How to Deal With Stress and Anxiety During Challenging Times

Life can get messy, and it’s natural to feel stressed out and anxious. Thankfully, there are many things you can do to alleviate those unsettling feelings.

“You might feel a sense of anxiety, dread, uncertainty, disillusionment, or a little bit of fear—all of those things make sense in times of stress, and all of those feelings are within the range of normal emotions,” says Jonathan DePierro, PhD, Associate Director of the Center for Stress, Resilience, and Personal Growth at Mount Sinai, which provides services that support the resilience and mental health of health care workers, first responders, and the general public.

Actions that help you feel better do not have to be big undertakings—you can begin with something as simple as a breathing exercise, says Dr. DePierro, who is also Associate Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai.

For those who might feel overwhelmed when the going gets tough, Dr. DePierro shares some pointers on getting past those hurdles and being resilient.

First things first: Have self-compassion

Sometimes people kick themselves or blame themselves for having certain reactions, but those reactions make sense, and it is OK to be in those states.

“For example, today I am not feeling my best, and I may not feel my best tomorrow. I may not even feel my best next week,” says Dr. DePierro, “but cutting yourself a break and not expecting the best out of yourself or out of the people around you during trying times is a good way to start.”

It is important to take time to acknowledge and engage your feelings. Avoiding them isn’t going to make you feel better, he adds.

Jonathan Depierro, PhD, Associate Director of the Center for Stress, Resilience and Personal Growth, and Associate Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai.

Don’t avoid doing things

Sometimes, when people get really stressed, they stop doing the things that make them feel less stressed because they don’t have the energy and don’t feel like it anymore, says Dr. DePierro.

“That is not great, because it cuts off that source of stress relief,” he notes. If you have routines to destress, like yoga, exercise, spiritual practices, hobbies, or hanging out with friends, it is even more important to do those things when you’re feeling demotivated.

“If you catch yourself not wanting to do them, do them anyway,” he says.

Not all relief has to involve big gestures—some can be quick and accessible, such as breathing exercises. A simple thing to try is “box breathing,” which involves taking a deep breath for four seconds, holding it in for four seconds, exhaling for four seconds, and then pausing for another four.

“The idea is that this can function as a reset button to our fight-or-flight response,” says Dr. DePierro. “This reminds your body that in this moment, you are safe. You might not know what will happen in the next week or 10 years from now, but right at this moment, you can remind yourself through changing your physiology that you are safe.”

Helping your friends helps yourself

Putting calendar reminders or alarms to do joyful things can be helpful, but so is telling a friend about your action plan.

“You might tell a friend, ‘Hey, I’m going to get on the bike at 2 pm, can I call you while I’m on the bike? Or can we do it together, either next to each other or virtually?’ and that can be really meaningful,” says Dr. DePierro. If both individuals are struggling, having each other for accountability helps pick both of you up.

You can start that by checking in on your friends, especially if you feel they might be going through similar stressors.

“It could be an unhappy face or waving hand emoji, and that initiates a conversation,” says Dr. DePierro. “It doesn’t have to be something elaborate.”

It requires a little bit of bravery and vulnerability to tell somebody you trust that you are suffering and not doing well, but if you do, they can try to understand what’s going on with you and support you, he adds.

Checking in on your friends is good for your friends, but it’s also good for you. Acting altruistically and offering support activates the positive emotion centers of our brain, notes Dr. DePierro. Sometimes, when people go through difficult times, they lose their sense of meaning and purpose, but it’s really important to recommit to one’s core values, and to align daily actions, even in very tiny ways, to those core values.

Use tools to place limits

It is very easy to “doomscroll” and be caught in a loop of negative news through social media and the internet.

There aren’t a lot of guardrails on some of these platforms, and strong emotions, misinformation, and conflicting information can come through unfiltered and unmoderated. “These can trigger a fight-or-flight response, enough to make the heart race and incite feelings of nausea or being tense,” says Dr. DePierro. These are not helpful states to be in, especially right before bed.

If you have to check the news or social media, don’t do it right before sleeping, and especially not while in bed, he points out. These can impact your quality of sleep.

Setting screen time limits can help too—just as a parent might set them for kids, adults can benefit from them, and nowadays there are built-in tools and applications that can help.

Part of why doomscrolling is bad is that the act is without intention and becomes a negative feedback loop, where the bad thing reinforces the bad. “It’s easy to keep scrolling and only see nothing good,” says Dr. DePierro. “In those instances, I might suggest a ‘palate cleanser’ instead on those platforms. Is there something you can watch that makes you feel good? Videos of puppies, perhaps? Or something inspiring.”

Being intentional about finding content that gives a sense of joy helps break the cycle of doomscrolling. Flagging, bookmarking, and favoriting those uplifting pieces of content so you can always return to them is helpful. “Think of it as a virtual shoebox of things that make you feel good, which you can use,” he adds.

Learn when to seek professional help

If the feelings of unease and anxiety persist for weeks or even months, or especially if they disrupt your daily life, it might be time to seek professional help. This could include a primary care provider or a therapist.

It’s important to note that a singular feeling, while distressing, does not necessarily indicate a psychiatric disorder. “Just feeling sad alone does not make a depressive episode, or having a bad memory does not make post-traumatic stress disorder,” says Dr. DePierro. It usually has to be a cluster of symptoms occurring over weeks to months for it to be considered a mental health disorder, and this is where professional help can make that determination, he says.

How Can I Protect My Eyes From Diabetic Macular Edema?

Beyond causing elevated levels of blood sugar, diabetes can cause other serious complications, including poor vision or blindness. The leading cause of blindness in the working population in the United States, diabetic macular edema (DME) can cause an inability to read, drive, and perform daily activities. According to the Centers for Disease Control and Prevention, diabetic macular edema can affect up to 28 percent of people diagnosed with diabetes.

Nazanin Barzideh, MD, FACS, FASRS

In this Q&A, Nazanin Barzideh, MD, FACS, FASRS, ophthalmologist and retina specialist at New York Eye and Ear Infirmary of Mount Sinai at Mount Sinai Doctors-Carle Place, and Assistant Professor of Ophthalmology, Icahn School of Medicine at Mount Sinai, explains what diabetic macular edema is, signs and symptoms to look out for, and why it’s important to get diagnosed and be treated early.

What is Diabetic Macular Edema?

DME is the most common cause of vision loss in people with diabetic retinopathy. Diabetic macular edema is due to leakage of fluid and accumulation in the macula (or the central area that is responsible for fine detail vision) from vascular damage due to diabetic damage. As fluid collects in this nerve tissue, it causes swelling and disrupts anatomy of the fovea. The macula is the central part in the retina that is in the back of the eye and where vision is the sharpest. Typically, vision loss from DME develops over time as the disease becomes more advanced, and makes it impossible to focus clearly.

What are signs of DME?

It’s important to know that DME may cause a spectrum of changes from mild blurry vision to significant vision loss, and it can affect daily functions such as reading, writing, and driving.

Some common symptoms include:

  • Blurry or distorted vision
  • Blind spots
  • Squinting
  • Double vision
  • Floaters
  • Colors appear dull or grayish
  • Difficulty reading, driving, or doing other activities
  • Difficulty seeing when there is bright light or a glare
  • Trouble with recognizing faces or objects

How is DME diagnosed?

Diagnostic tests ensure an accurate assessment of DME and may include the following:

  • Comprehensive dilated eye exam.
  • Fluorescein angiography (FA): A diagnostic imaging technique where a dye is injected to identify abnormalities in the retinal blood vessels.
  • Optical coherence tomography (OCT): A non-invasive imaging technique that shows cross-sectional images of the retina, helping to detect inflammation and fluid accumulation in the macula.
  • Optic coherence tomography angiogram (OCTA): A non-invasive imaging technique that maps out and identifies retinal vascular abnormalities without using a dye.

Why is it important to get diagnosed and treated early?

Early detection of and prompt intervention in DME are essential to preserve vision in diabetic patients. The sooner a diagnosis can be made, the sooner a personalized treatment plan can be put in place to take care of the eyes and manage DME so it doesn’t progress to more advanced stages.

It’s also important to understand that eye conditions related to diabetes like retinopathy and macular edema are impacted by the longevity of the elevated blood sugar levels. The highs and lows through time really affect long-term prognosis, which is why it’s critical to control glucose levels from the day of diagnosis and to maintain that control throughout the years.

How is DME treated?

  • Control blood sugar levels on a regular basis.
  • Eye drops in some cases.
  • Anti-VEGF, a group of medications known as vascular endothelial growth factor treatments, that block the hormone VEGF, which can cause abnormal blood vessel growth in the eyes. They are injected directly into the back of the eye.
  • Corticosteroids that reduce inflammation and fluid leakage, and help to improve and sustain vision and slow down the disease progression.
  • Laser therapy where a focused laser beam is used to seal blood vessels in the eyes to stop fluid leakage that leads to DME.

How can we prevent DME and protect vision?

  • Get a comprehensive dilated eye exam yearly at minimum, or as directed by your ophthalmologist or retina specialist.
  • Control diabetes and maintain good blood sugar, blood pressure, and cholesterol levels, monitoring them regularly.
  • Manage other conditions associated with diabetes like heart disease, kidney disease, and obesity, for example.
  • Stay active, exercise regularly, eat healthily, drink plenty of water, and maintain a healthy lifestyle.

Please call 516-408-4900 to schedule an appointment.

Exercise May Give Your Immune System a Boost

Vaccines and nutrition strengthen your immunity to viruses and other harmful pathogens—exercise may give it an even bigger boost. In this Q&A, Christine Schindler, MD, Assistant Professor of Medicine (General Internal Medicine), Icahn School of Medicine at Mount Sinai, explains why exercise likely helps strengthen the immune system and how much you need to reap the benefits.

How does exercise strengthen my immune system?
Exercise causes useful inflammatory responses in the immune system. With moderate exercise, these inflammatory effects can strengthen the immune system. Short bursts of high-intensity exercise are also quite beneficial to your health. One note of caution: According to research, more than 90 minutes of high intensity exercise in a single session is probably bad for your immune system. However, few people exercise at high intensity for that long.

What qualifies as moderate versus high intensity exercise?
A power walk or slow bike ride qualify as moderate intensity. You’re a little out of breath, but not too winded; you can speak in full sentences but not sing. High intensity exercise includes more vigorous activities like running, jumping rope, and tennis—you are getting your heart rate up, working up a real sweat, and are too out of breath to have a conversation.

Can exercise boost vaccine efficiency and reduce the risk of severe illness, especially in older adults?
The most recent studies suggest that exercise does boost vaccine efficacy for people of all ages. One study looked at people who got the flu and COVID-19 vaccines, then performed light to moderate intensity exercise for 90 minutes. About a month later, there was still a higher antibody response to those vaccines. In other studies, the immune response to the flu vaccine was found to be more robust in people who exercised regularly. In older adults, studies suggest that exercise leads to a longer antibody response that may offer more protection throughout the flu season.

These results are promising but not the last word, since researchers are also studying the effects of metrics such as age, gender, and the effect of daily exercise routines. However, the most probable answer is that moderate intensity exercise is beneficial for vaccine response. Exercising the day you get the vaccine also likely has some benefit.

How much, and how often, do I need to exercise to strengthen my immune system?
There is no specific number. Generally, the recommendation for all adults is to get 150 minutes of moderate intensity exercise a week, or 30 minutes a day, five days a week. Or get around 75 minutes of vigorous activity, or 15 minutes a day, five days a week. Strength training at least twice per week is also beneficial. There is evidence that walking 6,000 to 8,000 steps per day has positive health effects. In terms of benefits for your immune system, a power walk is going to be more effective.

What types of exercises do you recommend, especially for someone older or with mobility issues?
It’s important for older adults to walk if they can. Walking amongst nature decreases stress hormone levels and blood pressure and is beneficial for mental health. Joining a walking or exercise group can be very motivating. Senior centers and places like the YMCA often have exercise classes for older adults. It’s beneficial to work out in groups, whether walking around with friends, or going to a class. The team mentality helps people stay motivated. Regardless of your age, if you are new to exercise, it’s best to start slowly.

If you struggle with mobility, there are good beginner YouTube videos that show different ways to exercise: exercises you can do from the chair and exercises you can do in a small apartment space or without exercise equipment, such as using cans of beans instead of weights.

How can I get more exercise without joining a gym?
There are easy ways to incorporate exercise into your daily routine without a gym membership. For example, if you are a commuter, you can walk for part of your commute instead of taking the bus, and you can take the stairs at work instead of the elevator. If you don’t live in a neighborhood where you feel safe or the weather is bad, try walking up and down the stairs of your building or walk in a mall. Get creative with strategies that work for you and your schedule.

Learn About the First Flu Vaccine You Can Administer Yourself

On Friday, September 20, 2024, the U.S. Food and Drug Administration (FDA) approved FluMist®, a nasal spray flu vaccine that you can give to yourself or a loved one easily. This means you will be able to get a flu vaccine without going to a health care professional for a shot.

While FluMist has been available since 2003, until now it could only be given by a health care professional, such as a doctor or nurse, in a health care setting, such as a pharmacy or clinic. Being able to take a flu vaccine in the comfort of one’s home is a good thing, says Waleed Javaid, MD, Director of Infection Prevention and Control at Mount Sinai Downtown. FluMist is anticipated to be available for patients to use themselves for the 2025-2026 flu season.

“I have given FluMist to my children in the past and they’re happy not to be injected,” says Dr. Javaid. “Now, with the option to take the vaccine at one’s convenience, I can imagine this will help more people stay on top of their flu vaccines—I’ve heard from so many friends and even family members, ‘I’m too busy to get my flu shots.’”

Curious to know more about the FluMist vaccine? Dr. Javaid shares his thoughts.

What is the FluMist vaccine?

The FluMist vaccine has been available for quite some time now. Its main difference from the injected flu vaccines, however, is that it uses a live, attenuated—meaning weakened—virus to generate an immune response for protection against the flu. This is in contrast to the injectables that use inactivated (dead) viruses or proteins from a flu virus.

Who might be suitable or unsuitable to use attenuated flu vaccines?

There are certain populations we might consider unsuitable for a live, attenuated vaccine—primarily people who are immunocompromised, or those who might be on immunosuppressing therapy, such as chemotherapy. In those cases, we might recommend them to use inactivated flu vaccines instead.

Otherwise, FluMist is suitable for children and adults. This might be especially helpful for people who have mobility issues and are unable to go into a clinic, or even in a school setting where a non-health care professional could administer the vaccine.

The convenience of being able to pick up the vaccine at a place and time of your choosing is a really big advantage. So often have I heard from patients, family members, and friends about how they’ve skipped their flu shots because they’re too busy to make an appointment and go into the clinic or pharmacy for them.

Waleed Javaid, MD, Director of Infection Prevention and Control at Mount Sinai Downtown, and Professor of Medicine at the Icahn School of Medicine at Mount Sinai.

Fast facts about FluMist

  • Initially approved in 2003 for use in individuals ages 5 to 49. In 2007, approved to include children ages two to five. In 2024, approved for self-administration or by a caregiver.
  • Home delivery of FluMist is anticipated to be available for the 2025-2026 flu season.
  • Quadrivalent flu vaccine that protects against four strains of influenza A and B viruses.
  • For individuals ages 2 to 17, the FDA states that a caregiver should administer the vaccine. People ages 18 and older may self-administer the vaccine.

Can I get the flu from a vaccine like FluMist?

While people may experience side effects that are similar to symptoms of the flu, neither the attenuated nor the inactivated flu vaccine can give you the flu.

Side effects from using FluMist can include fevers and chills, runny nose and nasal congestion, and sore throat. In those situations, having plenty of rest, drinking plenty of water, and taking fever and pain medication where necessary are helpful.

How can I get the FluMist vaccine?

The vaccine currently requires a prescription, so this is not something you can just get over the counter. I imagine one could call their doctor’s office for the prescription, and with the availability of telehealth visits, getting in touch with a primary care provider is easier than ever.

The FluMist manufacturers have also set up a website to screen whether an individual is eligible for the nasal spray vaccine. If the system deems the vaccine recipient eligible based on the completed screening, a third-party writes the prescription and ships the vaccine to the provided address.

Is there anything we can expect about the upcoming flu season?

It might be a bit early to say in terms of severity. But with less masking and more relaxed rules of distancing, a flu virus can spread more easily. Thus it’s important to stay on top of your flu vaccines. Make sure you isolate yourself from others if you have cold- or flu-like symptoms, and consider masking if necessary to prevent spread of respiratory illnesses.

Is FluMist effective?

Ever since FluMist was reformulated in 2018 and added back to the Centers for Disease Control and Prevention’s (CDC) list of recommended flu vaccines, studies tracking the effectiveness of live, attenuated influenza vaccines such as FluMist have shown results similar to those of injectable, inactivated vaccines. It is important to note that the numbers are not from head-to-head comparison studies, and the CDC does not recommend one flu vaccine over another.

Effectiveness of various influenza vaccines
Flu season Live attenuated influenza vaccine Inactivated influenza vaccine
2018-2019 49% 7-48%
2019-2020 45-66% 34-52%
2021-2022 51-72% 13-51%
2022-2023 61-77% 71%

Source: FluMist Health Care Professionals page

What You Need to Know About Participating in Autism Research at Mount Sinai


Clinical research is critical to advance our understanding of the causes of neurodevelopmental disorders and to develop effective treatments. The Seaver Autism Center for Research and Treatment at Mount Sinai maintains an active clinical research portfolio with a variety of recruiting studies at any given time.

Individuals on the autism spectrum as well as those with certain related genetic syndromes may be eligible to participate. The Seaver Center’s Rare Disease Program studies Phelan-McDermid syndrome, ADNP syndrome, FOXP1 syndrome, and DDX3X syndrome. Areas of focus include biomarker discovery, natural history studies, and clinical trials.

In addition to valuable contributions to science, the Seaver Center team works hard to ensure study participation is an enjoyable and low stress experience. When reflecting on their experiences, Seaver Autism Center families often recall a sense of warmth and trust.

One parent, Sakia, felt touched by how happy her son is whenever her family arrives for a visit: “As soon as he walks in, he’s running in, running into rooms, and it doesn’t bother anybody. Everyone is very welcoming.”

Paige Siper, PhD

In this Q&A, Paige Siper, PhD, Chief Psychologist of the Seaver Center, explains how research studies are conducted, the benefits of participating, and how you or someone you know can get involved.

What happens at a research study visit?

Research visits include standardized assessments administered by the clinical research team. Our multidisciplinary team spans psychiatry, psychology, and neurology, including a robust training program of psychology and psychiatry students and fellows. For idiopathic autism studies, gold-standard diagnostic testing, including the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2) is administered to determine eligibility. For studies in genetic syndromes, results from genetic testing are reviewed to confirm eligibility. Most studies include cognitive and adaptive assessments. Results from clinical assessments are summarized in a research report and include personalized recommendations provided to families free of charge. Many research studies include our biomarker battery which includes electroencephalography (EEG), eye tracking and, in certain studies, brain imaging using functional magnetic resonance imaging (fMRI).

What are the benefits of participation?

In line with the Seaver Center’s mission, the goal of the clinical research program is to enhance the diagnosis of autism and related disorders, discover biological markers, and to develop and disseminate breakthrough treatments. Research participation is necessary to achieve these long-term objectives.

In addition to helping future generations through medical advancements, as mentioned above, research participants receive results from clinical testing in the form of a research report with recommendations at no cost. These reports may be used to access necessary services both within and outside the school setting.

Who can participate?

Every study has specified enrollment criteria and therefore eligibility varies by study. The Seaver Autism Center has a number of ongoing research studies and encourages you to reach out to the team to discuss studies you or your child may be eligible for.

How do you get involved?

To learn more, call the Seaver Autism Center at 212-241-0961 or email theseavercenter@mssm.edu and one of the clinical research coordinators will provide you with more information.

You may also stay in the know by signing up for the Seaver Autism Center newsletter and by following the Center on social media.

Five Signs That Your Child Needs Ear Tubes

Ear tube placement is the most common outpatient surgery performed on children in the United States according to a recent study. It is a treatment plan for chronic middle ear infections.

In this Q&A, Aldo V. Londino, MD, and Stephanie Wong, MD, ear, nose and throat (ENT) experts at Mount Sinai, explain why ear tubes are important, the signs a child might need them, and what to expect from the surgery.

Stephanie Wong, MD

It is important to recognize the signs and symptoms early of chronic ear infections and to have your child looked at by a specialist early to avoid hearing loss, further infections, and future complications. If you have concerns, it’s best to contact your pediatrician.

What are ear tubes, and why do they help?

Ear tubes are small devices that are placed in the eardrum to allow better airflow and improved ventilation in the middle ear, allowing fluid to drain out. The middle ear space sits between the eardrum and the Eustachian tube, which connects the middle ear space to the nasal cavity. When that space is not ventilated, fluid gets trapped. The ear tube lets the fluid drain out, reducing future ear infections. It also allows sound to travel normally through the ear, allowing your child to hear better.

How do I know if my child needs ear tubes?

If your child has recurring ear infections—which means at least three infections within six months or four ear infections in a year—then ear tubes will likely help them feel better. If a child has had persistent fluid buildup in the ears, a hearing test may be recommended to determine if they have hearing loss. Sometimes ear tubes are also recommended if your child has had consistent middle ear fluid for several weeks.

 What are signs to look out for?

  • Recurrent middle ear infections from a cold or a respiratory illness that don’t clear up easily.
  • Severe ear infections resulting in perforations of the eardrum.
  • Earaches that get worse over time.
  • Hearing loss or sound is muffled, and child may fail a hearing screening or test.
  • Delay in speech development.

 

Aldo V. Londino, MD

What happens during ear tube surgery?

Ear tube surgery usually takes about 10 to 15 minutes. The surgery is done in an operating room while your child is under a short period of general anesthesia. This is an outpatient procedure, so the child goes home the same day. The surgeon will make a tiny incision in each eardrum, remove existing fluid from the middle ear, and insert the small tube into the eardrum. In one to two years, ear tubes usually fall out on their own because they are pushed out as the eardrum heals. Doctors typically monitor the tubes while they are in place during regular checkups. The placement of ear tubes usually allows hearing to return to the child’s normal baseline level. Children may temporarily experience sensitivity to loud sounds after tube placement. The tubes themselves rarely can cause mild low-pitch hearing loss, which resolves after the tubes fall out.

How do we take care of the ears after ear tube surgery?

Usually there is little to no pain after ear tube placement. If a child feels some pain, they can find relief by taking acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) pain relievers. You should ask your health care team for the appropriate dose for your child’s age and weight. Antibiotic eardrops are routinely prescribed following the surgery. These eardrops are used to treat future infections and sometimes to help keep the tubes open while things heal. A child can go on with routine activities after surgery.

Drainage from one or both ears is common for two or three days after surgery. This drainage is either clear or cloudy. On occasion, the drainage can be bloody or yellow, depending on how infected the ear was at the time of surgery. It’s also common to see drainage on the pillowcase the first day. Drainage beyond three days following surgery is unusual, and you should notify your doctor about this.

You should avoid getting any kind of water (such as during swimming) in the ear besides sink water, the first seven days after surgery. Beyond this time, water precautions are generally not required. However, a shower spray should not be directed straight into the ear canal. Older children who dive more than a foot or two under water should wear earplugs, as should those who soak in a tub with their ears under soapy bathwater. Do not use cotton for this; use special earplugs that mold to the bowl of the ear.

If you think your child should see an ENT or if you have concerns or questions, please call 833-4ENTKID (833-436-8543) to schedule an appointment.

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