Tis To Season To Be SAD-Savvy

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Seasonal Affective Disorder & SAD Lamps

For those of us in the Northern Hemisphere, it’s that time of the year; especially after the clocks recently went back and the nights themselves are getting longer. So, what to do in the season of 3pm darkness?

First: the problem

The problem is twofold:

  1. Our circadian rhythm gets confused
  2. We don’t make enough serotonin

The latter is because serotonin production is largely regulated by sunlight.

People tend to focus on item 2, but item 1 is important too—both as problem, and as means of remedy.

Circadian rhythm is about more than just light

We did a main feature on this a little while back, talking about:

  • What light/dark does for us, and how it’s important, but not completely necessary
  • How our body knows what time it is even in perpetual darkness
  • The many peaks and troughs of many physiological functions over the course of a day/night
  • What that means for us in terms of such things as diet and exercise
  • Practical take-aways from the above

Read: The Circadian Rhythm: Far More Than Most People Know

With that in mind, the same methodology can be applied as part of treating Seasonal Affective Disorder.

Serotonin is also about more than just light

Our brain is a) an unbelievably powerful organ, and the greatest of any animal on the planet b) a wobbly wet mass that gets easily confused.

In the case of serotonin, we can have problems:

  • knowing when to synthesize it or not
  • synthesizing it
  • using it
  • knowing when to scrub it or not
  • scrubbing it
  • etc

Selective Serotonin Re-uptake Inhibitors (SSRIs) are a class of antidepressants that, as the name suggests, inhibit the re-uptake (scrubbing) of serotonin. So, they won’t add more serotonin to your brain, but they’ll cause your brain to get more mileage out of the serotonin that’s there, using it for longer.

So, whether or not they help will depend on you and your brain:

Read: Antidepressants: Personalization Is Key!

How useful are artificial sunlight lamps?

Artificial sunlight lamps (also called SAD lamps), or blue light lamps, are used in an effort to “replace” daylight.

Does it work? According to the science, generally yes, though everyone would like more and better studies:

Interestingly, it does still work in cases of visual impairment and blindness:

How much artificial sunlight is needed?

According to Wirz-Justice and Terman (2022), the best parameters are:

  • 10,000 lux
  • full spectrum (white light)
  • 30–60 minutes exposure
  • in the morning

Source: Light Therapy: Why, What, for Whom, How, and When (And a Postscript about Darkness)

That one’s a fascinating read, by the way, if you have time.

Can you recommend one?

For your convenience, here’s an example product on Amazon that meets the above specifications, and is also very similar to the one this writer has

Enjoy!

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  • Lychees vs Kumquats – Which is Healthier?

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    Our Verdict

    When comparing lychees to kumquats, we picked the kumquats.

    Why?

    In terms of macros, everything is comparable except for fiber, of which kumquats have 5–6x as much fiber, which means a very significant win for kumquats in this category.

    When it comes to vitamins, lychees have slightly more of vitamins B3, B6, C, and K, while kumquats have a lot more of vitamins A and B1, and moderately more vitamins B2, B9, E, and choline. A fair win for kumquats here.

    In the category of minerals, lychees have a little more copper, phosphorus, and selenium, while kumquats have 11x as much calcium, as well as a 2–3x more iron, magnesium, manganese and zinc. An easy win for kumquats.

    Both fruits have great phenolic profiles, being both rich in antioxidants.

    All in all, enjoy both, but if you’re going to pick one, kumquats easily win the day!

    Want to learn more?

    You might like to read:

    Take care!

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  • Rapid Rise in Syphilis Hits Native Americans Hardest

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    From her base in Gallup, New Mexico, Melissa Wyaco supervises about two dozen public health nurses who crisscross the sprawling Navajo Nation searching for patients who have tested positive for or been exposed to a disease once nearly eradicated in the U.S.: syphilis.

    Infection rates in this region of the Southwest — the 27,000-square-mile reservation encompasses parts of Arizona, New Mexico, and Utah — are among the nation’s highest. And they’re far worse than anything Wyaco, who is from Zuni Pueblo (about 40 miles south of Gallup) and is the nurse consultant for the Navajo Area Indian Health Service, has seen in her 30-year nursing career.

    Syphilis infections nationwide have climbed rapidly in recent years, reaching a 70-year high in 2022, according to the most recent data from the Centers for Disease Control and Prevention. That rise comes amid a shortage of penicillin, the most effective treatment. Simultaneously, congenital syphilis — syphilis passed from a pregnant person to a baby — has similarly spun out of control. Untreated, congenital syphilis can cause bone deformities, severe anemia, jaundice, meningitis, and even death. In 2022, the CDC recorded 231 stillbirths and 51 infant deaths caused by syphilis, out of 3,761 congenital syphilis cases reported that year.

    And while infections have risen across the U.S., no demographic has been hit harder than Native Americans. The CDC data released in January shows that the rate of congenital syphilis among American Indians and Alaska Natives was triple the rate for African Americans and nearly 12 times the rate for white babies in 2022.

    “This is a disease we thought we were going to eradicate not that long ago, because we have a treatment that works really well,” said Meghan Curry O’Connell, a member of the Cherokee Nation and chief public health officer at the Great Plains Tribal Leaders’ Health Board, who is based in South Dakota.

    Instead, the rate of congenital syphilis infections among Native Americans (644.7 cases per 100,000 people in 2022) is now comparable to the rate for the entire U.S. population in 1941 (651.1) — before doctors began using penicillin to cure syphilis. (The rate fell to 6.6 nationally in 1983.)

    O’Connell said that’s why the Great Plains Tribal Leaders’ Health Board and tribal leaders from North Dakota, South Dakota, Nebraska, and Iowa have asked federal Health and Human Services Secretary Xavier Becerra to declare a public health emergency in their states. A declaration would expand staffing, funding, and access to contact tracing data across their region.

    “Syphilis is deadly to babies. It’s highly infectious, and it causes very severe outcomes,” O’Connell said. “We need to have people doing boots-on-the-ground work” right now.

    In 2022, New Mexico reported the highest rate of congenital syphilis among states. Primary and secondary syphilis infections, which are not passed to infants, were highest in South Dakota, which had the second-highest rate of congenital syphilis in 2022. In 2021, the most recent year for which demographic data is available, South Dakota had the second-worst rate nationwide (after the District of Columbia) — and numbers were highest among the state’s large Native population.

    In an October news release, the New Mexico Department of Health noted that the state had “reported a 660% increase in cases of congenital syphilis over the past five years.” A year earlier, in 2017, New Mexico reported only one case — but by 2020, that number had risen to 43, then to 76 in 2022.

    Starting in 2020, the covid-19 pandemic made things worse. “Public health across the country got almost 95% diverted to doing covid care,” said Jonathan Iralu, the Indian Health Service chief clinical consultant for infectious diseases, who is based at the Gallup Indian Medical Center. “This was a really hard-hit area.”

    At one point early in the pandemic, the Navajo Nation reported the highest covid rate in the U.S. Iralu suspects patients with syphilis symptoms may have avoided seeing a doctor for fear of catching covid. That said, he doesn’t think it’s fair to blame the pandemic for the high rates of syphilis, or the high rates of women passing infections to their babies during pregnancy, that continue four years later.

    Native Americans are more likely to live in rural areas, far from hospital obstetric units, than any other racial or ethnic group. As a result, many do not receive prenatal care until later in pregnancy, if at all. That often means providers cannot test and treat patients for syphilis before delivery.

    In New Mexico, 23% of patients did not receive prenatal care until the fifth month of pregnancy or later, or received fewer than half the appropriate number of visits for the infant’s gestational age in 2023 (the national average is less than 16%).

    Inadequate prenatal care is especially risky for Native Americans, who have a greater chance than other ethnic groups of passing on a syphilis infection if they become pregnant. That’s because, among Native communities, syphilis infections are just as common in women as in men. In every other ethnic group, men are at least twice as likely to contract syphilis, largely because men who have sex with men are more susceptible to infection. O’Connell said it’s not clear why women in Native communities are disproportionately affected by syphilis.

    “The Navajo Nation is a maternal health desert,” said Amanda Singer, a Diné (Navajo) doula and lactation counselor in Arizona who is also executive director of the Navajo Breastfeeding Coalition/Diné Doula Collective. On some parts of the reservation, patients have to drive more than 100 miles to reach obstetric services. “There’s a really high number of pregnant women who don’t get prenatal care throughout the whole pregnancy.”

    She said that’s due not only to a lack of services but also to a mistrust of health care providers who don’t understand Native culture. Some also worry that providers might report patients who use illicit substances during their pregnancies to the police or child welfare. But it’s also because of a shrinking network of facilities: Two of the Navajo area’s labor and delivery wards have closed in the past decade. According to a recent report, more than half of U.S. rural hospitals no longer offer labor and delivery services.

    Singer and the other doulas in her network believe New Mexico and Arizona could combat the syphilis epidemic by expanding access to prenatal care in rural Indigenous communities. Singer imagines a system in which midwives, doulas, and lactation counselors are able to travel to families and offer prenatal care “in their own home.”

    O’Connell added that data-sharing arrangements between tribes and state, federal, and IHS offices vary widely across the country, but have posed an additional challenge to tackling the epidemic in some Native communities, including her own. Her Tribal Epidemiology Center is fighting to access South Dakota’s state data.

    In the Navajo Nation and surrounding area, Iralu said, IHS infectious disease doctors meet with tribal officials every month, and he recommends that all IHS service areas have regular meetings of state, tribal, and IHS providers and public health nurses to ensure every pregnant person in those areas has been tested and treated.

    IHS now recommends all patients be tested for syphilis yearly, and tests pregnant patients three times. It also expanded rapid and express testing and started offering DoxyPEP, an antibiotic that transgender women and men who have sex with men can take up to 72 hours after sex and that has been shown to reduce syphilis transmission by 87%. But perhaps the most significant change IHS has made is offering testing and treatment in the field.

    Today, the public health nurses Wyaco supervises can test and treat patients for syphilis at home — something she couldn’t do when she was one of them just three years ago.

    “Why not bring the penicillin to the patient instead of trying to drag the patient in to the penicillin?” said Iralu.

    It’s not a tactic IHS uses for every patient, but it’s been effective in treating those who might pass an infection on to a partner or baby.

    Iralu expects to see an expansion in street medicine in urban areas and van outreach in rural areas, in coming years, bringing more testing to communities — as well as an effort to put tests in patients’ hands through vending machines and the mail.

    “This is a radical departure from our past,” he said. “But I think that’s the wave of the future.”

    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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  • Build Muscle (Healthily!)

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    What Do You Have To Gain?

    We have previously promised a three-part series about changing one’s weight:

    1. Losing weight (specifically, losing fat)
    2. Gaining weight (specifically, gaining muscle)
    3. Gaining weight (specifically, gaining fat)

    And yes, that last one is also something that some people want/need to do (healthily!), and want/need help with that.

    There will be, however, no need for a “losing muscle” article, because (even though sometimes a person might have some reason to want to do this), it’s really just a case of “those things we said for gaining muscle? Don’t do those and the muscle will atrophy naturally”.

    Here’s the first part: How To Lose Weight (Healthily!)

    While some people will want to lose fat, please do be aware that the association between weight loss and good health is not nearly so strong as the weight loss industry would have you believe:

    Shedding Some Obesity Myths

    And, while BMI is not a useful measure of health in general, it’s worth noting that over the age of 65, a BMI of 27 (which is in the high end of “overweight”, without being obese) is associated with the lowest all-cause mortality:

    BMI and all-cause mortality in older adults: a meta-analysis

    Body weight, muscle mass, and protein:

    That BMI of 27, or whatever weight you might wish to be, ignores body composition. You’re probably aware that volume-for-volume, muscle weighs more than fat.

    You’re also probably aware that if we’re not careful, we tend to lose muscle as we get older. This is known as age-related sarcopenia:

    Protein, & Fighting Sarcopenia

    Dr. Gabrielle Lyon, our featured expert in the above article, recommends getting at least 1.6g of protein per kg of body weight per day (Americans, divide your weight in pounds by 2.2 to get your weight in kg).

    So for example, if you weigh 165lb, that’s 75kg, that’s 1.6×75=120g of protein per day.

    There is an upper limit to how much protein per day is healthy, and that limit is probably around 2g of protein per kg of body weight per day:

    Protein: How Much Do We Need, Really?

    You may be wondering: should we go for animal or plant protein? In which case, the short version is:

    • If you only care about muscle growth, any complete sources of protein are fine
    • If you care about your general health too, then avoiding red meat is best, but other common protein sources are all fine
    • Unprocessed is (unsurprisingly) better than processed in either case

    Longer version: Plant vs Animal Protein: Head to Head

    What exercises are best for muscle-building?

    Of course, different muscles require different exercises, but for all of them, resistance training is what builds muscle the most, and it’s pretty much impossible to build a lot of muscle otherwise.

    Check out: Resistance Is Useful! (Especially As We Get Older)

    Prepare to fail!

    No, really, prepare to fail. Because while resistance training in general is good for maintaining strong muscles and bones, you will only gain muscle if your current muscle is not enough to do the exercise:

    • If you do a heavy resistance exercise without undue difficulty, your muscles will say to each other “Good job, team! That was hard, but luckily we were strong enough; no changes necessary”.
    • If you do a heavy resistance exercise to the point where you can no longer do it (called: training to failure), then your muscles will say to each other “Oof, what a task! What we’ve got here is clearly not enough, so we’ll have to add more muscle for next time”.

    Safety note: training to failure comes with safety risks. If using free weights or weight machines, please do so under well-trained supervision. If doing it with bodyweight (e.g. press-ups until you can press no more) or resistance bands, please check with your doctor first to ensure this is safe for you.

    You can also increase the effectiveness of your resistance training by doing it in a way that “confuses” your muscles, making it harder for them to adapt in the moment, and thus forcing them to adapt more in the long term (e.g. get bigger and stronger):

    HIIT, But Make It HIRT: High Intensity Resistance Training

    Make time for recovery

    While many kinds of exercise can be done daily, exercise to build muscle(s) means at the very least resting that muscle (or muscle group) the next day.

    For this reason, a lot of bodybuilders have for example a week’s schedule that might look like:

    • Monday: Upper body training
    • Wednesday: Lower body training
    • Friday: Core strength training

    …and rest on other days. This gives most muscles a full week of recovery, and every muscle at least 48 hours of recovery.

    Note: bodybuilders, like children (who are also doing a lot of body-building, in their own way) need more sleep in order to allow for this recovery and growth to occur. Serious bodybuilders often aim for 12 hours sleep per day. This might be impractical, undesirable, or even impossible for some people, but it’s a factor to be borne in mind and not forgotten.

    See also:

    Overdone It? How To Speed Up Recovery After Exercise (According To Actual Science)

    Anything else that can (safely and healthily) be done to promote muscle growth?

    There are a lot of supplements on the market; some are healthy and helpful, other not so much. Here are some we’ve written about:

    Take care!

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    The Mediterranean Diet: What Is It Good For?

    More to the point: what isn’t it good for?

    What brought it to the attention of the world’s scientific community?

    Back in the 1950s, physiologist Ancel Keys wondered why poor people in Italian villages were healthier than wealthy New Yorkers. Upon undertaking studies, he narrowed it down to the Mediterranean diet—something he’d then take on as a public health cause for the rest of his career.

    Keys himself lived to the ripe old age of 100, by the way.

    When we say “Mediterranean Diet”, what image comes to mind?

    We’re willing to bet that tomatoes feature (great source of lycopene, by the way), but what else?

    • Salads, perhaps? Vegetables, olives? Olive oil, yea or nay?
    • Bread? Pasta? Prosciutto, salami? Cheese?
    • Pizza but only if it’s Romana style, not Chicago?
    • Pan-seared liver, with some fava beans and a nice Chianti?

    In reality, the diet is based on what was historically eaten specifically by Italian peasants. If the word “peasants” conjures an image of medieval paupers in smocks and cowls, and that’s not necessarily wrong, further back historically… but the relevant part here is that they were people who lived and worked in the countryside.

    They didn’t have money for meat, which was expensive, nor the industrial setting for refined grain products to be affordable. They didn’t have big monocrops either, which meant no canola oil, for example… Olives produce much more easily extractable oil per plant, so olive oil was easier to get. Nor, of course, did they have the money (or infrastructure) for much in the way of imports.

    So what foods are part of “the” Mediterranean Diet?

    • Fruits. These would be fruits grown locally, but no need to sweat that, dietwise. It’s hard to go wrong with fruit.
    • Tomatoes yes. So many tomatoes. (Knowledge is knowing tomato is a fruit. Wisdom is not putting it in a fruit salad)
    • Non-starchy vegetables (e.g. eggplant yes, potatoes no)
    • Greens (spinach, kale, lettuce, all those sorts of things)
    • Beans and other legumes (whatever was grown nearby)
    • Whole grain products in moderation (wholegrain bread, wholewheat pasta)
    • Olives and olive oil. Special category, single largest source of fat in the Mediterranean diet, but don’t overdo it.
    • Dairy products in moderation (usually hard cheeses, as these keep well)
    • Fish, in moderation. Typically grilled, baked, steamed even. Not fried.
    • Other meats as a rarer luxury in considerable moderation. There’s more than one reason prosciutto is so thinly sliced!

    Want to super-power this already super diet?

    Try: A Pesco-Mediterranean Diet With Intermittent Fasting: JACC Review Topic of the Week

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  • What Are The “Bright Lines” Of Bright Line Eating?

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    This is Dr. Susan Thompson. She’s a cognitive neuroscientist who has turned her hand to helping people to lose weight and maintain it at a lower level, using psychology to combat overeating. She is the founder of “Bright Line Eating”.

    We’ll say up front: it’s not without some controversy, and we’ll address that as we go, but we do believe the ideas are worth examining, and then we can apply them or not as befits our personal lives.

    What does she want us to know?

    Bright Line Eating’s general goal

    Dr. Thompson’s mission statement is to help people be “happy, thin, and free”.

    You will note that this presupposes thinness as desirable, and presumes it to be healthy, which frankly, it’s not for everyone. Indeed, for people over a certain age, having a BMI that’s slightly into the “overweight” category is a protective factor against mortality (which is partly a flaw of the BMI system, but is an interesting observation nonetheless):

    When BMI Doesn’t Quite Measure Up

    Nevertheless, Dr. Thompson makes the case for the three items (happy, thin, free) coming together, which means that any miserable or unhealthy thinness is not what the approach is valuing, since it is important for “thin” to be bookended by “happy” and “free”.

    What are these “bright lines”?

    Bright Line Eating comes with 4 rules:

    1. No flour (no, not even wholegrain flour; enjoy whole grains themselves yes, but flour, no)
    2. No sugar (and as a tag-along to this, no alcohol) (sugars naturally found in whole foods, e.g. the sugar in an apple if eating an apple, is ok, but other kinds are not, e.g. foods with apple juice concentrate as a sweetener; no “natural raw cane sugar” etc is not allowed either; despite the name, it certainly doesn’t grow on the plant like that)
    3. No snacking, just three meals per day(not even eating the ingredients while cooking—which also means no taste-testing while cooking)
    4. Weigh all your food (have fun in restaurants—but more seriously, the idea here is to plan each day’s 3 meals to deliver a healthy macronutrient balance and a capped calorie total).

    You may be thinking: “that sounds dismal, and not at all bright and cheerful, and certainly not happy and free”

    The name comes from the idea that these rules are lines that one does not cross. They are “bright” lines because they should be observed with a bright and cheery demeanour, for they are the rules that, Dr. Thompson says, will make you “happy, thin, and free”.

    You will note that this is completely in opposition to the expert opinion we hosted last week:

    What Flexible Dieting Really Means

    Dr. Thompson’s position on “freedom” is that Bright Line Eating is “very structured and takes a liberating stand against moderation”

    Which may sound a bit of an oxymoron—is she really saying that we are going to be made free from freedom?

    But there is some logic to it, and it’s about the freedom from having to make many food-related decisions at times when we’re likely to make bad ones:

    Where does the psychology come in?

    Dr. Thompson’s position is that willpower is a finite, expendable resource, and therefore we should use it judiciously.

    So, much like Steve Jobs famously wore the same clothes every day because he had enough decisions to make later in the day that he didn’t want unnecessary extra decisions to make… Bright Line Eating proposes that we make certain clear decisions up front about our eating, so then we don’t have to make so many decisions (and potentially the wrong decisions) later when hungry.

    You may be wondering: ”doesn’t sticking to what we decided still require willpower?”

    And… Potentially. But the key here is shutting down self-negotiation.

    Without clear lines drawn in advance, one must decide, “shall I have this cake or not?”, perhaps reflecting on the pros and cons, the context of the situation, the kind of day we’re having, how hungry we are, what else there is available to eat, what else we have eaten already, etc etc.

    In short, there are lots of opportunities to rationalize the decision to eat the cake.

    With clear lines drawn in advance, one must decide, “shall I have this cake or not?” and the answer is “no”.

    So while sticking to that pre-decided “no” still may require some willpower, it no longer comes with a slew of tempting opportunities to rationalize a “yes”.

    Which means a much greater success rate, both in adherence and outcomes. Here’s an 8-week interventional study and 2-year follow-up:

    Bright Line Eating | Research Publications

    Counterpoint: pick your own “bright lines”

    Dr. Thompson is very keen on her 4 rules that have worked for her and many people, but she recognizes that they may not be a perfect fit for everyone.

    So, it is possible to pick and choose our own “bright lines”; it is after all a dietary approach, not a religion. Here’s her response to someone who adopted the first 3 rules, but not the 4th:

    Bright Lines as Guidelines for Weight Loss

    The most important thing for Bright Line Eating, therefore, is perhaps the action of making clear decisions in advance and sticking to them, rather than seat-of-the-pantsing our diet, and with it, our health.

    Want to know more from Dr. Thompson?

    You might like her book, which we reviewed a while ago:

    Bright Line Eating – by Dr. Susan Peirce Thompson

    Enjoy!

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  • Procrastination, and how to pay off the to-do list debt

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    Procrastination, and how pay off the to-do list debt

    Sometimes we procrastinate because we feel overwhelmed by the mountain of things we are supposed to be doing. If you look at your to-do list and it shows 60 overdue items, it’s little wonder if you want to bury your head in the sand!

    “What difference does it make if I do one of these things now; I will still have 59 which feels as bad as having 60”

    So, treat it like you might a financial debt, and make a repayment plan. Now, instead of 60 overdue items today, you have 1/day for the next 60 days, or 2/day for the next 30 days, or 3/day for the next 20 days, etc. Obviously, you may need to work out whether some are greater temporal priorities and if so, bump those to the top of the list. But don’t sweat the minutiae; your list doesn’t have to be perfectly ordered, just broadly have more urgent things to the top and less urgent things to the bottom.

    Note: this repayment plan means having set repayment dates.

    Up front, sit down and assign each item a specific calendar date on which you will do that thing.

    This is not a deadline! It is your schedule. You’ll not try to do it sooner, and you won’t postpone it for later. You will just do that item on that date.

    A productivity app like ToDoist can help with this, but paper is fine too.

    What’s important here, psychologically, is that each day you’re looking not at 60 things and doing the top item; you’re just looking at today’s item (only!) and doing it.

    Debt Reduction/Cancellation

    Much like you might manage a financial debt, you can also look to see if any of your debts could be reduced or cancelled.

    We wrote previously about the “Getting Things Done” system. It’s a very good system if you want to do that; if not, no worries, but you might at least want to borrow this one idea….

    Sort your items into:

    Do / Defer / Delegate / Ditch

    • Do: if it can be done in under 2 minutes, do it now.
    • Defer: defer the item to a specific calendar date (per the repayment plan idea we just talked about)
    • Delegate: could this item be done by someone else? Get it off your plate if you reasonably can.
    • Ditch: sometimes, it’s ok to realize “you know what, this isn’t that important to me anymore” and scratch it from the list.

    As a last resort, consider declaring bankruptcy

    Towards the end of the dot-com boom, there was a fellow who unintentionally got his 5 minutes of viral fame for “declaring email bankruptcy”.

    Basically, he publicly declared that his email backlog had got so far out of hand that he would now not reply to emails from before the declaration.

    He pledged to keep on top of new emails only from that point onwards; a fresh start.

    We can’t comment on whether he then did, but if you need a fresh start, that can be one way to get it!

    In closing…

    Procrastination is not usually a matter of laziness, it’s usually a matter of overwhelm. Hopefully the above approach will help reframe things, and make things more manageable.

    Sometimes procrastination is a matter of perfectionism, and not starting on tasks because we worry we won’t do them well enough, and so we get stuck in a pseudo-preparation rut. If that’s the case, our previous main feature on perfectionism may help:

    Perfectionism, And How To Make Yours Work For You

    Don’t Forget…

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