Categories
Prejudice and Biases Social Psychology

Implicit Bias: Past Lessons and Future Directions

Are implicit bias interventions effective?

The unconscious, automatic components of prejudice have been investigated since the 1980s with the work of Patricia Devine. Her research showed that automatic activation of stereotypes and biased attitudes occur in both high- and low-prejudice persons. Social psychologists, Mahzarin Banaji and Tony Greenwald, followed up on her work, originally coining the term “implicit social cognitions”, referring to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner.  These attitudes are considered “biases” because they tend to link certain social and cultural groups with stereotypes. Early theories presumed that implicit biases were immutable and fixed in cognition. However, later research has shown that certain techniques, such as mental imagery, may have the potential to change these unconscious attitudes and stereotypes.

Recent studies have measured the short-term outcomes of bias-reducing interventions; however, there has been little investigation into the long-term impacts of these interventions. The most compelling evidence into lasting effects comes from an experimental study of 18 universities across the U.S. Results of the study showed that bias-reducing interventions were immediately effective; yet, none of the interventions produced a significant effect after one to two days. Psychologists and sociologists have interpreted these findings as evidence that implicit bias is inflexible and difficult to change. 

Implicit bias: the bias-of-crowds model

The inflexibility of individuals’ implicit biases towards psychological and sociological interventions may reflect another phenomenon. The bias-of-crowds model states that implicit bias may be driven by the mental accessibility of certain concepts linked to social groups. The accessibility of attitudes and stereotypes can vary as a feature of the person (i.e. how often I choose to think something) and as an aspect of the environment (i.e. how often certain information is presented to me). However, recent evidence suggests that cognitive accessibility of stereotypes is more likely to vary based on the environment, rather than as a feature of the individual. In simple terms, this may mean that more frequent exposure to indirect or direct external prejudices (i.e. from family, friends, or education) will lead to a greater likelihood of our biases being reinforced.

Fundamentally, the average levels of implicit bias in a community may reflect the structural inequalities of that environment. On an individual level, unconscious biases and stereotypes are malleable and can fluctuate quite regularly. Individual’s implicit biases are likely to change from one point of time to another; however, the aggregate estimate of implicit bias in an individual is more greatly dependent on their social environment.  Structural inequalities and inequities may play a much greater role in determining long-term implicit biases.

So, how can we change implicit biases?

Based on evidence from the bias-of-crowds model, the most direct way of changing implicit bias is by changing the structural and systematic inequalities of an individual’s environment. Yet, this is a demanding task, as a change in structural inequities often requires new or amended policies. Instead of focusing on systematic change, I would like to suggest a few means of bias-reducing interventions that may be applicable to current situations.

  1. Individual habits- Consciously recognize your own stereotypes and find ways to replace them. Do not fit cultural groups into your predetermined stereotypes; rather, find logical and situational explanations for an individual’s behavior. Even further, it may be necessary to step out of your comfort zone and engage with individuals who belong to groups that are unlike your own. Data from the studies of Patricia Devine and Will Cox (University of Wisconsin-Madison) show that these interventions work to reduce implicit bias.
  2. Temporary interventions – These types of interventions may be applicable at the time of making a decision, such as hiring an applicant or
    admitting an individual to a university. For example, having admissions committees consciously counteract stereotypical beliefs before reviewing applications may work to reduce implicit bias.
  3. Long-term interventions – According to bias-of-crowds, changing social environments may produce long-term effects on individual implicit bias. For example, increasing faculty diversity at universities or companies may combat unconscious stereotypical attitudes in students or other faculty members. Even further, removing cues of past inequality, such as Confederate monuments, may act to reduce overall implicit bias. 

The two interventions that I have mentioned here are not foolproof. The correlation between implicit bias and social environment does not necessarily imply that unconscious biases and stereotypes are caused by structural inequality. More research needs to be done into the effect of the social environment on unconscious attitudes and biases before enacting long-term interventions. Yet, I would still like to emphasize one thing. Implicit bias is real. We all suffer from unconscious stereotypes and attitudes. Working to overcome these biases will move us closer towards diminishing racist attitudes that plague society. Reducing implicit bias is a minor step towards solving the major problem of racism in today’s America.

Resources

Project Implicit – Harvard University: https://implicit.harvard.edu/implicit/takeatest.html

Kirwan Institute – OSU: http://kirwaninstitute.osu.edu/research/understanding-implicit-bias/

University Counseling Center – Notre Dame: https://ucc.nd.edu/diversity-inclusion-social-justice/social-justice-anti-racism-allyship/

Unconscious Bias Resources – UCSF: https://diversity.ucsf.edu/resources/unconscious-bias-resources

Find a Therapist: https://www.findcbt.org/FAT/

 

Disclaimer

The information and suggestions that I have provided here are in no means professional. This post has been reviewed by a faculty member of the University of Notre Dame Department of Psychology to verify accuracy.

 

Works Cited

Devine, P. G. (1989). Stereotypes and prejudice: Their automatic and controlled components. Journal of personality and social psychology56(1), 5.

Greenwald, A. G., & Banaji, M. R. (1995). Implicit social cognition: attitudes, self-esteem, and stereotypes. Psychological review102(1), 4.x

Nordell, S. (2017, July 10). Is This How Discrimination Ends? Retrieved August 23, 2020, from https://www.theatlantic.com/science/archive/2017/05/unconscious-bias-training/525405/

Vuletich, H. A., & Payne, B. K. (2019). Stability and change in implicit bias. Psychological Science, 30(6), 854-862.

Categories
Positive Psychology

Positive Psychology and Subjective Well-Being

What is positive psychology?

Throughout the past century, much of mental health research has focused on pathology and the preventative measures of disease. The psychological discipline has been dominated by studies investigating the cause, treatment, and prevention of certain disorders, such as depression and anxiety. Research has often turned a blind eye to the features of human existence that make life worth living. The concepts of hope, wisdom, courage, spirituality, and creativity “are ignored or explained as transformations of more authentic negative impulses” (Seligman & Csikszentmihalyi, 2000). Luckily, a new area of research has developed in the last few decades to address this gap: positive psychology.

Positive psychology, as founded by Martin Seligman, is about positive subjective experience in the past, present, and future. Positive psychology encompasses well-being, satisfaction, joy, sensual pleasures, optimism, and faith. For the individual, it involves his or her “capacity for love and vocation, courage, interpersonal skill, aesthetic sensibility, perseverance, forgiveness, originality, future-mindedness, high talent, and wisdom” (Seligman, 2002). Much of this article will be spent addressing the ways in which positive psychology can be utilized on an individual level; however, this field of study can be implemented to group settings, as well, guiding people towards better citizenship.

After Seligman and Csikszentmihalyi developed the positive psychology theory in 2000, research regarding this topic skyrocketed. Some studies have proven the effectiveness of interventions, such as setting personal goals and expressing gratitude. Others have flimsy experimental designs and make erroneous causal conclusions. A recent meta-analysis reviewed the effectiveness of the positive psychology interventions (PPIs), only looking at findings from randomized controlled trials. The researchers evaluated the efficacy of 39 studies, comprising 6,139 subjects, 4,043 in experimental groups, and 2,096 in control groups. Here are some of the findings…

  1. Positive psychology interventions significantly increase psychological well-being and limit depressive symptoms. The effect size between the experimental and control groups was around .3 (on a scale from 0-1.0). Although this is considered a relatively small effect size in psychological research, this is comparable to effect sizes in high-quality studies evaluating psychotherapy.
  2. Specific features of studies altered the effect on depressive symptoms. Greater effects were observed in interventions of longer duration, in individual interventions (vs. self-help), and when people with psychosocial problems engaged in interventions. 
  3. Short-term interventions also had small, yet significant effects. This may be helpful from a public health perspective, as it provides a means of reaching populations that may otherwise not be affected by long-term interventions. However, more research is necessary to evaluate the effectiveness of temporary, self-help interventions. Increasing compliance and adherence to self-help interventions may be a step to increasing effectiveness.

Positive Psychology Interventions

So how can these findings be implemented into practice? Positive psychology interventions (PPIs) may be most effective for individuals in remission from psychopathology. It may provide a means of improving psychological well-being and improving resilience against mental health problems in the future. In terms of public health, PPIs fulfill the preventative objective of clinical psychology and provide an accessible means of improving mental health. According to Bolier et al., these interventions can be used in mental health promotion and as a first step in a stepped care approach (start with low-intensity intervention and increase as needed).

As we continue to live in this time of uncertainty, certain PPIs can be applied to our own lives. The following self-help interventions were found to have the biggest effect size in terms of subjective well-being. The majority of these interventions are applicable to our everyday life.

  • Doing acts of kindness. Buchanan et al. found that kind acts, performed over a period of just 10 days can increase life satisfaction. In addition, if these acts were novel, the respondents reported a greater improvement in happiness.
  • Projecting a positive self in the future. Quoidbacha, Wood, and Hansenne found a significant increase in happiness for individuals in a group who thought positively about the future. Specifically, these subjects were told to imagine four positive events that could reasonably happen tomorrow. This “mental time travel” can have a positive effect, even if it is just short-term.
  • Practicing gratitude by counting one’s blessings. Emmons and McCullough revealed that a grateful outlook can have a positive impact on subjective well being. Specifically, participants in a gratitude condition were asked to write down five things in their life for which they were grateful. In another study, having participants rank the extent to which they had experienced discrete sentiments (grateful, thankful, appreciative) lead to a decrease in negative emotion.

Although most of these self-help interventions seem intuitive, we often fail to do these things on a daily basis. Finding a means of performing small acts of kindness or counting one’s blessings have been proven to improve subjective well-being. I suggest finding the thing that works for you and is convenient in your day-to-day life. Hold the door. Help a classmate. Keep a journal. Despite seeming minor, small actions and positive thinking can have a substantial impact on subjective wellbeing. 

Psychology Resources

Positive Psychology Center: https://ppc.sas.upenn.edu/

Authentic Happiness: https://www.authentichappiness.sas.upenn.edu/

APA Psychologist Locator: https://locator.apa.org/

Association for Cognitive and Behavioral Therapists: https://www.findcbt.org/FAT/

McWell Notre Dame: https://mcwell.nd.edu/

University Counseling Center Notre Dame: https://ucc.nd.edu/

Disclaimer

The information and suggestions that I have provided here are in no means professional. This post has been reviewed by a faculty member of the University of Notre Dame Department of Psychology to verify accuracy.

Works Cited

Bolier, L., Haverman, M., Westerhof, G. J., Riper, H., Smit, F., & Bohlmeijer, E. (2013). Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC public health, 13(1), 119.

Buchanan, K. E., & Bardi, A. (2010). Acts of kindness and acts of novelty affect life satisfaction. The Journal of social psychology, 150(3), 235-237.

McCullough, M. E., & Emmons, R. A. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377-389

Quoidbach, J., Wood, A. M., & Hansenne, M. (2009). Back to the future: The effect of daily practice of mental time travel into the future on happiness and anxiety. The Journal of Positive Psychology, 4(5), 349-355.

Seligman, M. E. (2002). Positive psychology, positive prevention, and positive therapy. Handbook of positive psychology, 2(2002), 3-12.

Seligman, M. E. P., & Csikszentmihalyi, M. (2000). Positive psychology [Special issue]. American Psychologist, 55(1), 5-14.

 

Categories
Police and Public Safety Psychology Social Psychology

Let’s Talk about Police Reform

Questionable Practice: Critical Incident Stress Debriefing

Last week, I was listening to a Joe Rogan podcast on my way home from the store. His guest was Dr. Nancy Panza, a clinical psychologist from Cal State Fullerton. Aside from lecturing undergrads, Dr. Panza’s research interests include criminal forensic assessment and police psychology. She has worked with police departments from New York City, Alabama, and California. As you can tell, she seems to be very qualified to be talking on the subject of police reform and mental health.

While on the podcast, Joe Rogan asked for her suggestions on psychological standardization procedures for police departments across the country. She advocated for two: pre-employment psychological testing and critical incident stress debriefing. In her words, “critical incident debriefings are a must and should always occur, and they should be mandatory because they take away the stigma”. For those of you who don’t know, critical incident stress debriefing (CISD) encourages individuals involved in a traumatic event to share their thoughts and feelings, making sense of this “critical incident”. In addition to the supportive aspect of this intervention, CISD also provides participants with information about necessary coping skills. This immediate intervention is hoped to delay or eliminate stress reactions from the incident.

Seems like a convenient and effective strategy, right? Not quite. There is little available evidence to prove the effectiveness of CISD. Although it may seem intuitive that CISD would reduce the prevalence of later psychological disorders, there is limited empirical data showing that it reduces later psychological symptoms. For example, a meta-analysis from 2002 showed that non-CISD interventions and no intervention improved symptoms of post-traumatic stress disorder, while CISD did not affect these symptoms.

Other studies have even shown that groups receiving CISD actually wound up worse than groups that received no treatment after a traumatic event.  In a follow-up to a randomized controlled trial, patients who had received psychological debriefing following a car accident had significantly worse long-term outcomes in terms of psychiatric symptoms, travel anxiety, pain, physical problems, and overall level of functioning. 

What would explain these findings? The basic argument is that CISD hinders the natural information processing following psychological trauma. Individuals are taught to rely on health professionals, rather than the support and comfort of close family and friends. Research has shown that most trauma survivors have symptoms relieved within three months of the initial incident, without any intervention. 

Years and years of research have shown evidence of the ineffectiveness of CISD, and yet, a clinical psychologist is still advocating for this practice to be implemented into police departments across the country. It is time that we begin to look at different interventions to limit negative mental health outcomes in the police. 

 

Future Practices: Pre-employment Screening & Critical Incident Training

Although there is little research on the effectiveness of police prescreening, many agencies use evidence-based personality assessment tools such as the Minnesota Multiphasic Personality Inventory (MMPI) and the Inwald Personality Inventory (IPI). Both the MMPI and IPI have shown evidence of predictive validity in the area of job performance among police officers. For example, high scores on the IPI Family Conflict scale were associated with poorer job performance at one year and conflicts with supervisors and peers. The IPI Guardedness domain, which measures the tendency to hide personal flaws, also predicted future job performance. 

Beyond pre-employment testing, more needs to be done in the area of training police officers for distressing situations. Police who received trauma resilience training as rookies show less negative mood, less heart rate reactivity, and better police performance compared to a control group. Trauma resilience training involves initial psychological sessions, consisting of relaxation and imagery training with mental skill rehearsal. In addition, the officers participate in critical incident stimulation, which involves confrontation by an armed suspect (actor). The relaxation and imagery training was found to improve the performance of adaptive police behaviors during the critical incident stimulation, such as safety and control of the bystanders. 

Both pre-employment psychological screening and trauma resilience training are necessary to limit negative mental health outcomes among police officers. These evidence-based techniques have been shown to predict job performance, and in some instances, mitigate unfavorable consequences of critical situations. Critical incident stress debriefing has unreliable potential and should not be included in the interventions that police departments utilize.

 

Police Psychology Resources (from APA website)

  • Blau, T.H. (1994). Psychological Services for Law Enforcement. New York: John Wiley & Sons.
  • Kirschman, E. (1997). I Love a Cop: What Police Families Need to Know. New York: Guilford Press.
  • Kurke, M.I., & Scrivner, E.M. (Eds.). (1995). Police Psychology into the 21st Century. Hillsdale, N.J.: Lawrence Erlbaum Associates.
  • Visit policefamilies.com for resources for families of police officers.
  • For more information on the Police Psychological Services Section of the International Association of Chiefs of Police, visit www.theiacp.org or contact Kim Kohlhepp at (800) 843-4227, ext. 237.
  • APA’s Div. 18 (Psychologists in Public Service) includes a section on Police and Public Safety. 
  • The National Institute of Justice’s Corrections and Law Enforcement Family Support Program’s Web site is www.ojp.usdoj.gov/nij/clefs.

Disclaimer

The information and suggestions that I have provided here is in no means professional. This post has been reviewed by a faculty member of the University of Notre Dame Department of Psychology to verify accuracy.

Works Cited

Arnetz, B. B., Nevedal, D. C., Lumley, M. A., Backman, L., & Lublin, A. (2009). Trauma resilience training for police: Psychophysiological and performance effects. Journal of Police and Criminal Psychology, 24, 1– 9. doi:10.1007/s11896‐008‐9030‐y

Detrick, P. and Chibnall, J. T. 2002. Prediction of police officer performance with the Inwald Personality Inventory. Journal of Police and Criminal Psychology, 17: 9–17.

Hobbs, M., & Adshead, G., (1997). Preventative psychological intervention for road crash survivors. In M. Mitchell (Ed). The aftermath of road accidents: Psychosocial, social, and legal consequences of an everyday trauma (pp. 159-171). London: Routledge

McCanlies, E. C., Mnatsakanova, A., Andrew, M. E., Burchfiel, C. M., & Violanti, J. M. (2014). Positive psychological factors are associated with lower PTSD symptoms among police officers: post Hurricane Katrina. Stress and health : journal of the International Society for the Investigation of Stress, 30(5), 405–415. https://doi.org/10.1002/smi.2615

Michael S. Rogers, Dale E. McNiel and Renée L. Binder. (2019) Effectiveness of Police Crisis Intervention Training Programs. Journal of the American Academy of Psychiatry and the Law Online September 2019, JAAPL.003863-19; DOI: https://doi.org/10.29158/JAAPL.003863-1

Rose, S., & Bisson, J. (1998). Brief early psychological interventions following trauma: A systematic review of the literature. Journal of Traumatic Stress, 11, 697–710.

Scogin, F., Schumacher, J., Gardner, J., & Chaplin, W. (1995). Predictive validity of psychological testing in law enforcement settings. Professional Psychology: Research and Practice, 26(1), 68–71. https://doi.org/10.1037/0735-7028.26.1.68

van Emmerik AAP, Kamphuis JH, Hulsbosch AM, Emmelkamp PMG. Single session debriefing after psychological trauma: a meta-analysis. Lancet 2002; 360: 766.

Categories
Clinical Psychology

How to De-stress during Stressful Times

Psychological Well-Being

COVID-19. Protests. Killer hornets.

The past six months have provided many of us with a new way of experiencing the world, from the comfort of our own homes. We have been frustrated by distracting family members and the disruption of our normal lives.  Many of us are worried about very real threats, like a deadly disease or racial discrimination. Others are worried about more trivial issues, such as putting on a mask or hoarding toilet paper. The research is still unclear about how the past six months have impacted overall mental health. Stress does often play a role in the development of depression and anxiety; however, I AM NOT saying that your mental health should be negatively affected because of the COVID-19 pandemic.  I AM simply providing basic research on how stress can impact mental health and how you can combat psychological distress.

Stress is an emotional and physical feeling that influences the development of depression and anxiety, two of the most common psychological disorders.  Depression results from a cycle of negative thought patterns and emotions that reinforce themselves. Aaron Beck posits that outside stressors in combination with negative cognitive appraisals can contribute to negative beliefs about yourself and the world. This “cognitive triad” can trigger emotions like sadness and physiological symptoms, such as loss of appetite and inactivity. As time progresses, this depressive program reinforces pessimistic beliefs, contributing to a cycle of depression for the individual. The more external stressors we experience, the more likely we are to be sucked into a negative thinking pattern about ourselves and the outside world.

The development of generalized anxiety (GAD) follows a very similar pattern to that of depression. According to cognitive theory, we estimate the danger of external threats to certain degrees. When we assess the stressor as a “low threat”, we tend to pay less attention to it and push it to the back of our minds. However, when a stressor is labeled as “high threat”, it becomes central to our thinking and perception of everyday events. This maladaptive information processing, which is central to GAD, is biased in the direction of the stressor and impacts daily functioning. Higher levels of subjective stress and danger leave us at a higher risk of anxiety.

Depression and anxiety are only a few of the mental health issues that can arise out of times of high stress. Other forms of mental illnesses, such as eating and psychotic disorders, could be results of periods of hardship and tribulation. Let’s review a few of the key points.

  • Research is still unclear about the impact of the pandemic on mental health.
  • External stressors contribute to the development of depression and anxiety.
  • Other mental disorders can also arise out of times of hardship and high stress.

How to De-stress

When discussing strategies for combating mental distress, symptomatology of psychological disorders must first be identified. When experiencing depression, an individual is likely to feel sad and frustrated, often losing interest in everyday activities. Other signs of depression include trouble sleeping, reduced appetite, and slowed thinking or body movements. For a full list see Mayo Clinic

Generalized anxiety is often brought upon by dysfunctional information processing of outside stimuli. Psychological symptoms include excessive worrying, overthinking, and indecisiveness. Oftentimes, physical symptoms also manifest themselves, including fatigue, difficulty sleeping, and nervousness. For a full list of symptoms, see Mayo Clinic.

The “psychological defense” strategies that I will discuss are meant as a guide to help with combating mental distress. These are meant to be convenient and practical preventative measures, rather than professional treatments that would be prescribed by a psychologist or psychiatrist. The following evidence-based strategies have been found effective in resisting stress.

  • Take care of your body. EXERCISE and SLEEP!!! A recent study found that 30-60 minutes of exercise, 3-5 days per week, was linked to a lower mental health burden. Although we cannot infer that exercise improves mental health, there is definitely evidence that people who exercise demonstrate a lower risk for mental illness. In addition to exercise, carve out enough time to get a good night of sleep. Again, it is still uncertain if sleep causes mental health problems or if psychological disorders lead to sleep problems.  However, studies have shown that sleep deprivation is strongly correlated with mood disorders. The CDC recommends that adults (age 18-64) get more than seven hours of sleep per night to reap optimal mental and physical benefits. If you have trouble sleeping, this guide offers some tips.
  • Carve out time for relaxation. This could include relaxing your mind, your body, or both. Easy relaxation activities include breathing exercises, stretching, or meditation. Evidence-based relaxation techniques include Progressive Muscle Relaxation, Autogenic Training, and Diaphragmatic Breathing.  Other everyday activities, such as reading and or taking a walk outside, can have a positive impact on mental wellbeing.  No matter the activity you choose, make sure it is something you enjoy doing.
  • Spend quality time with close friends and family. It seems like you hear this advice come out of every psychologist’s mouth. That’s because it works! A long-running study from Harvard has shown that there is a strong association between happiness and close relationships ( is the link to the TED Talk about this study). Although it may seem like a difficult time to cultivate friendships, now may be the best opportunity to improve relationships with our family and close friends. These past six months have been the longest I have spent with my family since I left for college. This may be the last time in my life that I live under the same roof as all three of my siblings! Rather than sulking that I was sent home for college, I made the most of this situation, playing practical jokes on my younger brother and creating some great memories. Whether it be in-person or over Zoom, talking with those who are close with us will help us de-stress and push forward through these trying times.

     

Seeking Professional Help

If you are experiencing severe psychological distress, please utilize one of the following hotlines or find treatment by a licensed psychologist or psychiatrist.

Hotlines

  • Suicide Prevention Line 1-800-273-8255
  • Veterans Crisis Line 1-800-273-8255
  • Substance Abuse & Mental Health Services Administration (SAMHSA) National Helpline 1-800-662-HELP (4357)
  • OK2Talk Helpline Teen Helpline 1 (800) 273-TALK
  • Crisis Text Line Text SIGNS to 741741 for 24/7, anonymous, free crisis counseling

Find Treatment

Disclaimer

The advice that I have provided here is in no means professional. This post has been reviewed by a faculty member of the University of Notre Dame Department of Psychology to verify accuracy.

Works Cited

Aikins, D. E., & Craske, M. G. (2001). Cognitive Theories of Generalized Anxiety Disorder. Psychiatric Clinics of North America, 24(1), 57-74. doi:10.1016/s0193-953x(05)70206-9

Beck Proposes an Integrative Theory of Depression. (2016, March 31). Retrieved August 04, 2020, from https://www.psychologicalscience.org/observer/beck-proposes-an-integrative-theory-of-depression

CDC – How Much Sleep Do I Need? – Sleep and Sleep Disorders. (2017, March 02). Retrieved August 04, 2020, from https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html

George E. Vaillant; Charles C. McArthur; and Arlie Bock, 2010, “Grant Study of Adult Development, 1938-2000”, https://doi.org/10.7910/DVN/48WRX9, Harvard Dataverse, V4, UNF:6:FfCNPD1m9jk950Aomsriyg== [fileUNF]

Liza, V. (2015, March 13). Stress management techniques: Evidence-based procedures that reduce stress and promote health. Retrieved August 04, 2020, from https://www.hsj.gr/medicine/stress-management-techniques-evidencebased-procedures-that-reduce-stress-and-promote-health.php?aid=3429

Publishing, H. (n.d.). Sleep and mental health. Retrieved August 04, 2020, from https://www.health.harvard.edu/newsletter_article/sleep-and-mental-health