Arizona’s mental health system continues to have problems, but it’s come a long way since the days when people with debilitating mental illnesses were left to fend for themselves in filthy boarding houses with no counseling, socialization or job training.

The impetus for change came from a landmark lawsuit known as Arnold vs. Sarn.

In 1981, Chick Arnold risked his job as the Maricopa County public fiduciary by suing his employer and the state of Arizona because people with mental illness were living deplorable lives. Not only was it wrong, Arnold knew it was against the law.

As public fiduciary, Arnold’s office acted as guardians or conservators for about 600 vulnerable adults, including a man named John Goss, a former New York City stockbroker who had developed schizophrenia in his 20s and was living in a single room in a dirty boarding house that he found so scary that he spent his days walking the streets of downtown Phoenix.

“He lived in a place called S&W Boarding home, which was notorious. It burned down three times. He was afraid to stay there,” Arnold said. “He didn’t have family, and so the court appointed the public fiduciary as his guardian.”

Arnold felt the state and county, per state law, were obligated to provide Goss with more support than he was getting, including a structured living situation, job training and counseling. Goss was the first plaintiff named in the lawsuit, which eventually turned into a class action.

“I balanced what I saw as my fiduciary responsibility with my employment responsibility, and that’s no contest — the fiduciary responsibility prevails,” Arnold said in a recent interview.

Arizona continually failed to care for people with mental illness

The supervisors fired Arnold over the now-historic Arnold vs. Sarn case (Sarn refers to Dr. James Sarn, who in was director of the Arizona Department of Health Services).

A judge ultimately ruled Arnold could have his job back, but Arnold soon quit anyway to work as a mental health lawyer, which was a job title unheard of at the time, he recalled. Arnold retired in 2020 after a career of helping patients and families of loved ones who were incapacitated by mental illness.

Arnold describes Arnold v. Sarn as having a “simple” premise of forcing the state to provide a comprehensive community mental health system to people with mental illness, which is required in state statute due to a law passed in 1979. Once the lawsuit got the public’s attention, the state didn’t have the “collective chutzpah” to take away rights, though officials did try to get the case dismissed, Arnold said.

“This guy (Goss) was walking the streets every day because there was nothing to do. What about the socialization program? What about the recreational program? What about the housing? All of that was set out in the statute, and it wasn’t being done,” Arnold said. “So that was the lawsuit, a very simple case.”

In 1986, a trial court ruled that the state and Maricopa County violated their statutory duty, and the Supreme Court affirmed the decision in 1989. The case ultimately stretched on for 33 years through seven different Arizona governors because of findings that the state continued to fall down on its job caring for people with serious mental illnesses.

An Office of the Court Monitor assigned to ensure the state reached compliance in its duties to people with mental illness did yearly audits of the Maricopa County mental health system that Arnold describes as “dreadful, year after year.”

After one scathing audit report, Maricopa County Superior Court Judge Bernard Dougherty in a 2004 minute entry called the mental health system “shocking” and “dysfunctional,” and said the audit showed “deplorable failure by the state and its agent/providers in meeting their commitments.”

Among the problems were poor patient care and problems with case management.

Another blistering audit in 2009 led Maricopa County Superior Court Judge Karen O’Connor to say Maricopa County’s mental health system was in crisis, Arizona Republic archives say.

A lack of housing is ‘shortsighted,’ Arnold says

The case was dismissed under Republican Gov. Jan Brewer, who has a family member with serious mental illness. The 2014 agreement to end the case included an agreement from the state to increase the number of Assertive Community Treatment, or ACT, teams, which are mobile teams of specialists who bring services like life skills, job help and medication to individuals with serious mental illness directly to wherever they are living.

The case technically was about Maricopa County because it grew out of the dysfunction in 1981 when it was filed. But as the case matured, its effects were statewide, Arnold said.

The settlement also included an agreement that the state would provide supported employment, permanent supportive housing and peer and family support services for people with serious mental illness. Arnold said he unsuccessfully fought to include more specifics on housing in the settlement agreement.

“What was lacking, and is still lacking through the mental health system, is effective housing. You can’t recover in the absence of having a safe and secure place to live,” Arnold said.

“That has never been addressed. … It’s impossible to get the benefits of a system in the absence of adequate housing. Shortsighted is the kindest way of describing it.”

The housing issue is extremely frustrating for Laurie Goldstein, who is vice president of the Phoenix-based Association for the Chronically Mentally Ill. Goldstein misses the days when the Arnold vs. Sarn case included a court monitor who could force the state to meet its obligations to people with mental illness.

“The court monitor was kind of the final judge. Now, there’s no one to go to,” Goldstein said.

As of June 30, 5,003 Arizonans were on a waiting list for permanent supportive housing through a program funded by the state general fund, and 4,674 of them were designated as having serious mental illness. The data comes from officials with the Arizona Health Care Cost Containment System, which administers the housing program but does not fund it.

Another problem with mental health in Arizona right now, Arnold said, is the way the state, via AHCCCS, contracts out all its mental health care to regional behavioral health authorities. The state ought to be directly providing that care itself, much the way Arizona’s Department of Developmental Disabilities does, he said.

“I believe the government has some inherent responsibilities, one of which is to provide health care, and we don’t do that,” Arnold said. “We contract out for it and that has been an issue that has stuck in my throat for 40 years … The case managers in the (Arizona) mental health system are employed by a private company that contracts with another company that contracts with the state.”

Emptying of psychiatric hospitals preceded Arnold vs. Sarn

Arnold vs. Sarn was in part a response to a nationwide problem.

People across the country who had been locked up in psychiatric facilities were released into communities with an aim of restoring their civil rights. But often they ended up like John Goss, who was a former resident of the state hospital and ended up living in the community, feeling lonely and without the support he needed.

“Part of the lawsuit’s energy was driven by the notion of stopping institutional care,” Arnold said. “His (Goss’) story was a typical story at the time. People were given acute care when needed, but then released into nothing. There was no system.”

In 1952, when Arizona’s population was about 842,000, there were nearly 2,800 patients in the Arizona State Hospital, which first opened in 1887 as the Insane Asylum of Arizona, then State Asylum for the Insane. It is the most restrictive facility in the state for people with serious mental illness.

While the state’s population has increased more than eightfold since 1952, the patient census at the Arizona State Hospital these days hovers around 316.

The drastic drop in psychiatric patients at the hospital that happened during the 1960s and 1970s was because of what’s known as “deinstitutionalization,” which took hold across the U.S. after the Community Mental Health Act of 1963. The act was signed by President John F. Kennedy one year after Ken Kesey published his novel “One Flew Over the Cuckoo’s Nest” and at a time when medication to treat mental illness was showing more effectiveness than in the past.

The deinstitutionalization left many patients such as Goss struggling and suffering. Goss did not live long enough to see the changes that came about as a result of Arnold vs. Sarn. According to Arizona Republic archives, he died in 1983 at age 41.

“I think he just gave up,” Arnold told the Republic in 1985. “He wasn’t a dumb man, but he had become a frustrated one. He knew he could do more.”

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes.

This article originally appeared on Arizona Republic: How Arnold v. Sam changed Arizona’s mental health system

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When we think of the best ways to reduce stress, we might picture activities such as exercise or meditation. But while these pursuits certainly work for some people, they aren’t the only techniques you can use to reduce stress.

Over the past couple of years, adult colouring books have also become a popular hobby for people looking to relax. Although the activity might be simple, our research has shown colouring really can be an effective way of reducing stress and improving wellbeing.

We’ve shown that colouring is an easy way to lower anxiety and reduce burnout – especially when combined with mindfulness practices.

Mindfulness is the deliberate practice of paying close attention to what’s happening in the present moment, without making judgements about any thoughts, emotions or distractions that happen.

Some people use meditation techniques during mindfulness to help them focus – such as concentrating on their breathing to help them stay in the present moment. The act of colouring can also work in a similar way by helping people stay focused on the present. So, we ran a series of studies to see if colouring mindfully could improve people’s wellbeing.

In one study, we investigated what effect colouring paired with mindfulness had on the wellbeing of university students. We divided 72 participants into two groups. One group received a colouring page and were told how to practice mindfulness while colouring.

Instructions included guidance on relaxing their body, focusing their attention on the task and sensation of colouring, and what to do if they found their mind was wandering. The other group simply coloured without any mindfulness guidance.

After the session, the group with mindfulness instructions reported feeling less anxious and more focused after colouring. The non-mindfulness group did not experience similar benefits. This suggests that using mindfulness while colouring can help to lower anxiety. However, some people didn’t like having instructions while colouring, which reduced the benefits of mindful colouring.

In another experiment, we investigated what effect using videos to teach mindful colouring had on 35 teachers from the UK. Participants were split into two groups. One group was given a daily mindful colouring activity for a total of five days. The other group continued with their working week as usual.

The teachers who practised mindful colouring reported feeling less stressed and more mindful and resilient. Learning how to colour mindfully before the activity may have helped participants to reap the best rewards from it.

Colouring may help reduce stress. (Jacob Lund/Canva Pro)

But a question that still remained after our research was whether mindful colouring offers similar benefits as traditional meditation practices. This is why we conducted another experiment, which compared colouring to meditation.

We looked at mindful colouring versus a specific type of meditation practice called loving-kindness meditation. Typically just used during meditation, this helps cultivate benevolence by focusing on sending good wishes or thoughts to yourself and others, and is shown to improve wellbeing and reduce stress.

We divided 180 participants into two groups. One group received a colouring page and were told how to practice loving-kindness colouring. The other group was taught how to practice loving-kindness meditation.

The results showed that colouring and meditating with loving-kindness helped people equally well to be more mindful and less anxious. This means that mindful colouring may work just as well as meditation in reducing anxiety.

Being mindful

Overall, our research shows that colouring can be a great way to relax and feel better – especially when combined with mindfulness. This may be because mindfulness reminds people to stay present in the moment and overcome feelings and thoughts that cause them stress.

Research in mindfulness indicates it can also have many other health benefits, including reducing pain and even insomnia. If you want to try mindful colouring yourself, start by finding a quiet and comfortable place where you can focus without distractions.

Choose your materials wisely. Having too many colours may be distracting. Abstract colouring pages can be more useful in allowing you to focus on the activity, rather than choosing logical colours for objects – such as trees or eyes.

While you’re colouring, observe your thoughts. If they wander off, or any other thoughts or feelings come up, simply let them go. Refocus on the colours transferring onto the page or your hand movements. It’s all about being present, so every time your mind wanders off, let it go and refocus on colouring.

If colouring isn’t your thing, research shows that mindfulness can be used alongside a range of other activities and still confer wellbeing and mental health benefits.

For example, drawing can help people to manage their anxiety, as can knitting. Even mindfully doing simple chores such as washing the dishes can be effective. Walking can also help to reduce stress.

Whatever activity you choose, no matter how simple, can still have a positive effect on wellbeing if you focus on being in the moment.

Michael Mantzios, Professor of Applied and Experimental Psychology, Birmingham City University and Kyriaki Giannou, Lecturer in Applied Psychology, Birmingham City University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Ukraine’s First Lady Olena Zelenska heads the country’s mental health campaign, called How Are You? She says the country is still overcoming the legacy of the Soviet era, when the government sometimes said dissidents had ‘psychiatric problems’ and locked them in mental institutions. She’s shown here meeting with students in Paris last December.

Julien de Rosa/AP

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Ukraine’s First Lady Olena Zelenska heads the country’s mental health campaign, called How Are You? She says the country is still overcoming the legacy of the Soviet era, when the government sometimes said dissidents had ‘psychiatric problems’ and locked them in mental institutions. She’s shown here meeting with students in Paris last December.

Julien de Rosa/AP

KYIV, Ukraine — How are you?

In Ukraine, this question is much more than a casual conversation starter. It’s an invitation to express how you’re coping with the war.

“This question becomes like a form of love, an act of love. We ask because we understand that it’s a part of our inner therapy,” said art historian Halyna Hleba.

Hleba is one of the curators of a large art exhibit — called How Are You? — featuring scores of works created by Ukrainians since Russia launched its full-scale invasion 18 months ago.

The paintings, sketches, sculpture and video are on display at Ukrainian House, a sprawling cultural center in Kyiv. The exhibit goes well beyond art, trying to get visitors thinking — and talking — about their mental health.

Hleba wrote the words stenciled onto the wall at the beginning of the exhibit, which fills the five-story center.

“We have changed and adapted to the realities of the war,” Hleba wrote. “Psychologists say it is required to accept the current reality of war because remaining in constant tension and states of shock and stress is counterproductive in the long run.”

A painting by a Ukrainian artist depicts the war at an exhibition at Ukrainian House, a cultural center in Kyiv. The exhibit features works produced since the full-scale Russian invasion last year, and is part of a larger effort to encourage Ukrainians to discuss mental health issues.

Kateryna Malofieieva/NPR

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A painting by a Ukrainian artist depicts the war at an exhibition at Ukrainian House, a cultural center in Kyiv. The exhibit features works produced since the full-scale Russian invasion last year, and is part of a larger effort to encourage Ukrainians to discuss mental health issues.

Kateryna Malofieieva/NPR

Ukraine can calculate the agony of war in many ways: lives lost, homes destroyed, families turned into refugees.

Yet there’s also trauma that’s harder to measure — this collective mental health crisis the war has inflicted. Men and women, young and old, soldiers and civilians are all trying to cope.

Ukraine’s First Lady leads the campaign

The wife of President Volodymyr Zelenskyy, Olena Zelenska, leads this national How Are You? campaign.

In a recent podcast, she said, “I am very pleased with the words and the tone of this program — kindly and friendly. It’s not a paternalistic approach.”

A painting at the ‘How Are You?’ art exhibit in Kyiv. The cell phone depicts an air raid alert that Ukrainians receive when a Russian air strike is underway. The background shows a famous World War II photo of Soviet troops capturing Berlin.

Greg Myre/NPR

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A painting at the ‘How Are You?’ art exhibit in Kyiv. The cell phone depicts an air raid alert that Ukrainians receive when a Russian air strike is underway. The background shows a famous World War II photo of Soviet troops capturing Berlin.

Greg Myre/NPR

She notes some Ukrainians, particularly the older generation, are still wary of raising mental health issues. This can be traced directly to the Soviet era, when the government often claimed political dissidents had “psychiatric problems” and locked them up in mental institutions.

“This fear still exists,” she said. “But people need to understand that it is no longer the case. It’s different now. That’s why we need to inform people, and help them understand about mental health care. It’s not scary.”

More Ukrainians are seeking help, said psychologist Oksana Korolovych, adding that many therapists like herself are being overwhelmed with requests for treatment.

For Korolovych, the war’s trauma is personal. She lost her husband to a Russian missile strike last year, just days after he joined the military.

“Ukrainians have been living in a permanent state of bereavement for the past 18 months,” she said. “When I was experiencing bereavement, I lived through the experience with other widows who also lost their husbands.”

She’s also been surprised by some of the responses she’s received from patients.

Anecdotally, she says, more married patients are now coming to her saying they want a divorce.

Also, some Ukrainians have been emboldened by the way the country has responded to the Russian invasion. In some cases, they’ve shaken off past feelings of helplessness.

“We are learning how to get out of this position as a victim. We are learning how to ask for help,” she said.

An online test for anxiety and depression

A recently formed Ukrainian company, Anima, is trying to nudge this process forward.

Nueroscientist Sergiy Danylov (left) and Roman Havrysh are co-founders of Anima, a company that has developed an online test designed to screen for signs anxiety or depression. They say the test can be used by civilians or members of the military, and is already being used by some military psychologists.

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Nueroscientist Sergiy Danylov (left) and Roman Havrysh are co-founders of Anima, a company that has developed an online test designed to screen for signs anxiety or depression. They say the test can be used by civilians or members of the military, and is already being used by some military psychologists.

Greg Myre/NPR

“I just wanted to bring it to the wider public and to diagnose depression and anxiety as widespread problems,” said Roman Havrysh, one of the co-founders.

Havrysh and his business partner, neuroscientist Sergiy Danylov, have created a rapid online test for screening both civilians or soldiers.

The person sits in front of a computer as images appear in rapid succession, two at a time, side by side.

One image is mundane — an empty chair or a desk. The other is graphic and often disturbing — a malnourished child, a dead body on the battlefield, a cobra about to strike.

The sharply contrasting images appear for just a second, and are then replaced by two more. By measuring eye movements to the millisecond, the test seeks to determine a person’s unguarded reaction.

“You can’t lie with your eyeball,” said Havrysh. “We track it. We have those tiny, millisecond windows where you don’t control, consciously, your eye, and we track it.”

There’s also a multiple choice questionnaire. The visual test and the questionnaire each provide a score from zero to 100. They say the higher the scores, the more likely a person may have anxiety or depression.

The founders emphasize this is not a diagnosis. They compare it to a blood pressure monitor you might use at home. If you consistently get high readings, you may want to seek treatment.

“People can Google us easily and come to the platform and test themselves,” Havrysh said. “We also distribute it through military psychologists and hospitals working with military personnel to help them diagnose incoming patients.”

In one battalion, the test has been used for several months to help screen troops. During this time, 40 of the 600 soldiers were temporarily taken out of combat roles.

Most returned after several days, though a few were reassigned to non-combat positions.

Danylov, the neuroscientist, said troops need an elevated level of vigilance while in combat. However, he added, “You can’t be in this state of hypervigilance for a long time.”

Troops who remain in combat for too long become vulnerable to an anxiety disorder, he said.

“When they return home, two or three months later they may start having panic attacks,” he said.

A range of approaches

The military is also organizing peer-to-peer discussions among troops after they go through a combat rotation.

“If we have a quite intensive battle, we understand that we need to have a decompression, or debriefing, for our soldiers,” said Dr. Vladyslav Syniagovskyi, a military psychiatrist.

“Inside of this group, we are discussing the most traumatic events during battle, he added. “We found a lot that is very useful for mental health. It’s a first step for treatment and for healing.”

He says preliminary data suggests perhaps 15 percent of Ukrainian troops suffer from Post-Traumatic Stress — a figure roughly in line with studies of U.S. troops who served in Iraq and Afghanistan.

Oksana Korolovych, the psychologist, believes the figure is even higher for Ukraine’s civilians. But she also sees some encouraging changes as the war grinds on.

“Last year, people were asking how to live through the war. Now people ask about how to live after the war. We already have a sense of victory in our consciousness,” said Korolovych.

Ukrainians, she said, are learning “how to defend borders. They’re defending physical borders on the front-line of the war, and defending personal borders in their own lives.”

Kateryna Malofieieva contributed to this report.

Greg Myre is an NPR national security correspondent. Follow him @gregmyre1.

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‘Think of two names in your diary today, and just pick up the phone to them. Call them to say hello and make them feel visible.’ (Photo: Other)

Sometimes, we sadly observe the unfairness in how certain sections of our society are marginalised. At times it is simply unconscious whereas, there are occasions where it is pure disregard.

I would love to hear more from the readers on the issues that are affecting them that warrant greater attention.

This week the issue that got under my skin is that of loneliness. I promised myself, I will steer clear of politics but the government is not paying attention to a looming epidemic, that is loneliness in different sections of our population. Covid-19 and ‘social distancing’ is just one example of factors that have exacerbated this problem.

If you put a post-it note on the wall to say, I must stretch today, every day you look at it but in time it just becomes part of the wall. Just like that we have become desensitised. I question are we doing enough to combat the causes, and provide support to those who need it the most?

The late MP for Batley and Spen, Jo Cox, noticed while on her rounds she was knocking on many doors which were rarely opened. That was in 2015. Many people whose votes were sought were in fact desperately isolated.

Loneliness does not just affect our elderly, even young students or single people feel it.

According to Age UK, 1.4 million older people in this country are often lonely. In this group there are many contributing factors that make this worse. I mentioned the pandemic and whoever invented the term ‘social isolation’ failed to see the obvious.

The factors that make loneliness worse in our elderly include the fear of falling. Fear of navigating public transport or getting into a taxi where the driver is not known.

AI is assumed to be for everyone, but how much of the AI out there is geared towards empowering the elderly? I remember getting my dad a mobile phone with big buttons, that was good, but how about the font on the iPad? Things have improved but an older person needs someone to show them how to use technology in the way it feels easy to them.

Story continues

So, what does help? As a mindset and leadership coach, I look at strategies for self- care and self-help.

Local neighbourhood networks are a fantastic solution to helping older people go somewhere warm where they will be welcomed with a cup of tea and more importantly provide them some company. In Leeds alone we have 37 such networks.

Smile regardless. This really helps to re-energise the happy hormones.

Invite friends over for tea.

Dance, I remember in the early days of my grief I used to dance clutching my dad’s photo to one of my favourite songs. Crazy, I know, but movement of any kind gets the energy flowing to lift our mood.

Visit the local library, we are fortunate to still have free libraries in our city. These places are warm with friendly staff. It can be comforting to go somewhere where you can read and see other people.

If you have someone who can, get them to teach you to use Zoom and Facetime to connect with your friends and family.

Volunteer with a local charity or the Church- helping others can make us feel less invisible, and engagement makes us feel valued.

Young people, the Generation Z, age 18-22, reported feeling loneliness according to a study by Cigna, and 71 per cent feeling lonely at times in a survey done by YouGov. Having nobody to turn to can lead to depression and poor mental health.

Debilitating long-term illness or disability can also compound a sense of loneliness. We all have physical health and we all have mental health. A feeling of loneliness is not age specific but by raising awareness we can all take responsibility for doing what we can to help others around us feel less lonely. Surely, that is within everyone’s gift, even mine. Ten minute GP appointments are unhelpful as often the only person you can turn to, to share how you are feeling is your GP. Stipulating that they can only talk about one ailment at a time means patients are deprived of asking for help.

My biggest bugbear is the rise in supermarkets of self-service checkouts. Good for improving profit margins but do supermarket owners appreciate their community responsibility? Checkout staff do more than just serve the customer, often they are the only person with whom the customer might speak to in that week.

The responsibility to reduce loneliness is not something we can outsource, we must own the problem and play our part to truly appreciate what is an avoidable epidemic.

If you take nothing else from this piece, think of two names in your diary today, and just pick up the phone to them. Call them to say hello and make them feel visible.

Daxa Patel is a solicitor, author and executive coach.

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Learn more about all the fun panels and special guests we have planned—then buy your ticket to join us in California this October!

Our second annual REAL SIMPLE Weekend is almost here! The event, taking place from Oct. 19-22, 2023, is an opportunity to relax, explore the beautiful seaside village of La Jolla, Calif., and meet and mingle with our editors and special guests.

Our editors will be moderating a variety of panels—on topics including mindfulness, decorating with color, beauty tips, and cooking inspiration—with expert panelists lending their insight. Basically, the weekend will include all kinds of discussions about unique ways to enjoy and simplify life—that’s kind of our brand, after all. In between the panels, there will be no shortage of relaxation and sight-seeing opportunities, guided by our gracious hosts at The Estancia La Jolla Hotel & Spa.

We’d love for you to join us in California this October for a fun-filled weekend. Buy your ticket here and learn more about the informative panels and special guests below.

Panel: Finding the Magic in the Mundane

What happens when you approach every day with mindfulness? This panel discusses the importance of little rituals and how to create them, along with tips on teaching your brain to go positive.

Moderator: Lisa Friedman

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Source: Priscilla Du Preez/ Unsplash

When I started doing keynote talks a decade ago, my confidence wasn’t a problem. I loved presenting and I was passionate about the ideas I was sharing. I was committed to helping the audience with what I taught them and I wholeheartedly believed in everything I taught.

Over time, as my business grew and evolved, so did my clientele and audience size. I found myself working with well-known brands and speaking to audiences of over 1,000 people. I even got invited to deliver a talk on television. This is when things got a little nerve-wracking and I knew my confidence needed a boost.

Questions of self-doubt tried to cloud my mind: Who am I to share anything useful? Why should they listen to me? Why did I sign up for this? Even though there was no truth in them, they felt real.

Yet, nothing had changed except my clientele and the number of ears listening to me. I had the same insights I’d had before and I actually had even more experience. I really had no logical reason to doubt myself, but I did. Why? Because they were new challenges.

Being a positive psychology practitioner, I dived into the array of tools I was already familiar with. I also went looking for more. I tried and tested many to find a series of confidence-building exercises that worked without fail. Now, whenever I feel nervous, I put them to good use. I encourage you to do the same.

These steps can build your confidence in various situations: professional or personal. They can help you feel calmer and more focused when delivering a presentation, doing a job interview, or approaching a new task that scares you. They can help you before a first date, a new class at the gym, or meeting the in-laws for the first time.

They will move you from simply surviving to thriving, enabling you to perform better and even enjoy overcoming the challenge you’re faced with.

Whatever the challenge is, these steps will help you approach it feeling empowered, confident, and calm.

1. Take it step by step.

Take the tiniest step you can to move forward in facing the challenge. Then take another one. Make each step as tiny and easy as possible so taking them won’t be so daunting and you’re guaranteed to succeed. With each step, you will feel more confident than with the previous one. Before you know it, you’ll have flown past the challenge with success.

2. Remind yourself of your why.

Why are you in the situation you are in? What is driving you? What is your motivation for being there? Maybe you’re passionate about the message you’re about to share or excited about being interviewed for your dream job. Perhaps you know that what you’re doing will help others and people are counting on you to get it done. Maybe it gets you one step closer to your long-term goal, whatever it may be. Whatever your why is, remind yourself of it, because it will motivate you through any moments of doubt and make you even more passionate about the performance you’re about to give.

3. Think of your past successes.

Identify situations in your past when you have succeeded under stress or pressure. It’s easy to forget how much you’ve already overcome, and hindsight can help you realize how much you’ve already grown. Remind yourself of when you were nervous about doing something, did it, and succeeded. Trust that the world only offers you situations you are ready for, and trust in yourself and your abilities to overcome them.

4. Practice positive self-affirmations.

By telling yourself that you are confident and brave, you will feel more confident and brave. The more you engage in positive talk with yourself, the more you build yourself up and reinforce the neural pathways in your brain that fuel your confidence. Here are some examples of affirmations you can say to yourself:

• I choose to believe I am confident.
• I believe in my abilities.
• I value my strengths and use them well.

5. Ignore the naysayers and surround yourself with the yaysayers.

Unfortunately, you will sometimes have pessimistic people around you. They might tell you that you can’t do something, that you’re not capable, or that you need more experience. Ignore them. You have every right to go for it and you absolutely can. Even if you don’t succeed, you will learn heaps, which will make you more likely to succeed the next time. If you can, surround yourself with a cheerleading team of positivity who will help you to aim high and go for it.

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CNN
 — 

Compulsive nail-biting, skin-picking, hairpulling, and lip- and cheek-biting are among a range of body-focused repetitive behaviors, or BFRBs, that can become a source of distress, but new research may offer hope for relief.

While many people may have one of these habits in a minor form, for a smaller but still significant number of people the behavior can cause visual skin damage — such as bald patches, scars, sores and lesions — and affect their mental health, said Steffen Moritz, head of clinical neuropsychology in the department of psychiatry and psychotherapy at the University Medical Center Hamburg-Eppendorf in Germany.

“Actually most people show one of these habits over their life span, especially nail-biting, to some degree, but all can become problematic when done excessively,” said Moritz, who is a former nail-biter.

“And a lot of these people also have (coexisting) problems, often as a consequence, because they are ashamed of their behavior,” he said. “They avoid intimacy, especially in trichotillomania (pulling out body hair) or in skin-picking, like not taking clothes off in front of their partner for example.”