Daughter Relationship,” who was not affiliated with the study, says that women living in urban environments are also likely to be working multiple jobs, and to be living in poverty. These stressors, on top of raising children, can test the limits of a new mother’s coping skills.

“People say poor mothers suffer from depression. Why is this a surprise? If you’re trying to be a good mother, it is very hard if you are poor and if you are isolated without having a sense of helplessness,” says Caplan.

Changes in the family dynamic also play a role; women are more likely to live further away from home than they have in the past, which means they are forced to manage without help from family members. While social networks may be more extensive thanks to social media, those connections still can’t replace the support and reassurance provided by the physical presence of a friend or loved one — especially for a new mother. “There are mommy blogs and social media, but there is no substitute for having someone right there who can break down our isolation and tell you you’re doing fine and your kids are okay,” says Caplan.

While hormones as well as possible genetic markers have also been connected to postpartum depression, Caplan believes that classifying the condition as a mental or physiological problem could take the focus away from social changes that could be made to support mothers. As the study results suggest, isolation and lack of social support can intensify feelings of discouragement, being overwhelmed, and loneliness that any new mother naturally experiences.

“We have completely unreasonable expectations for mothers,” says Caplan. “We live in a mother-blaming society where mothers get blamed for almost anything that goes wrong with their child. Mothers can feel isolated or scared to death. There are social changes that need to be made. These women do not need to be treated for alleged mental illness.” The study authors say better daycare options and more supportive services for women who have recently given birth could alleviate some of the burden that mothers feel. And as the results show, these services are needed not just in sparsely populated areas but in densely packed urban ones as well, since it’s possible to feel lonely even when you’re surrounded by people.

Chocolate craving comes from total sensory pleasure

2013-08-07

By Philippa Roxby Health reporter, BBC News

A chocolate lover’s dream? Overflowing molten chocolate

For most of us, chocolate is a guilty pleasure. We crave it because it tastes wonderful and sweet – although we know we should really be stretching for the fruit bowl.

The British are particularly fond of chocolate. Research shows that, on average, Britons enjoy about 11kg (24lb) of chocolate a year, making the UK one of the biggest consumers of chocolate in the world. Only the Swiss and Germans eat more.

But a recent study suggests that chocolate cravings are not a modern phenomenon. In fact, chocoholism may date back to the 18th Century and beyond.

Cacao beans, which are the basic component of chocolate, were roasted, ground and drunk with water by the Mayans from around 2,000 years ago.

In the 14th Century, the Aztecs concocted chocolate drinks with flavourings and used the beans to treat a number of common ailments.

Then in the late 1700s in Mexico, a young doctor started seeing chocolate as harmful, rather than medicinal. He blamed an increase in hysteria among women and nuns in several cities on their excessive consumption of chocolate.

Was this actually an extreme form of chocolate craving?

According to a paper presented at the International Congress on the History of Science, Technology and Medicine at the University of Manchester this weekend, cacao was very popular at the time and could be served hot or cold for medicinal or pleasure purposes.

Nuns were particularly privileged, says author Dr Mauricio Sanchez Menchero, and they “were able to have as much chocolate as they wished for regardless of costs”.

Even a sharp rise in the price of chocolate did not affect consumption levels in convents, he says.

So when new laws were brought in which forced nuns to do away with personal servants and make their own food and drinks, their intake of cacao was “greatly diminished” and they were afflicted by hysterical attacks.

Dr Jose Bartolache was convinced that the cacao plant played a major role in ill health, although very tight clothes and going to bed late were other supposed causes.

The bitter, dark chocolate eaten by the nuns is nothing like the sugary, flavoured milk chocolate which is popular today – but the reaction is understandable.

Many people would claim to crave chocolate and enjoy the feeling that eating it induces.

The key to this may be a chemical called anandamide, which is similar to the compounds released when cannabis is taken.

It is released in small quantities when we eat chocolate and it creates a relaxing feeling.

Prof Philip K. Wilson, joint author of Chocolate as Medicine – A Quest over the Centuries with Jeffrey Hurst, says what lies behind the aphrodisiac qualities of chocolate is still to be answered.

“It’s difficult to tease apart which chemicals may be contributing to which psychological functions. There are over 500 chemicals in consumer chocolate products, so there’s a lifetime of chemical analysis still to be done,” says Prof Wilson.

His hunch is that the “almost seductive” texture of chocolate is as important as its ingredients.

Dr Barry Smith, director of the Centre for the Study of the Senses at Birkbeck University of London, agrees.

He says the combination of the smoothness and creaminess of chocolate in the mouth, the sweetness of the taste – boosted by vanilla flavouring – and the smell of it before it even hits the taste buds make chocolate-eating a hugely pleasurable experience.

And this contrasts with other foods.

“Cheese might smell stinky but it can taste great. Brewed coffee always smells fantastic but it’s not the same taste when you drink it – and that’s disappointing.

“But with chocolate, the pleasure of anticipation and the reward in eating it match up. The aroma and the taste are the same.

“And that matters because there are two sorts of pleasure involved,” says Dr Smith.

He recommends taking time to savour a piece of chocolate, then comparing that experience with eating it quickly.

“When you start eating it, turn it around in your mouth to get the melting quality which strokes the tongue.

“Receptors in the tongue then respond to this stroking and it’s a different feeling from touch.

“That’s why we love a velvety wine or double cream – it’s the feeling on our tongues.”

Both men and women can experience the pleasure of chocolate but women’s superior sense of smell means that they may be more likely to enjoy the ride.

And yet not all countries and cultures show cravings for chocolate.

There is a theory that because chocolate is perceived as “bad food” – because of its sugar and fat content – we try to avoid eating it, and this leads us to crave it, because it is forbidden.

However in recent years, chocolate’s press has improved to the extent that it is now known to have some health benefits.

The type of polyphenols present in cacao beans, known as flavanoids, are antioxidants and there is some evidence that this action may help protect our hearts – but only as part of a healthy and balanced diet.

As for whether chocolate can actually improve our mood, there is limited evidence according to neuroscientists.

But millions of women (and nuns) can’t be wrong, can they?

Hotter World Means Hotter Tempers, More Violence

2013-08-05

By Maia Szalavitz

Climate change may be one of the factors contributing to violence within and among societies, according to the latest study.

Whether it’s a drought in India, a heat wave in the U.S. or an extreme change in rainfall in Africa, Asia or South America, the outcomes tend to be the same: more wars, more murder, more riots and more domestic violence.

The intimate connection between climate and human interaction has long been documented, and could have contributed to the downfall of Chinese and Mayan empires, say the study’s authors. Reporting in the journal Science,  lead author Solomon Hsiang, assistant professor of public policy at the University of California in Berkeley. and his colleagues analyzed 60 studies of climate change and human conflict at several levels, from domestic violence to the collapse of entire civilizations. “All around the world across different societies in the modern world as well as throughout history, we find that human conflict seems to be linked to changes in climate,” says Hsiang.

Rising temperatures have the greatest effect on human conflict; the equivalent of a five degree Fahrenheit increase in an average U.S. county over a month, for example, could raise the odds of personal violence such as assault, murder and domestic violence by 4%, and the risk of civil war, riots or ethnic violence by 14%.

Rainfall and drought can also contribute to conflict; the researchers found spikes in domestic violence in India, as well as higher murder rates in the U.S. and in Tanzania and civil wars in tropical regions tied to relatively small changes in rain or temperature.

The findings reinforce previous studies that linked climate change to human affairs, and raise concerns about the potential impact that changing environmental conditions will have on the stability of societies in coming decades. Most climate change estimates predict a rise of two to four standard deviations in temperature, rainfall or drought by 2050, which suggests a 30% greater risk of intergroup conflicts, says Hsiang.

“It’s a very, very impressive review of the literature,” says Dr. Mark Shapiro, chief of acute care surgery at Duke University Medical Center, who has published research on the link between heat and assaults, but was not associated with the latest study.

Heat could provide fertile ground for interpersonal violence by bringing people into closer contact indoors to seek relief. Assault, rape— even the number of baseball pitchers who retaliate against batters by hitting them with pitches — all rise with temperature, studies show. Even noise can become a more anger-inducing irritant, according to Dutch researchers.

On a population level, climate change may have more indirect effects on social stability; as crops fail due to drought or flood, for instance, migration may provoke conflicts as communities compete for more limited resources.

However, Shapiro says it’s not clear that rising global temperatures will necessary lead to ever-escalating conflict. His own work found a direct, linear relationship between assault and temperature, but other studies suggested there may be a threshold at which violence starts to decline.

Still, says Hsiang, his data show that man is historically ill-equipped to cope with changing climate, and may continue to fall prey to the influence that higher temperatures and more rainfall can have on the stability of both personal and society relationships. “We need to understand why climate changes cause conflict so we can help societies to adapt to these events and avoid the violence,” he said in a statement.

Your happiness type matters

2013-08-01

By Jen Christensen,

You feel happiness all the way down to your genes, scientists say. But the kind of happiness you’re feeling matters, as different kinds can have wildly different effects on your physical well-being.

In fact, the happiness you get from instant gratification — eating that giant cupcake or buying that fabulous pair of shoes — may have the same physical impact on your genes as depression or stress, according to a groundbreaking study published in the Proceedings of the National Academy of Sciences.

“I’ve been studying the physical and psychological impact of positive emotion for 20 years, (and) the pattern of results we found with this study completely surprised me,” said the lead author, Barbara Fredrickson.

Fredrickson is a professor of psychology and the principal investigator of the Positive Emotions and Psychophysiology Lab at the University of North Carolina.

“I’ve known anecdotally that positive emotions impact us on a cellular level, but seeing these results have given us proof that there is a real difference in the kinds of happiness we feel and its potential long-term consequences.”

The experts divide well-being into two different types: hedonic and eudaimonic. These are fancy words to describe happiness that comes from two different sources.

Hedonic well-being comes from an experience a person seeks out that gives them pleasure. As study co-author Steve Cole describes it, it’s “having lots of positive experiences that come from, say, eating great food or smelling beautiful flowers.”

Eudaimonic well-being is a kind of happiness that comes not from consuming something but from a sustained effort at working toward something bigger than you. In other words, it’s working toward a sense of meaning in your life or contributing to some kind of cause. Think of the happiness you see on the Dalai Lama or Mother Teresa’s face.

While the two kinds of happiness are conceptually different, they can and do influence each other, so it has been hard for scientists to measure which kind has had a greater positive influence on someone’s physical or psychological well-being.

Cole, a professor of medicine, psychiatry and biobehavioral sciences at UCLA, studies the biological pathways by which social environments influence gene expression.

“I know what misery looks like on a genetic level,” Cole said. “I can look at white blood cells and see a physical response to stress and misery, but we knew very little about how — if at all — positive psychology gets disseminated to the body. That’s what this study does.”

If you experience misery and stress, your genes react to it. Essentially, there is an increased expression of genes involved in inflammation and a decreased antiviral response. People who are subjected to long periods of stress have white blood cells that make slightly more pro-inflammatory proteins on a constant basis.

Inflammation is the first line of defense against infection, so that would be a very useful kind of protein to have; however, something that causes your body to create inflammation over a sustained amount of time can cause collateral damage to healthy tissue.

Colorado College microbiologist Phoebe Lostroh, who is not affiliated with the study but is familiar with its contents, explains it this way: “The immune system of someone stressed out is not at the normal level of green on the terrorism alert scale. Instead, it’s on yellow or orange, if not all the way on red. So there’s this low level of constant inflammation, which is not healthy.”

Low levels of inflammation can cause exhaustion. They also increase a person’s risk for cancer, heart disease and Alzheimer’s and can damage various tissues wherever the white blood cells are causing inflammation where they shouldn’t be, Lostroh said.

With this understanding in mind, the scientists in the new study took blood from 80 healthy adults who were screened for the two types of happiness. None of them reported being depressed or stressed.

Scientists extracted the RNA from their blood and took a closer look at the inflammatory and antiviral responses.

The study found that people who experienced the well-being that comes from self-gratification had high inflammation and low antiviral and antibody gene expression, a result similar to what people who are depressed or experience great stress have.

Bottom line? Happiness that comes from working for the greater good has a much more positive genetic impact.

“Keep in mind positives go with both kinds of well-being,” Fredrickson said. “But emotions you feel today … really will effect who you are at a cellular level.”

The study didn’t get at why the two kinds of well-being have different genetic impacts, but Cole has a theory.

“Hedonic well-being is dependent on your taking self-involved action to constantly feed this positive emotion machine,” he said. “If something threatens your ability to seek out this kind of personal happiness — if you get injured, for instance, or you experience a loss — your entire source of well-being is threatened. You are living closer to the edge of that kind of stress.

“But if you find well-being in the connections you have to others and in pursuing something that involves collaborating with other people, if in that circumstance you get sick or injured or suffer a personal loss, that community you’ve worked so hard to connect to, they will help you get through.”

How Writing Heals Wounds — Of Both the Mind and Body

2013-07-16

By Maia Szalavitz

Talking about difficult experiences can be a way of easing the emotional pain of trauma, but the latest research shows that expressing emotions in words can also speed physical healing.

The study is the latest delving into the mind-body connection to suggest that expressing emotions about a traumatic experience in a coherent way may be important to not just mental but physical health as well. It showed that the calming effect of writing can cut physical wound healing time nearly in half.

Researchers led by Elizabeth Broadbent, a senior lecturer in health psychology at the University of Auckland in New Zealand, studied 49 healthy senior citizens, aged 64 to 97.  For three days, half were assigned to write for 20 minutes a day about the most traumatic event they had experienced, and were encouraged to be as open and candid as they could about exactly what they felt and thought at the time. If possible, they were also asked to share thoughts or emotions that they had never expressed to others about what they had undergone.

The other participants wrote for the same duration about their plans for the next day, avoiding mentioning their feelings, opinions or beliefs. Two weeks after the first day of writing, researchers took small skin biopsies, under local anesthesia, that left a wound on the arms of all participants.  The skin tissue was used for another study.

A week later, Broadbent and her colleagues started photographing the wounds every three to five days until they were completely healed.  Eleven days after the biopsy, 76% of the group that had written about trauma had fully healed while only 42% of the other group had.

MORE: How Child Abuse Primes the Brain for Future Mental Illness

“This is the first study to show that writing about personally distressing events can speed wound healing in [an older] population that is at risk of poor healing,” says Broadbent.

It’s not the first, however, to reveal the intriguing connection between state-of-mind and physical health. In previous studies, this type of emotionally expressive writing, as opposed to writing on neutral topics, reduced viral load in HIV-positive patients and increased their levels of virus-fighting immune cells. The practice also increased the effectiveness of the hepatitis B vaccination by increasing antibody levels generated by the vaccine and speeding wound healing in young men.

But in terms of psychological health, the results are more conflicting. A recent study found that writing about disturbing combat experiences may improve marital satisfaction among soldiers returning home from war zones while another paper in which patients with post-traumatic stress disorder (PTSD) wrote about their difficult experiences did not find that the practice reduced symptoms. Putting emotions down in words did, however, improve mood and reduce levels of stress hormone  in these patients.

One way that writing about distressing events could give the body a boost is by promoting sleep. “We found that people who got at least seven hours of sleep most nights had faster healing than those who got less sleep,” Broadbent says. Sleep deprivation can lower levels of growth hormone, which is important for repairing injuries. And writing about their traumatic experiences also seemed to help participants to actually get more sleep.  “Many people who have written about their negative experiences report that it allowed them to gain greater insight into what happened and to put the event into perspective,” says Koschwanez, “This might reduce the extent to which the event troubles them and possibly improve their sleep.”

The writing may also help the body by reducing stress; less anxiety means fewer stress hormones, which can interfere with chemicals needed for wound healing. While Broadbent’s study did not find such a link, it’s possible the researchers were not evaluating the right anxiety measures.  “It might be that our perceived stress questionnaire was not assessing the right type or duration of stress,” says Heidi Koschwanez, a study co-author and postdoctoral fellow at the University of Auckland.

MORE: Blogging Helps Socially Awkward Teens

It’s also possible that emotional writing is not helpful for everyone. In one study published last month, when people who typically are stoic wrote about their worst trauma, their anxiety actually increased.  Those who were accustomed to being emotionally open, however, showed a drop in worry measures. That suggests that different people may have different ways of coping with traumatic events, and that writing may be an effective outlet for those who are normally more expressive, while pushing people to express feelings when they are not inclined to do so can actually increase risk for PTSD.

For those who do experience relief from expressing their emotions, however, writing may become an important part of helping them to recover —both in mind and in body— from difficult situations.

To Avoid Dementia, Stay Mentally Active Throughout Lifetime

2013-07-09

By Maia Szalavitz

The key to staying sharp in old age is to exercise your brain throughout life. Now the latest research shows that such activity may actually slow cognitive decline and, if you do develop dementia, shorten the time you spend living with it.

The new study, which was published in Neurology, involved nearly 300 older people, about half of whom developed dementia or mild cognitive impairment (often a precursor to dementia), over the course of six years. At the start of the study, participants reported on how frequently they engaged in mentally stimulating experiences throughout life such as extracurricular activities while in school and, more generally, reading books, writing letters, reading the newspaper and visiting libraries. (Because the research started over 20 years ago, internet related activity was not common.)

By studying brain autopsies after the participants died, the scientists found that 14% of the variability in mental decline could be attributed to the amount of intellectual activity in which people participated, both early and late in life. And that effect was seen even after the researchers accounted for other factors that influence dementia like age and education.

They also adjusted for the effect of brain changes due to diseases such as Alzheimer’s, stroke and Parkinson’s disease, which the research team said accounted for about a third of the differences in people’s cognitive decline before death. By comparison, cognitive activity accounted for nearly half as much as such pathology.

The people who were most active in late life showed a 32% slower rate of decline compared to those who maintained an average level of mental activity. And those who were the least active had a 48% faster fall into dementia.

“The beauty of this study is that they tested people at different points and followed them [through to] autopsy,” says Prashanthi Vemuri, an Alzheimer’s researcher at the Mayo Clinic who wrote an editorial accompanying the study, but was not otherwise associated with the trial. “People need to know [this] and be aware that it is possible to slow down the decline of dementia,” Vemuri says.

That’s important knowledge, given that nearly half of people over age 85 develop Alzheimer’s and the baby boom generation is rapidly approaching the age at which risk starts to increase; the lifetime risk of Alzheimer’s for women is 17% and for men is one in ten. By 2050, the Alzheimer’s Association estimates that the prevalence of dementia will double due to the increased proportion of the elderly in the population.

“Anything having to do with reading and writing counts in spades,” says the study’s lead author Robert Wilson, senior neuropsychologist at the Rush Alzheimer’s Disease Center at Rush University in Chicago. Sending emails or reading news online, he suspects, would have similar effects. “There’s no reason to think they wouldn’t be as mentally stimulating.”

How early does the mental activity have to start? Earlier research found that childhood intelligence can account for some of the differences in the brain once attributed to later-life cognitive activity. But whether it does so by increasing lifetime cognitive activity— people who grow up reading, for example, tend to be life time learners— or through some other means is not clear. The new study found that both early childhood cognitive activity and such activity in middle age were linked with slowing mental decline.

Vemuri says brain aging is similar to having money in the bank— people who are intelligent are cognitively “richer” and therefore have more reserves upon which to draw when brain function starts to decline. Consequently, it takes longer to “bankrupt” these resources. And cognitive activity throughout a lifetime can increase this “wealth.” But this study shows that greater cognitive activity not only adds funds, but actually slows the rate at which you lose intellectual resources— and that helps no matter how much you start out with.

Research also shows that engaging in more intellectual activity shortens the time during which someone is actually demented if they do get ill— meaning that it not only delays active disease, but shortens the worst part of it. “Reading, writing playing music, playing games [all of these] could be good,” says Vemuri, “I don’t want to pinpoint specific activities: keeping your brain mentally stimulated and active is what is primary.”

And it’s not just intellectual stimulation that may be important. Social engagement also seems to be crucial. “We’re finding in our studies that social interactions and group activities seem to help,” she says.

“The more, the better,” Wilson says. “But it’s not like physical exercise, [where it’s] ‘no pain, no gain.’ The metaphor should be ‘a hobby.’ In order to change structure and function, the activity needs to be sustained and to be sustained, it needs to be enjoyable. Hobbies like quilting or photography, acting and theatre, book clubs: those sorts of things. There’s no product that needs to be bought and one size won’t fit all.” What is important, he says, is that the activity is intellectually stimulating, and interesting enough to keep you occupied for more than one or two sessions.