Stanford Medicine Newsletter Updates For the Local Community

Stanford experts offer tips on how to weather these difficult times


Discuss family money matters

Sharon Williams, PhD


With so many families feeling the economic pinch, parents are worrying about how to address money issues with their children. How do you help your children feel secure in the face of economic uncertainty?

The best steps are to give your kids a chance to ask questions and to reassure them that you have a plan for family finances, said Sharon Williams, PhD, an associate professor of psychiatry and behavioral sciences at Stanford and the director of outpatient services for child and adolescent psychiatry at Lucile Packard Children’s Hospital.

“Parents should tailor whatever they say about money to the age of the child,” Williams said. “Younger kids need to know less; older kids need to know more. But regardless of age, all kids need to know that whatever changes happen in the family, the parents will handle them and the kids will be taken care of.”

Williams advised against trying to hide events such as job loss. “Parents should not assume that just because kids haven’t said anything, they don’t notice something is wrong,” she said. “If parents are more stressed and irritable because of money troubles, kids will pick up on that. In general, it’s always about sitting down with your kids and talking with them.”

At the same time, she said, discussing small details of family finances in front of the children may not be a wise idea.

“Sitting down and talking with your kids is different than talking in front of them,” she said. “When you talk with them, you’re giving them your undivided attention and letting them ask and answer questions. They don’t have to come to their own conclusions about the situation. That’s quite different than if they’re listening to a conversation about how to pay a bill. Those conversations are better held in private.”

Williams also advised that families try to stick to normal routines. “Packing a picnic, going to the park or having play dates will still let kids have fun in a way that doesn’t tax your budget,” she said. “The normalcy, routine and consistency help reassure kids.”


Eat well for less

Christopher Gardner, PhD


When families are stressed and finances are tight, some may turn to cheap, fast and processed foods as a budget-saving measure. But Stanford nutrition expert Christopher Gardner, PhD, said that families can still eat well while saving money and reaping other social, physical and psychological benefits.

Growing food in a backyard garden, plying farmers’ markets and enjoying simple, healthy meals prepared at home all can be an antidote to today’s economic woes, said Gardner, an associate professor of medicine with the Stanford Prevention Research Center.

“You can actually eat healthier,” he said. “You can eat local, seasonal foods at the peak of their freshness and taste. You can support your local economy and spend more time with your family.”

Gardner, a longtime vegetarian who is raising four vegetarian sons, said a diet that relies heavily on bulky plant foods, such as hearty soups, salads and whole-grain breads, can be nutritious and low cost. Carrots, tomatoes, broccoli, red cabbage and butternut squash are inexpensive, healthy and more filling than higher-priced and calorie-dense meat products.

He said he applauds the trend of planting backyard gardens or participating in community gardens, which not only provide a healthy resource but also enable people to become more connected with the food in their lives. The proliferation of farmers’ markets, which have doubled in number in the last decade, is another positive trend, he said, and helps boost the local economy.

“I like the idea that in an economic crunch, we can support California by buying California produce,” he said. “While you’re taking care of yourself, you can take care of your neighbor, and we can all lift ourselves up.”

Gardner said these hard times provide an opportunity for families to re-examine their priorities.

“All of us know we have more ‘things’ than we need. That’s one of the reasons we’re in this economic crisis. But when it comes to food, that is one of the first places your money should go. It affects your health, your mood, your energy level and how well you sleep,” he said. “In these times, it’s a great opportunity to think about using our dollars more effectively and more healthfully by eating lower on the food chain, eating out less frequently and making more meals at home with friends and our families.”


Get enough sleep

Rafael Pelayo, MD /Allison Siebern, PhD


As many as one-third of Americans report losing sleep over the economy, according to a poll this past spring by the National Sleep Foundation.

“We see this problem here in the Bay Area, as we have been very hard hit,” said sleep expert Rafael Pelayo, MD, who treats adults and children at the Stanford Sleep Medicine Clinic. He said Stanford’s sleep experts are seeing a growing number of visitors—both new patients and people whose problems have been exacerbated by economic worries.

“A lot of people have been laid off or are concerned about losing their jobs,” said Allison Siebern, PhD, a psychology fellow at the clinic. “People who still have jobs may be working longer hours and picking up the slack as others get laid off. So they have less transition time at night, less time to relax before sleep time.”

She said anxiety may trigger the arousal system, a process that enables humans to respond to imminent threats, which can interfere with normal sleep cycles.

“Now the threats are, ‘Am I going to lose my job?’ ‘How am I going to perform at work tomorrow?’” she said. “Lying in bed is a perfect time to start ruminating. That arousal system just breaks right through the sleep time.”


She recommends an hour buffer zone before sleep to engage in activities that are relaxing and calming. For most people, watching the news and checking e-mails probably isn’t helpful, as these activities may activate the arousal system, she said.

Pelayo said the sleep center has expanded its services to accommodate demand from people suffering from insomnia. The clinic, the only one in the community with a comprehensive insomnia management program, pairs psychologists with physicians to address the physical and behavioral issues at the root cause of the problem. After two months of starting treatment, about two-thirds of the clinic’s patients sleep better without medication, he added.

“It’s important to understand that although more people may be suffering from sleep problems, the vast majority will improve when the problems are addressed correctly,” Pelayo said. “We should all wake up feeling refreshed.”

(A podcast interview with sleep expert Allison Siebern, PhD, is available at 121/2009/siebern.html. To learn more about sleep medicine, visit


Keep stress in perspective

David Spiegel, MD


In a recent poll by the American Psychological Association, 80 percent of Americans reported significant stress as a result of the economy, up from 66 percent last April. David Spiegel, MD, professor of psychiatry and behavioral sciences, provides insight on how the economy can impact psychological health and offers some tips on how to cope.

How is today’s economy affecting health?

We’re seeing a lot of people coming to the emergency room—people who are unemployed and can’t find another job. They may be socially isolated. At work, you have daily contact with people. At home, on the Internet looking for jobs, you don’t have that social contact. There are other secondary ramifications of unemployment—the daily humiliation of not feeling like a part of the workforce, the things you can’t buy that you used to be able to. It tends to gnaw at your sense of self-esteem.

What signs and symptoms should people be on the lookout for?

People should be alert to disruption in their usual daily cycles—sleeping, eating and exercise. If you experience a big weight gain or if you’re starting to lean on drugs and alcohol, those may be signs. If you start to notice that you’re anxious all the time, even when you’re not looking for work or thinking about your financial problems, or if you’re feeling hopeless, helpless and worthless, that is when it moves into the psychiatric domain.

In what ways could children be affected by the economic situation?

First of all, they see the effects on their parents. A parent looking for a job may not be as emotionally free, so kids will sense the emotional withdrawal or irritability of the parent. The kids naturally blame themselves because they don’t understand the causes of these changes. They will act up to prove that they are in control and to distract their parents. It just creates conflict. It’s tough on everybody.

What advice do you have to help people to stay centered?

Give the devil his due. Do what you have to do to deal with your economic situation, but then keep your life going. I think it’s important to take time off from worrying about all this. There’s a way in which this economic downturn can push us back to basics, and I think that is a good thing. Instead of going to a sports game for $300, watch it on TV. Make some music together. Take a walk. It makes you feel better and brings people together.

The second thing is to recognize that you’re not alone. Spend time getting the big picture. It’s also a time to take stock about what’s important—like family—and what isn’t. I also think people should dose themselves on how much media input they’re getting. You cope with stressors better if you can do something about them. So acquire information to the extent that it will help you make a decision to do something about it, but then let it go.

(A podcast interview with David Spiegel is available at spiegel.html.)

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