Among college students, mental health diagnosis and treatment are up, stigma is down

Mental health diagnoses and treatment of college students increased substantially between 2007 and 2017. More than one-third of students reported a diagnosed condition in 2016-2017, according to a study published online today in Psychiatric Services in Advance.

The comprehensive nationwide study draws on 10 years of data from the Healthy Minds Study, an annual web-based survey involving more than 150,000 students from 196 campuses across the U.S. The study authors, led by Sarah Ketchen Lipson, Ph.D., EdM, with Boston University School of Public Health, found that from 2007 to 2017:

  • Mental health diagnoses increased from 22 percent to 36 percent
  • Treatment increased from 19 percent to 34 percent, with similar patterns for both therapy/counseling and medication use
  • Suicidal ideation increased from 6 percent to 11 percent
  • Mental health stigma decreased

Rates of both perceived and personal stigma decreased over time from 64 percent to 46 percent and from 11 percent to 6 percent, respectively. Perceived stigma was measured by agreement with the statement “most people think less of a person who has received mental health treatment,” and personal stigma was measured by agreement with “I would think less of a person who has received mental health treatment.” While the authors note the decreasing stigma and increasing mental health problems contribute to increased service use, they did not address the reasons behind those changes.

The most common location for receiving services was on campus. Nearly 12 percent of students reported using services of their campus counseling center in 2016-2017, about 9 percent used other mental health services, and about 1 percent accessed emergency psychiatric services.

“The trends revealed in this study have strained counseling centers across the country, as many are under-resourced and operate at full capacity with waitlists for much of the year,” according to the authors. They suggest that in addition to expanding capacity, increasing use of “preventive and digital mental health services, such as those delivered via mobile apps,” could help address the need.

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Materials provided by American Psychiatric Association. Note: Content may be edited for style and length.

10 Campers Share How They Get a Good Night’s Sleep in the Wilderness

Spending the night in the great outdoors under a dreamy, starry sky sounds great—until you actually try to fall asleep for the night. The sounds of critters scurrying through the woods, the hard and possibly rocky ground underneath you, and the endless loop of what-if situations running through your mind can make it seriously difficult to get any shut-eye. Oh, and don’t forget about the lack of heat or air conditioning to help you get cozy.

I’ve been there. On one backpacking trip, we heard a bear was in the area and I spent the whole night jolting at the slightest sign of movement until I collapsed, exhausted, as the sun started rising.

But I’ve also spent four months straight camping (when I hiked about 700 miles of the Pacific Crest Trail) and slept next to people who didn’t seem to have a care in the world when they crawled into their sleeping bags at night. So how do nature lovers manage to actually get a solid night of sleep outdoors? I talked to 11 of them to learn the key elements of their wilderness bedtime routines. Below, their tips for falling asleep while camping.

1. Use a quilt for temperature regulation and white noise to block out sounds.

“I use quilts instead of a sleeping bag so I can pop my legs out if I get too warm,” says Jill, 47, from Phoenix, Arizona. Camp quilts, like this versatile Kammok Mountain Blanket ($135, kammok.com), are often made of the same material as sleeping bags, but rather than zipping them up, you can lay them over your body like a blanket.

Jill also uses her phone to mask outside noise. “If I am not backcountry backpacking (and therefore not worried about charging my phone), I use the “floor fan” setting on the White Noise app.” This helps block out all those little random noises (like leaves blowing along the ground) that your sleepy, paranoid mind convinces you are hungry animals creeping toward your tent.

2. When white noise fails, use earplugs.

Sometimes white noise isn’t enough to put you at ease. “Earplugs are a must for me,” says Justina, 31, in Los Angeles, California. “I usually sleep without a tent so I can see the stars, but I don’t really need to also hear the animals crawling around the campsite!”

3. Pack extra warm layers if you get cold easily.

“I can’t fall asleep if I am cold, so setting up a warm bed is essential,” says Maria, 33, in Washington state. “[I bring a] comfy PJ set and wool socks, in addition to [a] thick sleeping pad and extra warm sleeping bag.” If you’re backpacking, you’ll be limited to what you can carry on your back, but if you’re driving to your campsite, there’s no reason you can’t throw some extra stuff in the car just in case.

4. Find a bedtime distraction and be sure to pee before lying down.

“I wear earplugs and either read or play solitaire [in bed],” says Kathleen, 25, from Phoenix, Arizona. “Keeping my bladder empty usually helps a lot also.”

5. If you’re camping with kids, figure out some tactics to keep them (and you) happy.

“As a mother, I’m only getting sleep if everyone else is,” says Karen, 38, from Phoenix, Arizona. “Therefore, I have a glow stick for my youngest who is scared of the dark, a Kleenex box accessible for my son with allergies, slight airflow into [the] tent to keep us all cool through the night, and white noise playing on the phone so we don’t hear each other snore.”

6. Listen to a podcast.

On that note, earbuds can also provide some comfort in the form of music or voices. “I almost always listened to a podcast while I went to sleep [on a recent trip],” says Niche Veraldi, 25, in Corpus Christi, Texas. “It made it feel like I was falling asleep to a conversation with friends. Even if I got mauled by a bear, at least my friends were making fun jokes.”

7. Choose your camping spot wisely.

Often, the choices you make about where to camp make a huge difference in how well you’ll sleep. “Don’t cowboy camp in mosquito country,” says Amelia, 19, from Reno, Nevada. “Don’t stealth camp next to a freeway.” (Cowboy camping is camping without a tent, and stealth camping is camping at an unestablished site where you’re not supposed to stay overnight.) Even little things, like tree roots and whether or not the ground is flat on sloped can make a difference. If you can, scope out where you’ll be camping beforehand. If you can’t see the specific spot up close, even looking at a map to figure out which spot is by the creek, or far from the restrooms, can help.

8. Bring the comforts of home.

If you’re not backpacking, why not bring whatever might do the trick? “Lavender oil on the feet, a warm drink before bed, and some sort of pillow” are all ingredients for a comfortable night for Annelle, 27, in Mountlake Terrace, Washington. (Just make sure to check the area’s bear population before bringing something fragrant.)

9. Stuff a hot water bottle in your bag to stay warm.

“When it’s super cold, I boil water, pour it in a Nalgene bottle, and throw it in my sleeping bag before I go to bed,” says Kenzie, 30, in Syracuse, New York. “I just tried it the other weekend when it got down to about 35 degrees and it was a total game-changer.”

10. Just bring a pillow—it makes a bigger difference than you might think.

“A lightweight inflatable pillow makes me a million times more likely to fall asleep quickly and stay asleep,” says Isaac, 24, in Culver City, California. “I recently did a four-day trip, and I didn’t have one because I wanted to test if it was something I really wanted or just a luxury, and my sleep was definitely worse.” Try this Compressible Travel Pillow by Therm-a-Rest ($20, amazon.com), or this blow-up one from Wise Owl Outfitters ($15, amazon.com).

Aunting: The New Childfree and Why I Love It

Having children in my life is one of the most rewarding feelings I could ever imagine—they just don’t happen to be mine.

My husband and I have chosen to be child-free, a choice more American women are making. According to The New York Times, the U.S. has reached a record low birth rate for the second consecutive year. Among the top reasons young women cited for not having kids—after not having a partner, not being able to afford it, and wanting more leisure time and personal freedom—was simply not wanting them.

I get it. I don’t have a problem with kids, I just don’t want any. Which is why I’ve embraced aunting, a sort of catch-all description for the joyous, full-hearted caring of children who are not your own—not just nieces and nephews, or even biological relatives, but your friends’ kids, too. Based on a 2012 report, the website Savvy Auntie—devoted to resources for “PANKS” (professional aunt, no kids)—estimates that one in five women age 18 and up, as many as 23 million North American women, don’t have kids but do have a special bond with someone else’s child.

Aunting is my child care of choice. I love children—I also love to give them back to their parents.

I’m on a group text chain we call The Godmothers. Comprising mothers and nonmothers, it stems from a friend who had a baby and hoped for her nearest and dearest to play a significant role throughout her daughter’s life. And while she officially named two child-free women in our group as the co-godmothers, we all share in the responsibility. We text daily—often hourly—and chat about everything from breaking news to our parents to celebrity gossip. We share lots of photos—especially of the children.

I love being around all my friends’ and family’s children and my goddaughter. I look forward to the days that I can take her for manicures, to Broadway shows, and maybe even on trips.

Kristen Luna, a journalist who runs the wildly successful blog Camels and Chocolate and has been married for nine years this December, says she and her husband are happy with their choice to be child-free. She tells me over email: “We decided 10 years ago that neither of us wanted children and that decision has never swayed.” She recalls the day when the choice was solidified. “We were in a hotel in Guatemala City when we both admitted to each other that neither of us wanted kids (thank God we were on the same page!). Though people still want to tell us all the time that we’ll change our minds (insert eye roll here)…even though we’re 35 and 44 and pretty sure we know ourselves better than that.”

Luna is a proud aunt who will quickly show you the Nieces & Nephews folder on her phone as if they were her own kids. “I have three nieces and two nephews and several cousins’ children who I treat as such, too. I get to spend a lot of time with all of them, so I definitely get my kid fill! Just this past weekend, we went on a mountain retreat with my sister’s in-laws—including nine children, eight of whom are under age 10—and while I’m not related by blood to eight of them, I will gladly claim them as my own anyway.” Luna’s sister had a baby this past spring; she’s 8 months old and Luna will tell anyone that she’s her favorite person on the planet, after her husband.

My husband and I are also lucky enough to be a biological aunt and uncle, which has been an incredible experience. Our niece began staying the night with us when she was just a little girl, and while we made what I’m sure are very nonparental judgements—like allowing her to jump on all the furniture, stay up as late as she pleased, and make her brownies and ice cream for breakfast—we learned the joys of this role early in our marriage. That niece is now 18 years old, and we just took her with us on a trip to Peru and climbed Machu Picchu together. Our nephew will do the same come senior year.

I know that these are formative experiences that my niece and nephew will remember for the rest of their lives. I will, too. I also know that it was tough and expensive and I’m glad I had the privilege to give them something special without the massive responsibilities that come along with 18 years’ worth of actual parenthood. As Luna tells me, one of the things she appreciates most about being child-free is: “I’m not responsible for someone else’s livelihood, well-being, emotional development, happiness, education. That’s a HUGE burden I’m not sure I’d want to bear, and I’ll be the first to say that all parents who choose that path are absolute saints. They’re doing the Lord’s work, as we say in the South.”

In the past, I’ve felt that people assume I’ve chosen not to have children because I dislike them, and this kind of idea has created a great divide between those who are child-free and mothers, like we’ve been pitted against each other for the lives we’ve chosen. But I believe this is changing, as more of us choose to be child-free. As women, so many of our choices are made for us. I can only hope that as mothers and those who willingly mother without offspring, we are finding ways to support each other and our decisions.

For me, this means that I get the best of both worlds: to be a part of my favorite people’s families and to leave the child rearing to those more fit for the job. I really do believe that kids enrich our lives, and—for my husband and myself—so do our careers, running a marathon, and traveling the world together. I’m not going to speculate on whether or not women who want to be mothers can “have it all.” But, for me, I have all that I need.


Anne Roderique-Jones is a freelance writer and editor whose work has appeared in Vogue, Marie Claire, Southern Living, Town & Country, and Condé Nast Traveler. Twitter: @AnnieMarie_ Instagram: @AnnieMarie_


Brain Stimulation Therapies for Mental Health: What You Should Know

When you hear the words “electroconvulsive therapy,” you might picture the scene in One Flew Over the Cuckoo’s Nest where Jack Nicholson’s character, Randle Patrick McMurphy, is subjected to barbaric, unjustified shock treatment as a punishment rather than as a mental health therapy. Cultural depictions like this have attached a stigma to electroconvulsive therapy (ECT) and other brain stimulation treatments, but the reality is quite different. For starters, people getting ECT are sedated—Randle wasn’t—to prevent them from feeling any pain. Instead, ECT and other brain stimulation therapies are used today to relieve the emotional pain that can come with conditions like depression.

It’s estimated that around 30 percent of people with depression don’t respond to typical antidepressants. This is known as treatment-resistant depression, and brain stimulation therapies can be life-changing for people who experience it.

“Brain stimulation therapies involve the application of [electric] energy over specific brain regions to modulate the function of neural circuits,” Joshua Berman, M.D., Ph.D., assistant professor of psychiatry at Columbia University Irving Medical Center, tells SELF. This can help alleviate symptoms of depression or other mental illnesses that aren’t responding to typical treatments, such as bipolar disorder.

The five main types of brain stimulation therapies used to treat mental illness are electroconvulsive therapy, vagus nerve stimulation, deep brain stimulation, repetitive transcranial magnetic stimulation, and magnetic seizure therapy. Let’s explore what they are, how they work, and their potential risks.

Electroconvulsive therapy (ECT)

In addition to severe or treatment-resistant depression, ECT may be used to treat conditions like schizophrenia and bipolar disorder if you’re not responding to treatment or if you need extremely prompt treatment due to suicidal ideation, according to the Mayo Clinic. While many insurers currently cover ECT to treat certain conditions, the FDA proposed changing the classification of ECT devices back in 2015 from class III medical devices to class II medical devices, while also putting certain restrictions on who should use the therapy (due to potential risks, which we’ll discuss in a bit). That proposed reclassification is still ongoing.

So, let’s say your medical care team has decided you’re a good candidate for ECT. In each session, you’ll be anesthetized to prevent pain and given a muscle relaxant, the National Institute of Mental Health (NIMH) explains. Then, doctors will expose you to a direct electrical current via electrodes on your scalp. The current triggers a short seizure, usually under a minute long. Again, you shouldn’t feel any discomfort, which might be hard to believe. But that’s the beauty of anesthesia.

Five to 10 minutes later, you’ll wake up and should be able to get back to your usual activities within an hour, according to the NIMH. Although it obviously depends on what your doctor thinks is best, a person receiving ECT will typically get a few treatments a week and may experience less severe depression (or other mental health symptoms) within six to 12 treatments.

“We don’t know the exact mechanisms by which ECT works,” Dr. Berman says. One theory holds that the seizures change blood flow in various parts of the brain such as the amygdala, which is linked with your emotions. There’s also evidence that ECT affects neurotransmitters that impact your mood, like serotonin and dopamine, which some antidepressants also target. The difference is that ECT seems to engage the same brain systems as conventional antidepressants more powerfully and possibly more quickly as well, Dr. Berman explains.

The most common side effects someone might experience after ECT are headaches, an upset stomach, muscle aches, and memory loss, the NIMH says. The memory loss might sound alarming, but it’s usually temporary, and it seems to be less severe if the ECT electrodes are on just one side of the head instead of both. This is known as unilateral ECT, and it’s the more modern take on bilateral ECT, the older form of the treatment that is linked with more intense memory issues, the NIMH says.

Vagus nerve stimulation (VNS)

Vagus nerve stimulation was initially developed as a treatment for the seizure disorder epilepsy, and in a happy accident, scientists discovered that it could help with depression as well, the NIMH explains. So, the FDA approved VNS for treatment-resistant depression in 2005.

Although VNS is a brain stimulation treatment, it actually starts outside your head. If you’re getting this kind of therapy, doctors will surgically implant a tool called a pulse generator into the upper left portion of your chest, the NIMH explains. An electrical wire connects the pulse generator to your vagus nerve, which runs from your brain through your neck and into your chest and abdomen. From its command center in your chest, the pulse generator will send bursts of electric currents to your brain every couple of minutes. Pulse generators typically work for around 10 years before they need to be replaced, the NIMH says.

It appears as though VNS can improve issues like severe depression by changing levels of neurotransmitters in your brain including serotonin, norepinephrine, GABA, and glutamate, the NIMH explains. A 2018 study published in The Journal of Clinical Psychiatry analyzed quality of life reports from 599 people with treatment-resistant depression, finding that those who combined VNS with other antidepressant treatments experienced significant improvements in their quality of life, even if their symptoms didn’t disappear completely.

That points to an important fact about VNS: Anyone receiving it will need to continue their other treatments (like taking antidepressants), the NIMH explains. Even so, it can take months to see a difference when using VNS, and the device could shift or malfunction, which may require more surgery.

Doctors don’t know of long-term side effects of VNS, but short-term ones include voice changes, neck pain, a cough or sore throat, discomfort or tingling in the chest, breathing issues (particularly during exercise), and trouble swallowing, according to the NIMH. Your doctor should give you a special magnet you can hold over the pulse generator to stop it temporarily if the side effects are really bothersome, the Mayo Clinic explains.

The NIMH notes that some people’s conditions get worse after they try VNS, not better. It’s not a surefire fix, which is why it’s only recommended for cases in which a person’s depression hasn’t abated after trying at least four other treatments, the NIMH says.

Deep brain stimulation (DBS)

This started as a treatment for Parkinson’s disease, according to the American Association of Neurological Surgeons. Then doctors realized it shows promise for easing depression and obsessive compulsive disorder, too. (DBS is FDA-approved for OCD, but not yet for depression.)

Like VNS, deep brain stimulation uses pulse generators in the chest to send electrical pulses to the brain. Unlike VNS, which delivers stimulation in bursts, DBS involves more continuous stimulation, the NIMH explains, but you should be able to customize the exact frequency with your doctor’s help. DBS also involves surgery to place two electrodes on either side of the brain and two generators in your chest.

If you’re getting DBS, you’ll actually be awake for the brain surgery, which, yes, sounds terrifying. But anesthesia will numb your head, and your brain doesn’t actually feel pain (nerves in other parts of your body transmit pain messages to your brain). Being awake for this part shouldn’t hurt, and it gives your doctors a chance to ask you questions so they can make sure they’re targeting the right areas of your brain.

It seems as though the DBS pulses “reset” the parts of the brain that are causing symptoms, the NIMH explains. For instance, if you have treatment-resistant depression, doctors might target your subgenual cingulate cortex, which is implicated in depression, along with other portions of your brain. If OCD is your issue, they might focus on a part of the brain called the ventral capsule/ventral striatum.

Even though you won’t actively feel pain during the brain surgery to get the DBS device, you can experience related side effects such as infection, confusion, mood changes, movement issues, lightheadedness, trouble sleeping, and in more severe cases, brain bleeding or stroke, the NIMH says. And the stimulation could cause numbness and tingling, muscle tightness in the face or arm, speech and balance issues, lightheadedness, and mood changes, according to the Mayo Clinic.

It’s pretty unfortunate that mood changes are a potential side effect of both brain surgery and stimulation meant to address mood-related mental illnesses. That goes to show that, like the other therapies on this list, deep brain stimulation may be helpful—but isn’t perfect.

Repetitive transcranial magnetic stimulation (rTMS)

In 2008, repetitive transcranial magnetic stimulation (rTMS) was approved by the FDA as a treatment for people with depression who aren’t responding to antidepressants. In August 2018, approval was expanded to include treatment of obsessive compulsive disorder.

A less invasive brain stimulation therapy than the above options, rTMS uses an electromagnetic coil to deliver short electromagnetic pulses to specific areas of the brain for 30 to 60 minutes, the NIMH explains. This is typically administered five times a week for four to six weeks, according to the Mayo Clinic.

If you’re getting this treatment, you’ll be awake during each session and shouldn’t feel any serious pain; the pulses pass seamlessly from the coil through your skull into your brain. You might feel a knocking or tapping sensation as this happens, though.

“[rTMS] is very well-tolerated, and there are no cognitive side-effects such as memory loss associated with it,” Irving Michael Reti, M.B.B.S., M.D., associate professor of psychiatry and behavioral sciences at The Johns Hopkins University and director of the Brain Stimulation Program at The Johns Hopkins Hospital, tells SELF.

Instead, possible side effects include tingling or tightness in the muscles of the scalp, jaw, and face, the NIMH says. You might also feel some discomfort at the stimulation site and a headache during or after the procedure. A much rarer potential side effect is seizures, meaning rTMS may not be appropriate for people at high risk such as those with epilepsy, a history of head injury, or other serious neurologic issues.

A NIMH study of 190 people published in Archives of General Psychiatry in 2010 found that 14 percent of people who got rTMS experienced less intense depression compared with 5 percent who received what was essentially a fake treatment. The second phase of the trial allowed everyone (including those who got the fake treatment) to try rTMS, and around 30 percent of study subjects experienced less intense depressive symptoms. Although it’s a small study, it’s promising.

However, the NIMH notes that doctors still aren’t sure which parts of the brain are best to target and whether rTMS is most effective on its own or when added to a regimen of more conventional treatments, like therapy and medication, so more research is required.

Magnetic seizure therapy (MST)

One of the newest brain stimulation therapies, magnetic seizure therapy (MST) is something of a mix between electroconvulsive therapy and repetitive transcranial magnetic stimulation. Like ECT, MST induces a seizure, but like rTMS, it does so by using magnetic pulses over specific parts of the brain involved with mental illness instead of electrical currents. Since these pulses are more intense than they are with rTMS, if you’re having MST, you’ll need to be anesthetized and given a muscle relaxant as though you were undergoing ECT. As of now, the only known side effects are those that come with anesthesia and seizure induction, the NIMH says.

MST was developed to address remaining concerns about the effects of other brain stimulation therapies on cognition. A 2015 review in Neural Plasticity looked at eight different studies on MST, depression, and bipolar disorder, ultimately finding that 40 to 60 percent of people with treatment-resistant depression responded to MST, 15 to 30 percent experienced significant relief from depressive symptoms, and that this could be helpful in treating bipolar depressive episodes. The review also found that people were able to recover more quickly after receiving MST than receiving ECT and that it didn’t come with the same level of cognitive risk as ECT when it comes to functions such as memory. Although that’s all exciting, experts aren’t yet sure of a standard protocol for how often to administer MST for mental health conditions, the NIMH explains, and it hasn’t yet been FDA-approved for that purpose.

Science has only scratched the surface when it comes to the potential of brain stimulation therapies to treat mental illness.

While they may not be a first-line treatment for depression and other psychiatric disorders, they may offer promise when other treatment methods don’t work. If you think you may be a good candidate for one of these treatments, get in touch with a mental health professional who can walk you through which option may be best for you, how much your insurance may be able to help, and what you can expect from your new treatment regimen.

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I Wore the Outdoor Voices Exercise Dress to 5 Types of Workouts

I love all things loungewear and leggings, but I’m not the biggest fan of getting all gussied up. Because I prefer the couch to the club any day, the amount of dresses in my wardrobe has winnowed down over the years to a measly handful. (As a freelance writer, loungewear is my work attire.) When I do opt for a dress in my everyday life, it has to be comfortable, functional, and well-made. I also need it to be easy to style. Bonus points if I can wear it in a slew of different settings and for a variety of occasions.

So imagine my excitement when, this summer, I was searching my favorite activewear sites for yet another piece of loungewear to add to my relatively behemoth collection and stumbled upon the Outdoor Voices Exercise Dress ($98, outdoorvoices.com). I promptly ordered it (and Insta Storied it, duh), while visions of trekking around the city in my comfy, stylish getup ran through my head.

I will say, though, it took me several months to work up the courage to actually exercise in the exercise dress. I honestly was worried about what people might think. The dress has built-in spandex shorts, but the other people in my exercise class probably wouldn’t know that. I’d personally never seen someone show up to yoga in a dress, so I anticipated getting maybe a few looks at first.

Here’s what I learned after wearing the dress for five different types of workouts.

Courtesy of the author

The dress is incredibly comfortable, thanks to the stretchy, sweat-wicking material and built-in bike shorts.

As I mentioned, the dress came this summer. As someone who constantly runs hot, it was a pretty easy decision to slip it on right out of the package. I had already overdressed earlier that day and had broken into a full sweat, so I was ready for the respite of lighter summer layers.

When I put on the dress, I was honestly amazed at how comfortable it was. The construction is brilliant. The inner layer is a leotard of sorts, but with the added benefit of bike shorts, which placated arguably my biggest concern about working out in an exercise dress: inner-thigh chafing. Like most women whose thighs touch, chafing is an inevitable part of my warm-weather life. Thankfully, the built-in shorts, made of a moisture-wicking fabric, kept my legs from rubbing together and causing any sort of irritation that would make a workout—or just a day running errands—uncomfortable. The shorts are also so low-profile that you can’t even tell there’s an extra layer under the dress by looking at it on.

There’s also a version without the bike shorts and just a leotard lining, if that’s more your style.

What’s more, the shorts have a side pocket—and I love a good pocket.

I shouldn’t waste time waxing poetic about the beauty of a conveniently placed pocket—after all, I dedicated several hundred words to the same feature on my favorite pair of Lululemon leggings. But a dress with pockets is extra exciting. Since dresses almost never have pockets, this piece immediately went from workout functional to everyday functional. A place I can put my subway card and credit card so I don’t need to carry my wallet around all day? You could say I was obsessed.

In fact, I loved this dress so much that I wore it nonstop this past summer.

It became a staple for me, which I wore multiple times per week. Basically, whenever it was clean, I threw it on. The navy number garnered legions of compliments from strangers and friends, who marveled at its flattering-functional combo. (Same, you guys, same.)

I got a lot of weird looks whenever I worked out in it—more than I expected.

I tried running, indoor cycling, yoga, boxing, and barre in the exercise dress. And honestly, each went quite well. Outdoor Voices is no stranger to the workout game, and that shows with the exercise dress. It was stretchy and breathable, just what I ask of a good pair of workout leggings.

What stunned me, though, was how many stares I got. I mean, I figured people might think it was unique. But I live in New York City. There’s a cowboy in tighty whities playing a guitar in the middle of Times Square. There’s a man who regularly jogs up and down First Avenue in just a thong. An exercise dress isn’t really all that shocking in comparison.

Yet during a 3-mile run around my busy Queens neighborhood, I would wager not a single person didn’t do a double-take—it was like I had three heads or something. Same goes for yoga and barre. Technically speaking, I got the least amount of confused looks in my Flywheel (indoor cycling) class, but that could have just been because the room was dark. It was frustrating every time, not only because I harbor some body image issues, but also because why should anyone care what anyone else is wearing to exercise? If you’re busy working out and focusing on yourself, it shouldn’t matter what the person next to you has on—even if it’s something you wouldn’t choose yourself.

Working out in this dress ended up being quite the unexpected learning experience.

Being stared at, while uncomfortable, also turned out to be a great reminder to focus only on myself and my own comfort no matter where I’m exercising. I’d never want to make anyone else feel the way I felt when people were gawking at me. Everyone deserves to get their sweat on in whatever apparel they choose.

And honestly, I bet if all those people knew how comfortable this dress is, they’d be jealous that they weren’t working out in it, too. Joke’s on them.

Buy it: Outdoor Voices Exercise Dress ($98, outdoorvoices.com)

Training for a Marathon After Having a Baby Wasn’t Fun, But It Helped Me Feel Like Myself Again

The days after our daughter was born were a blur. I remember my boyfriend and I packing up all of our belongings strewn around our stale hospital room. I remember us, as terrified new parents, dressing her in her too-big going home outfit and trying to keep our cool as our Uber driver waited patiently for us to figure out how to buckle the car seat in correctly. And then I remember getting home and realizing that the hard part was just beginning. Exhaustion played a large part, sure, but so did the disorienting elements of our new normal. It didn’t matter whether it was day or night anymore; our birthing classes had warned us that a newborn eats and sleeps on a schedule so intermittent and frantic it’s as if they’re hazing you, the untested parent, to see if you make the cut. The birthing classes were right. I followed suit, eating, sleeping, and breastfeeding on her terms, barely able to eke out anything more. When I went back to work three months later, I had the added pleasure of juggling the needs of a tiny baby with a full-time job.

It was shortly after all of this, naturally, that I decided the best thing to do for myself was to train for a marathon. I’d been invited to run by New Balance, a sponsor of the New York City Marathon, one of the world’s most iconic races and one of the only ones I told myself I’d consider running after trudging my way through two previous ones. The promise of that bump of self confidence I’d feel afterward was alluring; there aren’t so many other goals in life that have such a tangible and measurable payoff in a relatively short period of time. I knew what to expect: Train for a set number of months, run the requisite number of miles, endure physical pain and emotional roller coasters throughout training and on race day, and boom—cross the finish line and reap the benefits of all my hard work.

As a new mom, I needed all the confidence boosts I could get. To use an apt metaphor, I’d spent the months since my daughter was born finding my footing. My transition into motherhood started out on an alarming note; after a breezily uncomplicated pregnancy, I had an emergency C-section, then contracted a life-threatening infection as a result. What I thought would be a happy 48-hour stay turned into a seemingly unending string of days spent learning how to care for a screaming newborn while being so sick and weak that I couldn’t get out of bed. I spent much of that time doubled over in pain and exhaustion, tethered to both an IV cart and a hospital-grade pumping machine trying to will the droplets of colostrum my body had managed to muster up into breast milk.

Since then I’d plunged deeper into a new reality, where certainties seem to lie only in the confusingly vague concept of “maternal instinct.” Not very confident in my own, I found myself googling almost everything I could think of—when you should worry about a fever, what it means if your baby won’t stop crying when you put her down. Overwhelmed by the unknown, I figured running—which had been part of my life since I was young—was the best way to connect to a version of my old self that knew the shape of things. The assuredness of putting foot to pavement as I’d done countless times before, of seeing the miles on my watch creep up in predictable fashion, was enticing.

Once I started actually training, though, I found that even my familiar ground had changed. Instead of being able to run (or procrastinate about going for a run) as much as I chose, I was bound by lack of time. If I was particularly slow one day, I couldn’t spend more time making sure I hit my mileage goal. I was constantly rushing from work to the gym and back home and then doing it all over again the next day. It wasn’t fun—it was, in fact, often a frantic period in my family’s life—but I needed it. Even if I was constantly doing a series of guilt-ridden calculations in my head: I’ve been this many hours away from my daughter already. Or, If I don’t pick up my pace, I’ll owe the babysitter this much money. Even if sometimes the only time I could train was in the middle of the day in the height of summer (special thanks to the Lyft driver who, worriedly eyeing me sweating and panting in the backseat of his car after a truncated long run, pulled up to a food truck alongside the road to buy me a cold water). Even if my milk supply plummeted while I figured out how to eat for both marathon and baby.

Even with these constant feelings of being selfish or not doing enough, I felt joy at being on the road. It wasn’t just the runner’s high that made me feel better, although the regular surge of endorphins certainly didn’t hurt. My body calling upon its mechanical memory while on a run—the feeling of my legs loosening up after mile two, of my lungs finding their rhythm as I breathed through a long session—was reassuring in its familiarity. Having to consciously make time to run also allowed me to step away a few hours at a time from a routine of new experiences and obligations. Realizing all of this was a simple motivator to get me out the door when I felt like skipping a workout. It was nice. I ran well on race day, much better than I had in previous marathons when my time was solely my own.

A year later, with my daughter now a toddler and me comfortably settled into motherhood (why yes, I have sung “Baby Shark” more times than I can count!), I realize that training for a marathon helped me transition, intact, through that life-altering “becoming a mom” phase. I surprised myself with how much of my personality, seemingly ensconced in habits honed over three decades, had welcomed these changes. How proud of myself I was that I could leave the house three hours early and run 18 miles to work if I needed to, even though during a previous marathon season I would’ve balked because I considered myself “not a morning person.” How much I needed the constraints of a training plan to help me shift my perspective. Knowing that my hard-coded runner habits could morph so fluidly helped give me the confidence to take on the other changes in my life. It might not be the same ever again (you won’t see me signing up for another one to find out), but during that chaotic first year, training for a marathon was exactly what I needed to feel like myself again.

Training for a Marathon After Having a Baby Wasn’t Fun, But It Helped Me Feel Myself Again

The days after our daughter was born were a blur. I remember my boyfriend and I packing up all of our belongings strewn around our stale hospital room. I remember us, as terrified new parents, dressing her in her too-big going home outfit and trying to keep our cool as our Uber driver waited patiently for us to figure out how to buckle the car seat in correctly. And then I remember getting home and realizing that the hard part was just beginning. Exhaustion played a large part, sure, but so did the disorienting elements of our new normal. It didn’t matter whether it was day or night anymore; our birthing classes had warned us that a newborn eats and sleeps on a schedule so intermittent and frantic it’s as if they’re hazing you, the untested parent, to see if you make the cut. The birthing classes were right. I followed suit, eating, sleeping, and breastfeeding on her terms, barely able to eke out anything more. When I went back to work three months later, I had the added pleasure of juggling the needs of a tiny baby with a full-time job.

It was shortly after all of this, naturally, that I decided the best thing to do for myself was to train for a marathon. I’d been invited to run by New Balance, a sponsor of the New York City Marathon, one of the world’s most iconic races and one of the only ones I told myself I’d consider running after trudging my way through two previous ones. The promise of that bump of self confidence I’d feel afterward was alluring; there aren’t so many other goals in life that have such a tangible and measurable pay-off in a relatively short period of time. I knew what to expect; train for a set amount of months, run the requisite amount of miles, endure physical pain and emotional roller coasters throughout training and on race day, and boom: cross the finish line and reap the benefits of all my hard work.

As a new mom, I needed all the confidence boosts I could get. To use an apt metaphor, I’d spent the months since my daughter was born finding my footing. My transition into motherhood started out on an alarming note; after a breezily uncomplicated pregnancy, I had an emergency c-section, then contracted a life-threatening infection as a result. What I thought would be a happy 48-hour stay turned into a seemingly unending string of days spent learning how to care for a screaming newborn while being so sick and weak that I couldn’t get out of bed. I spent much of that time doubled over in pain and exhaustion, tethered to both an IV cart and a hospital-grade pumping machine trying to will the droplets of colostrum my body had managed to muster up into breast milk.

Since then I’d plunged deeper into a new reality, where certainties seem to lie only in the confusingly vague concept of “maternal instinct.” Not very confident in my own, I found myself Googling almost everything I could think of: when you should worry about a fever, what it means if your baby won’t stop crying when you put her down. Overwhelmed by the unknown, I figured running, which had been part of my life since I was young, was the best way to connect to a version of my old self that knew the shape of things. The assuredness of putting foot to pavement as I’d done countless times before, of seeing the miles on my watch creep up in predictable fashion, was enticing.

Once I started actually training, though, I found that even my familiar ground had changed. Instead of being able to run (or procrastinate on going for a run) as much as I chose, I was bound by lack of time. If I was particularly slow one day, I couldn’t spend more time making sure I hit my mileage goal. I was constantly rushing from work to the gym and back home and then doing it all over again the next day. It wasn’t fun—it was, in fact, often a frantic period in my family’s life—but I needed it. Even if I was constantly doing a series of guilt-ridden calculations in my head: I’ve been this many hours away from my daughter already. Or, If I don’t pick up my pace, I’ll owe the babysitter this much money. Even if sometimes the only time I could train was in the middle of the day in the height of summer (special thanks to the Lyft driver who, worriedly eyeing me sweating and panting in the backseat of his car after a truncated long run, pulled up to a food truck alongside the road to buy me a cold water). Even if my milk supply plummeted while I figured out how to eat for both marathon and baby.

Even with these constant feelings of being selfish or not doing enough, I felt joy at being on the road. It wasn’t just the runner’s high that made me feel better, although the regular surge of endorphins certainly didn’t hurt. My body calling upon its mechanical memory while on a run—the feeling of my legs loosening up after mile two, of my lungs finding their rhythm as I breathed through a long session—was reassuring in its familiarity. Having to consciously make time to run also allowed me to step away, a few hours at a time, from a routine of new experiences and obligations. Realizing all of this was a simple motivator to get me out the door when I felt like skipping a workout. It was nice. I ran well on race day, much better than I had in previous marathons when my time was solely my own.

A year later, with my daughter now a toddler and me comfortably settled into motherhood (why yes, I have sung Baby Shark more times than I can count!), I realize that training for a marathon helped me transition, intact, through that life-altering “becoming a mom” phase. I surprised myself with how much of my personality, seemingly ensconced in habits honed over three decades, had welcomed these changes. How proud of myself I was that I could leave the house three hours early and run 18 miles to work if I needed to, even though during a previous marathon season I would’ve balked because I considered myself “not a morning person.” How much I needed the constraints of a training plan to help me shift my perspective. Knowing that my hardcoded runner habits could morph so fluidly helped give me the confidence to take on the other changes in my life. It might not be the same ever again (you won’t see me signing up for another one to find out), but during that chaotic first year, training for a marathon was exactly what I needed to feel myself again.

Chrissy Teigen First Noticed Her Postpartum Depression Symptoms 3 Months After Giving Birth

Postpartum depression can be a distressing, often confusing, experience for new parents. Part of the issue, as Chrissy Teigen found out after giving birth to her daughter in 2016, is that postpartum depression symptoms don’t always come on immediately.

In a new interview with Glamour, Teigen remembers the moment she realized something wasn’t quite right—and that it came later than she would have expected.

“I think the most surprising thing for me was that it happened three months after,” Teigen says in the interview.

“I thought postpartum was, you have the baby and you’re sad,” she continues. “It was like, no. It sneaks up on a lot of people. That’s why I thought it was important for me to talk about.” Teigen was apparently dressed as Eleven from Stranger Things as part of her appearance on Lip Sync Battle when she noticed that something was off.

Previously, Teigen said that one of the first subtle signs she picked up on was that her relationship with food had changed. “I started looking at food and was like, ‘I’m just not in the mood,'” she told People in September. “It’s like going to the grocery store when you’re full. You just don’t want the same things. Food wasn’t that thrilling for me.”

Postpartum depression—and all variations on postpartum mood changes—can be different from person to person.

As SELF wrote previously, the symptoms of postpartum depression can be both mental and physical, including feelings of sadness, hopelessness, irritability, anxiety, and restlessness as well as changes in appetite or sleep habits and fatigue. And, although research suggests that the majority of people begin to experience symptoms in the early postpartum period (within six weeks of delivery), about one in five people experience them later on.

But the most important thing, no matter when your symptoms begin, is to recognize them and get help as soon as you can, whether that’s from your support network, your doctor, or a mental health professional.

Related:

12 Stretches to Relieve Tight Shoulders

As someone who spends a large part of my day hunched over a laptop, I am very familiar with tight shoulders. No matter how often I remind myself to sit up straight and maintain good posture, every now and then I look up and realize I’m huddled over with my spine rounded, shoulders high near my ears, and my neck in some wonky position so that my face is practically pressed against the computer screen. (I guess that’s my “concentrating” pose?) Without constant reminders (though, my Apple Watch‘s frequent reminders to stand up do help a little), it’s very easy to revert to a not-so-ideal sitting position. Combined with my propensity to carry no less than two very heavy tote bags around with me most days, my shoulders are often tight and achey.

Turns out, I’m definitely not alone. “Stiff, tight shoulders are one of the most common complaints among all people today—especially anyone who spends extended amounts of time slumped at a desk or sitting behind a steering wheel,” Brad Walker, Australian trainer and triathlon coach and director of education at StretchLab in Los Angeles, tells SELF. “This position causes our upper back to round forward, our chest to tighten, and our shoulders to lift and compress, all leading to very poor posture and eventual shoulder tightness and pain.”

It’s not just poor posture, though, that can make your upper body feel super tense. “Your shoulders may become tight as a result of poor posture, muscle tension, overuse (for example, too many push ups), or even stress,” Dan Giordano, D.P.T., co-founder of Bespoke Treatments Physical Therapy in New York City and Seattle, tells SELF.

Strengthening the core and upper body, including your back and shoulders, is a great way to improve your posture over time. And your shoulders specifically may benefit immensely from rotator cuff exercises, which strengthen and stabilize the small muscles that help keep the ball-and-socket joint in place. But if tightness is what plagues you, doing some shoulder stretches can provide short-term relief.

Also, it’s important to pay close attention to what you’re feeling. Tightness isn’t so much to be worried about, and stretching is a good way to improve that. Pain is another story. The shoulder is the most mobile joint in the body (fun fact), which also means it tends to be unstable and prone to injuries. If you feel pain that’s sudden, sharp, or doesn’t start improving after a few days, it could be a sign you’re actually injured and should see a doctor.

If you’re just looking to stretch out your tight shoulders, try the stretches below from Walker, Giordano, Rachel Prairie (corporate personal trainer and programming specialist at Anytime Fitness), and Jacque Crockford, M.S., C.S.C.S. (exercise physiology content manager at American Council on Exercise). They target both the shoulders and surrounding muscles, like those in the neck, chest, and back, which all can contribute to tightness. Pick a few and add them to your recovery routine a few times a week or when you feel like you need them.

Modeling the moves is Caitlyn Seitz, a New York-based group fitness instructor and singer/songwriter.

9 Acne Cleansers on Amazon That People Really Love

If there’s one skin-care annoyance I absolutely can’t stand, it’s getting a pimple. I’ve been in the battle for clear skin since I was in high school, which means I’ve tested a ridiculous number of cleansers that are formulated for acne. While there are plenty that I had to find out the hard way weren’t the right fit for my skin, I’m happy to say that I’ve found a handful that are (here’s looking at you, Effaclar).

My work is never finished when it comes to helping my skin look its best, so I’m always ready to try out new products that others are loving—especially if they can help me kiss my pimples goodbye. Since Amazon shoppers don’t hold back when it comes to their opinions, I know that their customers’ top-rated picks are always worth the money. Read on for nine cleansers for acne-prone skin on Amazon with at least a four-star rating and upwards of 300 reviews.