Safe Effective Sleep Aids For Seniors
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Safe Efective Sleep Aids For Seniors
Choosing a safe, effective sleep aid can be difficult, especially as we get older. Take for example this research review, which practically says, when it comes to drugs, “Nope nope nope nope nope, definitely not, we don’t know, wow no, useful in one (1) circumstance only, definitely not, fine if you must”:
Review of Safety and Efficacy of Sleep Medicines in Older Adults
Let’s break it down…
What’s not so great
Tranquilizers aren’t very healthy ways to get to sleep, and are generally only well-used as a last resort. The most common of these are benzodiazepines, which is the general family of drugs with names usually ending in –azepam and –azolam.
Their downsides are many, but perhaps their biggest is their tendency to induce tolerance, dependence, and addiction.
Non-benzo hypnotics aren’t fabulous either. Z-drugs such as zolpidem tartrate (popularly known by the brand name Ambien, amongst others), comes with warnings that it shouldn’t be prescribed if you have sleep apnea (i.e., one of the most common causes of insomnia), and should be used only with caution in patients who have depression or are elderly, as it may cause protracted daytime sedation and/or ataxia.
See also: Benzodiazepine and z-drug withdrawal
(and here’s a user-friendly US-based resource for benzodiazepine addiction specifically)
Antihistamines are commonly sold as over-the-counter sleep aids, because they can cause drowsiness, but a) they often don’t b) they may reduce your immune response that you may actually need for something. They’re still a lot safer than tranquilizers, though.
What about cannabis products?
We wrote about some of the myths and realities of cannabis use yesterday, but it does have some medical uses beyond pain relief, and use as a sleep aid is one of them—but there’s another caveat.
How it works: CBD, and especially THC, reduces REM sleep, causing you to spend longer in deep sleep. Deep sleep is more restorative and restful. And, if part of your sleep problem was nightmares, they can only occur during REM sleep, so you’ll be skipping those, too. However, REM sleep is also necessary for good brain health, and missing too much of it will result in cognitive impairment.
Opting for a CBD product that doesn’t contain THC may improve sleep with less (in fact, no known) risk of long-term impairment.
See: Cannabis, Cannabinoids, and Sleep: a Review of the Literature
Melatonin: a powerful helper with a good safety profile
We did a main feature on this recently, so we won’t take up too much space here, but suffice it to say: melatonin is our body’s own natural sleep hormone, and our body is good at scrubbing it when we see white/blue light (so, look at such if you feel groggy upon awakening, and it should clear up quickly), so that and its very short elimination half-life again make it quite safe.
Unlike tranquilizers, we don’t develop a tolerance to it, let alone dependence or addiction, and unlike cannabis, it doesn’t produce long-term adverse effects (after all, our brains are supposed to have melatonin in them every night). You can read our previous main feature (including a link to get melatonin, if you want) here:
Melatonin: A Safe Natural Sleep Supplement
Herbal options: which really work?
Valerian? Probably not, but it seems safe to try. Data on this is very inconsistent, and many studies supporting it had poor methodology. Shinjyo et al. also hypothesized that the inconsistency may be due to the highly variable quality of the supplements, and lack of regulation, as they are provided “based on traditional use only”.
Chamomile? Given the fame of chamomile tea as a soothing, relaxing bedtime drink, there’s surprisingly little research out there for this specifically (as opposed to other medicinal features of chamomile, of which there are plenty).
But here’s one study that found it helped significantly:
The effects of chamomile extract on sleep quality among elderly people: A clinical trial
Unlike valerian, which is often sold as tablets, chamomile is most often sold as a herbal preparation for making chamomile tea, so the quality is probably quite consistent. You can also easily grow your own in most places!
Technological interventions
We may not have sci-fi style regeneration alcoves just yet, but white noise machines, or better yet, pink noise machines, help:
White Noise Is Good; Pink Noise Is Better
Note: the noise machine can be a literal physical device purchased to do that (most often sold as for babies, but babies aren’t the only ones who need to sleep!), but it can also just be your phone playing an appropriate audio file (there are apps available) or YouTube video.
We reviewed some sleep apps; you might like those too:
The Head-To-Head Of Google and Apple’s Top Apps For Getting Your Head Down
Enjoy, and rest well!
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Balanced Energy Cake Bars
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Unlike a lot of commercially available products, these bars won’t spike your blood sugars in the same way. There’s technically plenty of sugar in them, mostly from the chopped dates, but they’re also full of fiber, protein, and healthy fats. This means they can give you an energy boost (along with lots of gut-healthy, heart-healthy, and brain-healthy ingredients) without any crash later. They’re also delicious, and make for a great afternoon snack!
You will need
- 1 cup oats
- 15 Medjool dates, pitted and soaked in hot water for 15 minutes
- 3 carrots, grated
- 4oz almond butter
- 2 tbsp tahini
- 2 tbsp flaxseeds, milled
- 1 tbsp sesame seeds, toasted
- Optional: your choice of dried fruit and/or chopped nuts (mix it up; diversity is good!)
Method
(we suggest you read everything at least once before doing anything)
1) Steam the grated carrots for 3–4 minutes; pat dry and allow to cool
2) Drain and pat dry the dates, roughly chop them and add them to a bowl with the carrots. Because we chopped the dates rather than blended them (as many recipes do), they keep their fiber, which is important.
3) Add the oats, seeds, almond butter, and tahini. Also add in any additional dried fruit and/or chopped nuts you selected for the optional part. Mix well; the mixture should be quite firm. If it isn’t, add more oats.
4) Press the mixture into a 10″ square baking tin lined with baking paper. Refrigerate for a few hours, before cutting into bar shapes (or squares if you prefer). These can now be eaten immediately or stored for up to a week.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
Take care!
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It’s Not Hysteria – by Dr. Karen Tan
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Firstly, who this book is aimed at: in case it wasn’t clear, this book assumes you have, or at least have had, a uterus. If that’s not you, then well, it’ll still be an interesting read but it won’t be about your reproductive health.
Secondly, about that “reproductive health”: it’s mostly not actually about reproductive health literally, but rather, the health of one’s reproductive organs and the things that they affect—which is a lot more than the ability to reproduce!
Dr. Tang takes us on a (respectably in-depth) tour of the relevant anatomy, before moving on to physiology, before continuing to pathology (i.e. things that can go wrong, and often do), and finally various treatment options, including elective procedures, and the pros and cons thereof.
She also talks the reader through talking about things with gynecologists and other healthcare providers, and making sure concerns are not dismissed out-of-hand (something that happens a lot, of course).
The style throughout is quite detailed prose, but without being difficult at all to read, and (assuming one is interested in the topic) it’s very engaging.
Bottom line: if you would like to know more about uteri and everything that is (or commonly/unfortunately) can be attached to them, the effects they have on the rest of the body and health, and what can be done about things not being quite right, then this is a good book for that.
Click here to check out It’s Not Hysteria, and understand more of what’s going on down there!
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How To Lower Your Blood Pressure (Cardiologists Explain)
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Today we enjoy the benefit of input from Dr. Zalzal, Dr. Weeing, and Dr. Hefferman!
If the thought of being in an operating room with three cardiologists in scrubs doesn’t raise your blood pressure too much, the doctors in question have a lot to offer for bringing those numbers down and keeping them down! They recommend…
150 mins of Exercise
This isn’t exactly controversial, but: move your body!
See also: Exercise Less; Move More
Reduce salt
Most people eating the Standard American Diet (SAD) are getting far too much—mostly because it’s in so many processed foods already.
See also: How Too Much Salt May Lead To Organ Failure
Eating habits
There’s a lot more to eating healthily for the heart than just reducing salt, and over all, the Mediterranean diet comes out scoring highest:
- What Is The Mediterranean Diet Anyway? ← a primer for the uncertain
- Four Ways To Upgrade The Mediterranean ← includes a heart-specialized version!
Reduce alcohol
According to the WHO, the only healthy amount of alcohol is zero. According to these cardiologists: at the very least cut down. However much or little you’re drinking right now, less is better.
See also: How To Reduce Or Quit Alcohol
Maintain healthy weight
While the doctors agree that BMI isn’t a great method of measuring metabolic health, it is clear that carrying excessive weight isn’t good for the heart.
See also: Lose Weight (Healthily!)
No smoking
This one’s pretty straight forward: just don’t.
See also: Addiction Myths That Are Hard To Quit
Reduce stress
Chronic stress has a big impact on chronic health in general and that includes its effect on blood pressure. So, improving one improves the other.
See also: Lower Your Cortisol! (Here’s Why & How)
Good sleep
Quality matters as much as quantity, and that goes for its effect on your blood pressure too, so take the time to invest in your good health!
See also: The 6 Dimensions Of Sleep (And Why They Matter)
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Bushfire smoke affects children differently. Here’s how to protect them
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Bushfires are currently burning in Australian states including Victoria, Tasmania, Western Australia and South Australia. In some areas, fire authorities have warned residents about the presence of smoke.
Bushfire smoke is harmful to our health. Tiny particles of ash can lodge deep in the lungs.
Exposure to this type of smoke may worsen existing conditions such as asthma, and induce a range of health effects from irritation of the eyes, nose and throat to changes in the cardiovascular system.
Public health recommendations during smoke events tend to provide general advice, and don’t often include advice specifically geared at children. But children are not just little adults. They are uniquely vulnerable to environmental hazards such as bushfire smoke for a number of reasons.
Different physiology, different behaviour
Children’s lungs are still developing and maturing.
Airways are smaller in children, especially young children, which is associated with greater rates of particle deposition – when particles settle on the surfaces of the airways.
Children also breathe more air per kilogram of body weight compared with adults, and therefore inhale more polluted air relative to their size.
Further, children’s detoxification systems are still developing, so environmental toxins take longer to effectively clear from their bodies.
Meanwhile, children’s behaviour and habits may expose them to more environmental toxins than adults. For example, they tend to do more physical activity and spend more time outdoors. Higher levels of physical activity lead to more air inhaled per kilogram of body weight.
Also, a normal and important part of children’s early play is exploring their environment, including by putting things in their mouth. This can result in kids ingesting soil, dust and dirt, which often contain environmental contaminants.
For these reasons, it’s important to consider the specific needs of children when providing advice on what to do when there’s smoke in the air.
Keeping our environments healthy
The Australian government offers recommendations for minimising the health risks from exposure to bushfire smoke. The main advice includes staying indoors and keeping doors and windows closed.
This is great advice when the smoke is thick outside, but air pollutants may still accumulate inside the home. So it’s important to air your home once the smoke outside starts to clear. Take advantage of wind changes to open up and get air moving out of the house with a cross breeze.
Kids are natural scientists, so get them involved. For example, you and your child can “rate” the air each hour by looking at a landmark outside your home and rating how clearly you can see it. When you notice the haze is reducing, open up the house and clear the air.
Because air pollutants settle onto surfaces in our home and into household dust, an easy way to protect kids during smoky periods is to do a daily dust with a wet cloth and vacuum regularly. This will remove pollutants and reduce ingestion by children as they play. Frequent hand washing helps too.
Healthy bodies and minds
Research exploring the effects of bushfire smoke exposure on children’s health is sparse. However, during smoke events, we do see an increase in hospital visits for asthma, as well as children reporting irritation to their eyes, nose and throat.
If your child has asthma or another medical condition, ensure they take any prescribed medications on a regular schedule to keep their condition well controlled. This will minimise the risk of a sudden worsening of their symptoms with bushfire smoke exposure.
Make sure any action plans for symptom flare-ups are up to date, and ensure you have an adequate supply of in-date medication somewhere easy to locate and access.
Kids can get worried during bushfires, and fire emergencies have been linked with a reduction in children’s mental health. Stories such as the Birdie’s Tree books can help children understand these events do pass and people help one another in times of difficulty.
Learning more about air pollution can help too. Our group has a children’s story explaining how air pollution affects our bodies and what can help.
It’s also important for parents and caregivers not to get too stressed, as children cope better when their parents manage their own anxiety and help their children do the same. Try to strike a balance between being vigilant and staying calm.
What about masks?
N95 masks can protect the wearer from fine particles in bushfire smoke, but their use is a bit complicated when it comes to kids. Most young children won’t be able to fit properly into an N95 mask, or won’t tolerate the tight fit for long periods. Also, their smaller airways make it harder for young children to breathe through a mask.
If you choose to use an N95 mask for your children, it’s best to save them for instances when high-level outdoor exposure is unavoidable, such as if you’re going outside when the smoke is very thick.
N95 masks should be replaced after around four hours or when they become damp.
If your child has an existing heart or lung condition, consult their doctor before having them wear an N95 mask.
Our team is currently recruiting for a study exploring the effects of bushfire smoke in children. If you live in south east Queensland and are interested in participating in the event of a bushfire or hazard reduction burn near your home, please express your interest here.
Dwan Vilcins, Group leader, Environmental Epidemiology, Children’s Health Environment Program, The University of Queensland; Nicholas Osborne, Associate Professor, School of Public Health, The University of Queensland, and Paul D. Robinson, Conjoint Professor in Respiratory and Sleep Medicine, Child Health Research Centre, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Why Many Nonprofit (Wink, Wink) Hospitals Are Rolling in Money
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One owns a for-profit insurer, a venture capital company, and for-profit hospitals in Italy and Kazakhstan; it has just acquired its fourth for-profit hospital in Ireland. Another owns one of the largest for-profit hospitals in London, is partnering to build a massive training facility for a professional basketball team, and has launched and financed 80 for-profit start-ups. Another partners with a wellness spa where rooms cost $4,000 a night and co-invests with “leading private equity firms.”
Do these sound like charities?
These diversified businesses are, in fact, some of the country’s largest nonprofit hospital systems. And they have somehow managed to keep myriad for-profit enterprises under their nonprofit umbrella — a status that means they pay little or no taxes, float bonds at preferred rates, and gain numerous other financial advantages.
Through legal maneuvering, regulatory neglect, and a large dollop of lobbying, they have remained tax-exempt charities, classified as 501(c)(3)s.
“Hospitals are some of the biggest businesses in the U.S. — nonprofit in name only,” said Martin Gaynor, an economics and public policy professor at Carnegie Mellon University. “They realized they could own for-profit businesses and keep their not-for-profit status. So the parking lot is for-profit; the laundry service is for-profit; they open up for-profit entities in other countries that are expressly for making money. Great work if you can get it.”
Many universities’ most robust income streams come from their technically nonprofit hospitals. At Stanford University, 62% of operating revenue in fiscal 2023 was from health services; at the University of Chicago, patient services brought in 49% of operating revenue in fiscal 2022.
To be sure, many hospitals’ major source of income is still likely to be pricey patient care. Because they are nonprofit and therefore, by definition, can’t show that thing called “profit,” excess earnings are called “operating surpluses.” Meanwhile, some nonprofit hospitals, particularly in rural areas and inner cities, struggle to stay afloat because they depend heavily on lower payments from Medicaid and Medicare and have no alternative income streams.
But investments are making “a bigger and bigger difference” in the bottom line of many big systems, said Ge Bai, a professor of health care accounting at the Johns Hopkins University Bloomberg School of Public Health. Investment income helped Cleveland Clinic overcome the deficit incurred during the pandemic.
When many U.S. hospitals were founded over the past two centuries, mostly by religious groups, they were accorded nonprofit status for doling out free care during an era in which fewer people had insurance and bills were modest. The institutions operated on razor-thin margins. But as more Americans gained insurance and medical treatments became more effective — and more expensive — there was money to be made.
Not-for-profit hospitals merged with one another, pursuing economies of scale, like joint purchasing of linens and surgical supplies. Then, in this century, they also began acquiring parts of the health care systems that had long been for-profit, such as doctors’ groups, as well as imaging and surgery centers. That raised some legal eyebrows — how could a nonprofit simply acquire a for-profit? — but regulators and the IRS let it ride.
And in recent years, partnerships with, and ownership of, profit-making ventures have strayed further and further afield from the purported charitable health care mission in their community.
“When I first encountered it, I was dumbfounded — I said, ‘This not charitable,’” said Michael West, an attorney and senior vice president of the New York Council of Nonprofits. “I’ve long questioned why these institutions get away with it. I just don’t see how it’s compliant with the IRS tax code.” West also pointed out that they don’t act like charities: “I mean, everyone knows someone with an outstanding $15,000 bill they can’t pay.”
Hospitals get their tax breaks for providing “charity care and community benefit.” But how much charity care is enough and, more important, what sort of activities count as “community benefit” and how to value them? IRS guidance released this year remains fuzzy on the issue.
Academics who study the subject have consistently found the value of many hospitals’ good work pales in comparison with the value of their tax breaks. Studies have shown that generally nonprofit and for-profit hospitals spend about the same portion of their expenses on the charity care component.
Here are some things listed as “community benefit” on hospital systems’ 990 tax forms: creating jobs; building energy-efficient facilities; hiring minority- or women-owned contractors; upgrading parks with lighting and comfortable seating; creating healing gardens and spas for patients.
All good works, to be sure, but health care?
What’s more, to justify engaging in for-profit business while maintaining their not-for-profit status, hospitals must connect the business revenue to that mission. Otherwise, they pay an unrelated business income tax.
“Their CEOs — many from the corporate world — spout drivel and turn somersaults to make the case,” said Lawton Burns, a management professor at the University of Pennsylvania’s Wharton School. “They do a lot of profitable stuff — they’re very clever and entrepreneurial.”
The truth is that a number of not-for-profit hospitals have become wealthy diversified business organizations. The most visible manifestation of that is outsize executive compensation at many of the country’s big health systems. Seven of the 10 most highly paid nonprofit CEOs in the United States run hospitals and are paid millions, sometimes tens of millions, of dollars annually. The CEOs of the Gates and Ford foundations make far less, just a bit over $1 million.
When challenged about the generous pay packages — as they often are — hospitals respond that running a hospital is a complicated business, that pharmaceutical and insurance execs make much more. Also, board compensation committees determine the payout, considering salaries at comparable institutions as well as the hospital’s financial performance.
One obvious reason for the regulatory tolerance is that hospital systems are major employers — the largest in many states (including Massachusetts, Pennsylvania, Minnesota, Arizona, and Delaware). They are big-time lobbying forces and major donors in Washington and in state capitals.
But some patients have had enough: In a suit brought by a local school board, a judge last year declared that four Pennsylvania hospitals in the Tower Health system had to pay property taxes because its executive pay was “eye popping” and it demonstrated “profit motives through actions such as charging management fees from its hospitals.”
A 2020 Government Accountability Office report chided the IRS for its lack of vigilance in reviewing nonprofit hospitals’ community benefit and recommended ways to “improve IRS oversight.” A follow-up GAO report to Congress in 2023 said, “IRS officials told us that the agency had not revoked a hospital’s tax-exempt status for failing to provide sufficient community benefits in the previous 10 years” and recommended that Congress lay out more specific standards. The IRS declined to comment for this column.
Attorneys general, who regulate charity at the state level, could also get involved. But, in practice, “there is zero accountability,” West said. “Most nonprofits live in fear of the AG. Not hospitals.”
Today’s big hospital systems do miraculous, lifesaving stuff. But they are not channeling Mother Teresa. Maybe it’s time to end the community benefit charade for those that exploit it, and have these big businesses pay at least some tax. Communities could then use those dollars in ways that directly benefit residents’ health.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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What’s the difference between shyness and social anxiety?
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What’s the difference? is a new editorial product that explains the similarities and differences between commonly confused health and medical terms, and why they matter.
The terms “shyness” and “social anxiety” are often used interchangeably because they both involve feeling uncomfortable in social situations.
However, feeling shy, or having a shy personality, is not the same as experiencing social anxiety (short for “social anxiety disorder”).
Here are some of the similarities and differences, and what the distinction means.
How are they similar?
It can be normal to feel nervous or even stressed in new social situations or when interacting with new people. And everyone differs in how comfortable they feel when interacting with others.
For people who are shy or socially anxious, social situations can be very uncomfortable, stressful or even threatening. There can be a strong desire to avoid these situations.
People who are shy or socially anxious may respond with “flight” (by withdrawing from the situation or avoiding it entirely), “freeze” (by detaching themselves or feeling disconnected from their body), or “fawn” (by trying to appease or placate others).
A complex interaction of biological and environmental factors is also thought to influence the development of shyness and social anxiety.
For example, both shy children and adults with social anxiety have neural circuits that respond strongly to stressful social situations, such as being excluded or left out.
People who are shy or socially anxious commonly report physical symptoms of stress in certain situations, or even when anticipating them. These include sweating, blushing, trembling, an increased heart rate or hyperventilation.
How are they different?
Social anxiety is a diagnosable mental health condition and is an example of an anxiety disorder.
For people who struggle with social anxiety, social situations – including social interactions, being observed and performing in front of others – trigger intense fear or anxiety about being judged, criticised or rejected.
To be diagnosed with social anxiety disorder, social anxiety needs to be persistent (lasting more than six months) and have a significant negative impact on important areas of life such as work, school, relationships, and identity or sense of self.
Many adults with social anxiety report feeling shy, timid and lacking in confidence when they were a child. However, not all shy children go on to develop social anxiety. Also, feeling shy does not necessarily mean a person meets the criteria for social anxiety disorder.
People vary in how shy or outgoing they are, depending on where they are, who they are with and how comfortable they feel in the situation. This is particularly true for children, who sometimes appear reserved and shy with strangers and peers, and outgoing with known and trusted adults.
Individual differences in temperament, personality traits, early childhood experiences, family upbringing and environment, and parenting style, can also influence the extent to which people feel shy across social situations.
However, people with social anxiety have overwhelming fears about embarrassing themselves or being negatively judged by others; they experience these fears consistently and across multiple social situations.
The intensity of this fear or anxiety often leads people to avoid situations. If avoiding a situation is not possible, they may engage in safety behaviours, such as looking at their phone, wearing sunglasses or rehearsing conversation topics.
The effect social anxiety can have on a person’s life can be far-reaching. It may include low self-esteem, breakdown of friendships or romantic relationships, difficulties pursuing and progressing in a career, and dropping out of study.
The impact this has on a person’s ability to lead a meaningful and fulfilling life, and the distress this causes, differentiates social anxiety from shyness.
Children can show similar signs or symptoms of social anxiety to adults. But they may also feel upset and teary, irritable, have temper tantrums, cling to their parents, or refuse to speak in certain situations.
If left untreated, social anxiety can set children and young people up for a future of missed opportunities, so early intervention is key. With professional and parental support, patience and guidance, children can be taught strategies to overcome social anxiety.
Why does the distinction matter?
Social anxiety disorder is a mental health condition that persists for people who do not receive adequate support or treatment.
Without treatment, it can lead to difficulties in education and at work, and in developing meaningful relationships.
Receiving a diagnosis of social anxiety disorder can be validating for some people as it recognises the level of distress and that its impact is more intense than shyness.
A diagnosis can also be an important first step in accessing appropriate, evidence-based treatment.
Different people have different support needs. However, clinical practice guidelines recommend cognitive-behavioural therapy (a kind of psychological therapy that teaches people practical coping skills). This is often used with exposure therapy (a kind of psychological therapy that helps people face their fears by breaking them down into a series of step-by-step activities). This combination is effective in-person, online and in brief treatments.
For more support or further reading
Online resources about social anxiety include:
- This Way Up’s online program for managing excessive shyness and fear of social situations
- Beyond Blue’s resources on social anxiety
- a guide to looking after yourself if you have social anxiety, from the Western Australian health department
- social anxiety online program for children and teens from the University of Queensland
- inroads, a self-guided online program for young adults who drink alcohol to manage their anxiety.
We thank the Black Dog Institute Lived Experience Advisory Network members for providing feedback and input for this article and our research.
Kayla Steele, Postdoctoral research fellow and clinical psychologist, UNSW Sydney and Jill Newby, Professor, NHMRC Emerging Leader & Clinical Psychologist, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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