How to talk about teen suicide – Guidelines by age group

If you’re thinking about suicide, are worried about a friend or child, or would like emotional support, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor.

As professionals and as individuals, we are deeply grieved by the tragic loss of a senior student in our Fort Lauderdale community on October 6, 2022. We extend our sincere condolences to family, friends, and to the community who knew and loved this student. At this time of sadness and shock, may strong, loving support surround all who mourn, and may there be comfort in sharing positive memories of this special young person. 

The suicide of a young person is always a tragedy, one that happens more frequently than you might realize. Suicide is the second leading cause of death among young people 10 to 24 years old. So although talking about suicide is painful, it’s critical that we give our children and teens a safe space to answer questions and talk about their feelings. They need to know that they will be listened to, supported, and taken seriously and that there is no shame or embarrassment in admitting to the pain they feel.  

Honest conversations about suicide can help to destigmatize it, surface mental health issues, and provide an opportunity to offer assistance. We can’t afford to let our discomfort with the subject get in the way of saving a life.   

As a parent or trusted adult with young people in your life, you may want to know more about the warning signs of suicide and how to talk to those in your care about how they are feeling. Below, we offer a few thoughts and additional resources for further information.    

Suicidal Risk Behaviors 

 

While there are certain warning signs to watch for, it may not always be obvious that a young person is in emotional difficulty, and possibly even thinking about taking the ultimate step of suicide.  Your best warning system is your day-to-day effort to engage with your child, and if you have a concern, to address signs of depression or any other mental health issues early.  

Risk factors contributing to the rise of suicides among young people:

young person laying on the bed with hands covering her face. Text reading: suicidal thinking can start as early as the age of nine.

Suicidal thinking can start as early as the age of nine. Suicide among 9-year-olds remains relatively rare, and not all children who have suicidal thoughts will attempt suicide, but such thoughts are believed to increase a child’s risk. That risk carries on through the teen years.

Because adolescent brains are still ‘works in progress’ until about the age of 25, young adults are less able to control impulsive behavior. At this stage of life, emotions rule their choices, because the connections between two key areas of the brain are developing at different rates — the rational prefrontal cortex, responsible for decision-making, and the amygdala, responsible for processing strong emotions like fear. So, biology can play a role in leading a young person, struggling with other risk factors, to make a tragic decision. 

Young people face both personal struggles and serious concerns about the world around them. Many are struggling academically in the wake of the Covid pandemic and worry about college admission and job prospects. Their families may be experiencing financial difficulties. Many young people worry about climate change and its impact on their generation. War, political division, and other socio-economic issues are amplified on television and on social media.  

Add these concerns to normal adolescent development, including struggles to fit in and find their place in the world, and it’s not surprising that the pressures and anxieties facing young people can feel overwhelming. Young people live complicated inner lives, in addition to the stresses of the world around them. That’s why it’s so critical to sustain a healthy level of involvement with your child.   

Other risk factors: 

  • Genetic vulnerability: a family history of suicide, depression, or other mental illness biochemical factors and issues, e.g., faulty mood regulation isolation – physically and emotionally 
  • History of physical or emotional abuse, loss of a close family member, friend, or classmate by suicide or other sudden death 
  • Relationship breakup 
  • Previous history of depression or other mental illness 
  • Previous suicide attempts 
  • Threats, bullying, or violence from peers (especially with social media); as perpetrator or victim 
  • Substance use 

If you are concerned about any of the risk factors above or observe any of the signs listed below, take the time to talk to your teen. Even if they are not, in their case, a sign of suicidal thinking, they may still indicate some kind of struggle or mental health issue. We encourage you to seek help as soon as possible by contacting a mental health professional. The Bougainvilla House is here for you at (954) 764-7337. 

Warning signs: 

  • Increased substance (alcohol or drug) use 
  • Sees no reason for living; no sense of purpose in life 
  • Anxiety, agitation, inability to sleep, or sleeping too much 
  • Changes in eating patterns
  • Lack of energy and unwillingness to carry out regular tasks and responsibilities such as schoolwork or caring for a family pet 
  • Changes in academic performance – missing assignments, plummeting grades
  • Feels trapped – like there’s no way out 
  • Does not feel connected or have a sense of belonging 
  • Belief that they are a burden to others 
  • Hopelessness, feelings of failure, low self-esteem, harsh self-judgment 
  • Withdrawal from friends, family, activities, and favorite pastimes 
  • Rage, uncontrolled anger, seeking revenge, lashing out at and rejecting the support of loved ones 
  • Acting recklessly or engaging in risky activities without thinking 
  • Dramatic mood changes 

Young person leaning on a hall with the suicide and crisis lifeline number. Reading call or text 988 available 24 hours.

Urgent Warning Signs: 

  • Talking about suicide or a suicidal plan (verbalizing, depicting, or writing about suicide) 
  • Researching ways to harm or kill oneself 
  • Saying things like: “I’m going to kill myself,” “I wish I were dead,” or “I shouldn’t have been born” 

Take statements and actions like these seriously – they are truly red flags. Call 911 and/or get immediate professional attention. Note the important crisis hotlines and resources listed at the conclusion of this post. 

Talking About Suicide – Guidelines by Age Group 

 

Don’t worry that bringing up the topic of suicide will somehow ‘plant’ the idea in your child’s mind. Approach the subject honestly, calmly, and at an age-appropriate level, acknowledging their thoughts and emphasizing that assistance is always available. Remember to maintain an open mind and a non-judgmental tone. Young people need to know they are loved, valued, that help is available, and you will be there for them. And they can offer the same support to their friends. Here are some ways to open up a conversation.  

Children  

When talking to young children, keep it simple and short. Talk about it like any other health condition and use words that your child will understand. For example, “This person had a disease in their brain that made them really sad, and they died.” Follow their lead and answer their questions with short, clear replies. Keep the conversation positive with a hopeful outlook and reassure them that they are not responsible in any way. 

Children can understand that death is permanent and that a person who has died is not coming back. But they may continue to think or act as though the person is still present, able to see and hear them and to experience feelings.   

Pre-teens (9-12) 

With pre-teens, you can give more details and introduce them to the warning signs of suicide. Around this age, pre-teens experience strong emotions and sometimes may not know how to cope with their feelings or those of their friends. They likely have heard someone talk about depression or suicide, so ask them what they know about it and how it makes them feel. Listen to their answers and correct any misinformation. You may gain insights into the state of your child’s mental health or identify a concern they may have about a friend.  

Pre-teens can also understand that death is permanent, and they may even have questions about what specifically caused the death. They generally know when adults are trying to protect them by not telling the truth, and they often learn of suicide from other children or by overhearing conversations. 

Teens (13-17) & Young Adults (18-24) 

Teens have a good understanding of mental health conditions, and they likely know someone who has experienced mental illness, if they do not live with mental illness themselves.  Let them know that the pain of depression and other mental illnesses is real, and not something one can just “power through”. Reassure them that these conditions are not caused by weakness, but rather are illnesses that can be treated. 

Offer support and let them know you are there for them if they ever want to talk, whether about themselves or about a friend. Remind them it is okay, and, in fact, critical to reach out for help, and follow up with resources if they or a friend are in emotional distress   Be a good listener and allow your teen to talk openly and express their opinions and thoughts. Again, we can’t overemphasize the importance of maintaining a ‘healthy connectedness’ with the young person in your life. As adults, we want to fix whatever isn’t working for them, but ask yourself if it’s a time to intervene or a time to offer support and a listening ear. There’s such a thing as being too involved and intrusive, but also too hands-off.  

In mental health, as in many other situations, there’s a happy medium that will help your child grow and problem-solve for themselves — even fail sometimes — knowing you are there for them if they are struggling. 

For more specific questions to ask your child or teen about suicide visit here.

If you’re worried about a young person in your life, be the one who asks all the important questions — you could save their life.

 

Suicide and Crisis Lifeline Call or Text- 988 
Hours: Available 24 hours. 

Crisis / Suicide Intervention
24-Hour Helplines – Dial 211
First call for Help – Broward   County
24 hours / 7 days a week 

Teen Hotline
Phone: (954) 567-TEEN
Phone: (954) 567-8336 

Seek help  

If you or someone you know shows one or more signs of suicide risk factors or struggling with mental illness, or emotional distress, consider talking to a mental health professional. The Bougainvilla House is here for you, with a safe space and an understanding and welcoming environment for you and your family. Take that important first step and ask for help.     

The Bougainvilla House also offers Parenting Workshops to provide tools and strategies that support healthy families and nurture future generations as they grow.      

Call now to find support for you and your family: (954) 764-7337. 

Realistic goal setting and improved self-esteem: exploring the connection

It feels good to set a goal and achieve it. But there’s a much deeper connection between goal setting and self-esteem than you might realize, especially for those who struggle with self-doubts and negative self-talk. Here’s the good news: as you progress toward your goal, you can actually break that cycle of self-criticism, low self-esteem, fear of failure, and inertia.

As you commit to and work toward your goal, you’re also boosting your self-esteem in all kinds of important ways:
– motivation
– sense of purpose
– improved focus

Every small success you experience along the way releases positive hormones and builds your resiliency and your ability to deal better with any setbacks or emotional ups and downs. And you can’t beat that sense of satisfaction and achievement when you finally check that box – you did it! So, whatever your goal — starting a gym routine, saving money, finding a new friend group or hobby, or improving your grades –your journey starts with a strong inner voice telling yourself you can do it and that you deserve to succeed.

But if you struggle with low self-esteem, don’t let that stop you from going after a goal that matters to you. Self-worth is something you work on throughout your life. Just be extra aware, recognize when your negative self-talk is preventing you from making progress, and channel your inner cheerleader instead. Make a list of positive qualities and things you do well. If there’s a person in your life who lifts you up, reach out to them for support. With a positive mindset, you are ready to go to work! Here is a step-by-step guide to help you set, plan, and start achieving your goals.

What is your true ‘why’?

Before you start writing down or even thinking about your goals, you need to understand what you want to accomplish and why it matters to you. Think about your true ‘why’ as a word, feeling, or theme that you care about deeply – something that will affirm, motivate and reward your efforts.

For example, if your goal is to be financially independent and save money, then perhaps your true ‘why’ is ‘security’. Or if you want to make the world a better place by getting involved and volunteering, then your true ‘why’ could be ‘generosity’. A desire for more ‘confidence’ might drive you to set goals related to physical fitness. Think about what really matters deeply to you and set goals accordingly.

Your goals should align with how you want to feel in the end. If they don’t align or feel right, you won’t care as much about accomplishing them. Give yourself some time to think about your ‘why’ and then set your goals.

How to set realistic goals

Remember to keep your goals clear and concrete, using positive language: “I will” vs. “I won’t”. And try to create goals that play to your strengths.

1. Make your goal specific

Be specific when setting your goals. For instance, if you want to be more physically active, get into the details: “I’d like to work out at least twice a week at the gym for 3 months.” rather than a vague, easily procrastinated goal like “go to the gym.” Which goal would be more likely to encourage you to work out?

2. Set achievable goals

For example, if your goal is to get into an Ivy League school and your grades just aren’t up to their standards, you’re setting yourself up for disappointment. However, that doesn’t mean you won’t be able to attend a great college. It just means the Ivy League goal isn’t realistic. As you decide which goals to pursue, it’s good to know the difference between an ambitious yet realistic goal and a goal that isn’t achievable. The process of creating a plan to achieve your goal should help clarify whether or not your goal is realistic and reachable.

3. Plan for success

Now it’s time to get real and get detailed. Map out the decisions, actions, and habits that will make it easier to succeed. Think about possible barriers, and what might have to be changed or set in place in order to clear the way for you to reach your goal. And make your goal measurable: how will you define success?

Next, break down your goal into categories, and think about the action steps, tasks, milestones, and timeline that you will follow. Your plan is there to help you progress toward your goal, so as you move forward, rethink your action steps if you find they aren’t working for you. This is under your control – you can always revisit and revise your plans along the way.

4. Give yourself a deadline

Deadlines give you structure, allow you to plan, and create a sense of urgency, which can create momentum to help you reach your goal. Think about a realistic timeline that will allow you to successfully meet your goal while carrying on with day-to-day life.

5. Make yourself accountable

Don’t be shy about telling others what you want to achieve. By sharing your goals with someone who cares about you, you give yourself a 65% chance of success – and if you set up a weekly check-in with your ‘accountability buddy’, you raise your chances of success to 95%. When you share your goals, others can see and support your efforts — and celebrate with you when you accomplish them!

Try to minimize and eliminate temptations that might derail you. For instance, if you’ve set a goal to go out for a run at a certain time, set an alarm, get ready to go, and don’t get distracted by mindless scrolling or anything that might give you an excuse that “oh, now it’s too late.”

As you work toward your goal, pay attention to your emotions and state of mind, and try to curb any self-critical thoughts. This is your journey and it’s as much about positive mental health as it is about checking the box. You can do this – go for it!

Need more help?

If you or a loved one feel depressed or unmotivated to achieve their goals, consider talking to a mental health professional. Find a safe person and space in which to talk. The Bougainvilla House is here for you, with an understanding and welcoming environment for you and your family. Take that important first step and ask for help.

The Bougainvilla House also offers Parenting Workshops to provide tools and strategies that support healthy families and nurture future generations as they grow.

Call now to find support that works for you and your family: (954) 764-7337.

The insidious danger of fentanyl: facts to help you protect yourself, your friends, and your family

An extended hand full of prescription drugs (fentanyl)

As we enter September and National Recovery Month, we at The Bougainvilla House pause to recognize International Overdose Awareness Day, August 31st. Many wear purple to destigmatize drug-related deaths and remember the individuals and families tragically impacted by drug overdoses, including one of the most deadly and insidious of all — fentanyl. 

In 2017, the U.S. Department of Health and Human Services (HHS) declared misuse of opioids, including fentanyl, a public health emergency and a crisis we continue to face today.  

To mark National Recovery Month, TBH wants to highlight and educate young people and families on the dangers of opioids, fentanyl in particular. In addition, we want to share resources that might save a life or help a friend or family member start their journey of recovery from addiction.   

What is Fentanyl? 

Fentanyl is a manufactured opioid drug, first developed in 1959 and introduced in the 1960s as an anesthetic and medication to relieve cancer breakthrough pain. The drug is odorless, tasteless, and colorless, making it difficult to identify unless it’s tested. It’s so powerful that an amount the size of two grains of salt is enough to overdose and kill. 

As an analgesic (pain reliever), fentanyl is 50-100 times stronger than morphine and 50 times stronger than heroin. Fentanyl’s addictive properties and potential for abuse immediately concerned the U.S. Food and Drug Administration (FDA). To minimize this risk, fentanyl was initially approved only for use in combination with droperidol, a drug used as a sedative, tranquilizer, and anti-nauseant. In 1972, fentanyl became available for use on its own.  

Fentanyl abuse and death tolls continue to spike 

As early as the mid-1970s, cases of prescription fentanyl abuse were already being reported, due to theft, fake prescriptions and illegal distribution by patients and some members of the medical community.  

By 1979, illegally-produced fentanyl had hit the streets. From about 1000 deaths reported by the US Drug Enforcement Administration (DEA) between 2005 and 2007,  deaths from mainly non-prescription use of fentanyl have spiraled to more than 70 times that number. This past May, the Centers for Disease Control (CDC) reported 71,238 fentanyl overdose deaths in 2021. To put this into perspective, that’s more people than a sold-out Hard Rock Stadium, and only a portion of all the opioid overdose deaths that year.

Why are fentanyl-related deaths so high? 

Illegally-produced fentanyl is sold by itself but, even more dangerous, it is often mixed with or sold to the unknowing buyer as heroin, cocaine, or in pills purporting to be oxycodone or other well-known legal pharmaceuticals. Fentanyl goes by the street names Apace, Friend, Murder 8, China Girl, China Town, China White, Dance Fever, Jackpot, King Ivory, Goodfellas, Great Bear, He-Man, Poison, and Tango & Cash. 

Fentanyl use – effects on the body 

  • Confusion 
  • Changes in pupil size  
  • Cold, clammy skin 
  • Cyanosis 
  • Slow, shallow breathing 
  • Nausea, vomiting 
  • Drowsiness, dizziness,
  • The presence of coma, pinpoint pupils and slow, shallow breathing are strong signs of fentanyl or other opioid poisoning. 

Who is most vulnerable to fentanyl overdoses?  

Because fentanyl is so powerful, prevalent, and often disguised as other drugs, including prescription drugs, the reality is that anyone can be a victim of a fentanyl overdose. Someone who needs prescription painkillers, who uses drugs recreationally, or is just curious is at risk of becoming a victim of accidental addiction or overdose.  

Many famous celebrities have been victims of an accidental overdose:  

  1. Juice WRLDShortly after his 21st birthday, in December 2019, rapper Juice WRLD suffered a seizure after arriving in Chicago. The cause of death was an accidental overdose of codeine and oxycodone (opioids). 
  2.  Mac MillerIn September 2018, the rapper died at his home in the Los Angeles area following an accidental overdose of fentanyl, cocaine and alcohol. Miller had reportedly requested the painkiller Percocet. The rapper-producer was 26 years old.  
  3. Prince – The music legend was only 57 when he died of an accidental fentanyl overdose, in April 2016. He believed he was taking Vicodin (a chronic pain pill), but his pills were laced with fentanyl.  

People who are dependent on opioids often also have a co-existing mental health condition, such as depression or anxiety, and many turn to drugs as a way to cope. By recognizing and seeking treatment for mental health problems, vulnerable individuals get the support they need and learn healthy coping skills that might prevent them from turning to drugs. If you or someone you love suffers from mental illness, please seek help. It’s the right thing to do to improve quality of life, prevent addiction, reduce unnecessary deaths, and avoid the trauma and heartbreak that too many American families have experienced. 

How to talk to a friend or family member about their possible drug use

If you are uneasy about a friend or family member’s drug use (or suspected drug use), talk out your concerns. Give examples of times when you were worried about them or noticed a change in their behavior. Share your love and reassure them that help is available and that you will support them throughout. Encourage them to take that first step and seek help, sooner than later. 

In the meantime, educate yourself on the signs of an overdose and on how you can save a life by reversing an overdose. Here is a small list of resources in Broward and Palm Beach County.  

Resources 

  1. The Bougainvilla House – Substance use therapy program.
  2. End.Overdose – Fentanyl test strips, Narcan and more.  
  3. Find Naloxone in your state – Nalaxone (also known as Narcan) is a life-saving medication that can reverse an opioid overdose. 
  4. Broward County Recovery Center – Schedule an appointment to be evaluated for detoxification.  
  5. The Recovery Villagedetox, inpatient, and outpatient treatment centers.  

Need more help?   

If you or a loved one feel depressed or are having a hard time with substance use, consider talking to a mental health professional. Find a safe person and space in which to talk. The Bougainvilla House is here for you, with an understanding and welcoming environment for you and your family. Take that important first step and ask for help.     

The Bougainvilla House also offers Parenting Workshops to provide tools and strategies that support healthy families and nurture future generations as they grow.    

Call now to find support that works for you and your family: (954) 764-7337.

Body Positivity – A Guide to Embracing Yourself!

4 woman of different body shapes and sizes smiling

These days, we can’t get away from images of “happy beautiful people” who populate our digital world. Just check out all the carefully curated posts in your social media feed, not to mention media advertisements and content –no wonder they collectively fuel unattainable body expectations.  

But the problem isn’t limited to unrealistic media imagery. We also compare ourselves to people we know – classmates, teammates, coworkers.  

We all have things we don’t like about the way we look — weight, height, skin, hair, muscularity, shape, voice, smile, style…whatever it is, it’s easy to hyperfocus on it, and to think that’s all that other people see in you as well. 

How we see ourselves, and how we think others see us, has a lot to do with how we feel day to day, fueling feelings that easily spiral into depression, anxiety, and other mental health issues. To combat the negative impact that looks can have on self-esteem, the body positivity movement has gained national attention and flooded our timelines in recent years. The movement promotes being comfortable in your own skin, offering messages like “You’re beautiful just the way you are,” or “Love your imperfections.”  

This movement may feel like it’s recent, but it’s actually been around since the 1960s! To understand its true meaning, we need to go back to 1969 during the Fat Rights Movement, when a young engineer from New York named Bill Fabrey was angry about the way the world was treating his overweight wife, Joyce. He gathered a small group of people and created the National Association to Aid Fat Americans, today known as the National Association to Advance Fat Acceptance (NAAFA) to promote body positivity through community activism.  

It’s easy to preach positivity, but sometimes not so easy to truly feel it. Want to transform your life and change how you see yourself? Here are some ideas on how to embrace yourself and help others feel better as well. You deserve it – we all do!  

A Guide to Embracing Yourself 

Focus on how you feel instead of on the scale  

There is no one body type that’s ‘perfect’ or ‘healthy.’ So don’t get caught up in the numbers, or what’s in the mirror, when you are measuring the progress of your health journey. Instead, focus on how you feel physically and mentally, and remember that a number on a scale does not measure your body composition, the ratio of muscle to fat in your body, or your energy, spirits, or enjoyment of life!  

Remember to speak to a health professional you trust. They can help you better understand your body’s needs, choose healthy habits and behaviors, and set realistic goals. Understand and accept that if you do want to make changes to any aspect of your health, it will take a combination of large and small goal-setting, and a lot of commitment, patience and effort. But you can get there, especially if you have faith in yourself. And it never hurts to have good professional help in your corner! 

The numbers that we often focus on – weight, BMI, and bodyfat percentage – are each only a small part of our overall wellbeing. Check out this social experiment to see how misleading those numbers can be and how hard it can be to guess them. 

Avoid body-shaming yourself 

Focus on what you DO like about yourself and your body, rather than what you don’t. Celebrate it and play it up! Try to avoid giving voice to body-shaming thoughts or comments. Be a friend to yourself – that includes your body! 

Take care of your body 

Learn to recognize and give your body what it needs – like rest, relaxation, destressing, healthy food, and activity. Learning to love and care for yourself includes loving and caring for your body – and that starts with awareness. 

Get Inspired  

Embracing yourself includes taking time to do whatever brings you joy. Not sure where to start? Write down the things that make your heart, your mind, AND your body feel good. Look for people and activities that encourage you and build you up, both in the real and digital worlds.  Find sources of inspiration and motivation that keep you positive and help you work toward your goals. 

Use Positive Affirmations  

Despite best efforts, it’s easy to look in the mirror, give in to your insecurities and make judgments about yourself. These negative thoughts can really affect your mental health especially if they develop into a pattern of behavior which alters the way you view yourself and others.  

Positive affirmations challenge these negative thoughts by reminding you that you’re worthy, strong and beautiful. They help you remember to be kind to yourself. They say talking positively to plants helps them grow — imagine what it can do for yourself and those around you.

Here are some affirmations you can say to yourself:

  • My body is beautiful, my mind is strong.  
  • I am at peace with my body, my mind, and my life. 
  • I love myself yesterday, today and tomorrow.  

 More affirmation for every aspect of your life.  

Curate Your Social Media 

We spend 5.4 hours a day on our phones, so it’s important to be intentional about the content we consume. Social media platforms curate your feed based on content in which you show interest, and the people and organizations you engage with and follow. Review your feed and ask yourself: does this content help me mentally or physically? Does it inspire me? Does this person make me feel good about myself? 

If the answer is no, it is best to unfollow them and look for people who do.  Follow social media accounts that truly align with your life goals. Not only will this boost your self-esteem, mental health and well-being, it will help you redirect yourself toward the life and self-image you want and deserve.  

Beauty is Defined by YOU.  

“The best and most beautiful things in the world cannot be seen or even touched but must be felt with the heart.” Despite Helen Keller’s sight and hearing disabilities, she felt and was constantly inspired by the beauty of the world.  

Beauty is defined by you –not by a number on a scale or by other people’s opinions. So, love and care for yourself. Your sense of confidence and conviction will not only inspire and sustain you – others will feel and respond to it as well.  

Women Who Embrace Body Positivity  

  1. Ashley Graham — The first size-16 model to land on the cover of Sports Illustrated. The supermodel quickly became an icon and example of body positivity in the fashion industry.  
  2. Lizzo – This singer and songwriter doesn’t shy away from advocating for the body positivity movement. The Grammy Award-winning artist has been open about how society judges people’s appearances, and about negativity towards plus-size women. 
  3. Estefania (Tefi) Pessoa – Famous for her TikToks about pop culture and life advice. She is known for her personality and views about the beauty industry, as she shared her struggles with an eating disorder in her teens.  
  4. Laverne Cox – You might know her from the Netflix show Orange Is The New Black. The actress and LGBTQ advocate makes it a priority to inspire others to love themselves, across all identities, shapes, and sizes.
  5.  Jules Von Hep – Influencer, podcast host and celebrity tanning expert. He’s best known as a promoter of body positivity and inclusivity in his videos.  

For more inspiring people to follow, click here.  

Need more help?  

If you or a loved one feel depressed or are having a hard time with self-image or self-esteem, consider talking to a mental health professional. Find a safe person and space in which to talk. The Bougainvilla House is here for you, with an understanding and welcoming environment for you and your family. Take that important first step and ask for help.    

The Bougainvilla House also offers Parenting Workshops to provide tools and strategies that support healthy families and nurture future generations as they grow.   

Call now to find support that works for you and your family: (954) 764-7337. 

 

Communication, Comfort, Caring: Age-appropriate conversations about school shootings

Our screens are full of horrifying images and accounts of the recent massacre of children in Uvalde, Texas, on May 25, and of other shootings both before and since.   

Here at The Bougainvilla House, we are thinking with compassion of the families and their trauma, and also of all the families across the nation and right here in our community, trying to make sense of the senseless loss of precious lives. Of parents trying to support their children. Of children and teens as they wonder if they are safe at school. 

We understand the shock, the sorrow, and the stress our families are enduring, and also the importance of talking about it together. Below, we offer a few thoughts on how to talk to children and teens about school shootings, and additional resources for further information.  

How to talk about tragedy: 

  1. Manage your own response 
  2. It’s important to talk 
  3. Age by age 
  4. Keep it normal 
  5. Limit media exposure 
  6. Know your child 
  7. Seek help if it’s needed 

Manage your own response.

Before you talk with your child, make sure your own emotional reactions are under control. It’s understandable to feel deep grief, fear and other emotions, but take time to look after yourself and to process these feelings so that you are ready to support your children. 

Should I talk about it with my kids? 

If you are a parent of a young child, decide if you want to tell them about the event. As a general rule, the American Psychiatric Association and the American Academy of Pediatrics counsel against telling children age 8 and under about tragic events like a school shooting, unless they are directly affected or likely to hear about it from others. Know your child and the likelihood that they may find out about the event, and decide accordingly.  

It’s important to signal to teens and older children that you’re open to talking about the tragedy, even if they don’t bring it up themselves. Equally important, don’t force the conversation if your teen is unwilling to discuss it. Let them know you are willing to talk anytime, that you’re concerned about their feelings and want them to know they can come to you with questions, comments and concerns.  

Age by age 

 

Preschool and early elementary-age children:

Decide on the simple story and message you want to give very young children. If you have reason to think they have seen or heard something about the shooting, plan out a simple sentence or two to explain, and try to balance it with a positive or caring message; for example, “a very angry person hurt some people, but the helpers are taking care of their families, just like we are here taking care of each other. Especially when we feel sad.” 

Parents who want to talk more directly about the event may want to consider this approach, offered by Dr. David Schonfeld, director of the National Center for School Crisis and Bereavement. Schonfeld, who works with communities affected by mass shootings, suggests parents include some context for the location of the event relative to their own community: “I want to let you know that in a school that is hours away from us, there was a person who shot some children and adults, and a lot of people are sad.” 

Older elementary-age children: 

Find out what your child knows and wants to know, if anything. That gives you an opportunity to correct any misinformation and to answer their questions, but without giving too much detail. If you don’t know, or want to think about your response, say so, and follow up if you think it is appropriate. 

Young children quickly focus on how the event affects them. Talk with your child about everything that the school and the community do to keep them safe. It may also help to remind them that these events are uncommon (even if it doesn’t feel like it to you) and that they can go to school without worrying about their safety.  

Tweens and young teens: 

You can safely assume your child knows about the event, so ask them what they’ve heard. Listen actively and carefully, for both possible misinformation and for their emotional response to the news. They may be sad and scared, but afraid to show it or to appear babyish. Reassure your child that it’s okay to be upset, that this is a time when we all need to lean on others, and that you’re there to listen and support.    

Teens: 

Teens are old enough to understand if you express your own feelings about tragic events. Depending on your child’s personality, it may open the door to a discussion of their own feelings. Again, active and sensitive listening is the key, as well as respect for their own willingness to discuss their feelings.   

Make sure they know you are willing and open to talk about the event, including a discussion of the larger issues at stake, and what the country, state, community, school, and individuals can do to address it.  Gen Z teens can be skeptical challengers of information and opinions, so be prepared to say, “I don’t know” and to be honest and direct with your teen.   

With older children and teens, an event such as a mass shooting is also a reminder to reinforce the need to avoid bullying, judging, or isolating others, to be kind and inclusive with fellow students, to let a trusted adult know if they see or hear something concerning, and to call out negative behavior when they see it in others.  

Other healthy practices: 

 

Limit media exposure 

For your children’s sake and for your own, limit the amount of exposure to media coverage of events like the recent school shooting. It’s easy to keep watching and following every sad, horrific detail, but there is a cost to your family’s peace of mind and to yours as well.   

Keep it normal

Maintain normal household routines, rules, and expectations: doing homework, getting rest, exercising, enjoying activities, and eating healthy meals.  There is comfort in routine, for both you and your children, and it will help to reassure them that their world continues to be safe and predictable.  

Know your child 

You know your child, so watch for any changes in behavior, habits, attitude, mood, and socializing. If you have concerns, keep in touch with teachers, coaches, employers, youth leaders, and others who might need to be aware. And be sure to keep an open line of communication with your child, whether or not they appear to welcome it.  Find out more here. 

Seek help 

If you or a loved one are struggling with fear, anxiety or stress, consider talking to a mental health professional. The Bougainvilla House is here for you, with a safe space and an understanding and welcoming environment for you and your family. Take that important first step and ask for help.    

The Bougainvilla House also offers Parenting Workshops to provide tools and strategies that support healthy families and nurture future generations as they grow.     

Call now to find support for you and your family: (954) 764-7337.  

Additional Resources: 

 

https://www.schoolcrisiscenter.org/wp-content/uploads/2020/08/Guidelines-Talking-to-Kids-About-Attacks-Two-Sided-Onesheet-Format.pdf 

https://www.nctsn.org/sites/default/files/resources//parents_guidelines_for_helping_youth_after_the_recent_shooting.pdf  

https://healthychildren.org/English/family-life/Media/Pages/talking-to-children-about-tragedies-and-other-news-events.aspx 

https://kidsafefoundation.org/topics/an-age-by-age-guide-to-talking-to-children-about-mass-shootings/ 

Original source: https://www.nytimes.com/article/talk-about-school-shootings-kids.html? 

The Myth of the “Strong, Silent Type” – Understanding Male Depression

In an episode of The Sopranos, crime boss Tony Soprano describes American actor Gary Cooper as the epitome of the ‘strong, silent type’. During the golden age of Hollywood, Cooper’s on-screen persona became the dominant image of the ideal American male figure. He portrayed a specific breed of masculinity, a physically strong man of action, quiet and emotionally reserved, never displaying feelings or weakness. Thankfully, things have changed since the 1950s. With the rise of mental health awareness, men are now encouraged to share their emotions and seek help in handling life’s challenges. 

June is Men’s Health Month and, while we have come a long way in encouraging men to be vulnerable, old perceptions of masculinity and gender stereotypes still affect young men.  

Brendan Maher, Movember’s global mental health director, saysyoung men are still feeling under pressure to conform to age-old, masculine stereotypes that stop them from talking about the things that keep them up at night.”  

Why is it hard for young men to talk about their feelings?  

The outdated perceptions of masculinity pressures young men to “man up” when life gets hard, causing them to suffer in silence to avoid being bullied, mocked, or labeled as weak. They feel this pressure not only from older men, such as relatives, but also from peers.  

Call it for what it is: an emotionally stunting expectation that makes it hard for teens and young men to express themselves honestly, because they may come to believe that it is inappropriate and risky to do so.  This reticence can affect their present and future relationships and, potentially, their parenting styles. 

A study conducted by research firm Ipsos MORI, found:

  • 58% of men feel like they’re expected to be “emotionally strong and to show no weakness.” 
  • 38% of men have avoided talking to others about their feelings to avoid appearing “unmanly.”  
  • Over half (53%) of American men between ages 18 and 34 say they feel pressure to be “manly.”  
  • 22% of those in this age group say they’re always or frequently mocked for “not being manly enough.” 

If a boy grows up in an environment where they aren’t encouraged to talk about their feelings, it’s tough to overcome later on in life.  This can lead to problems in developing their emotional and relational abilities.  

There are other reasons why men have a tough time sharing feelings. You can find more reasons here.  

Male depression 

Part of being human is the ability to share experiences and connect with others. Suppressing emotions has been linked to cardiovascular health issues, memory loss,  lower immunity to illness, lower productivity and faster burnout. It can also lead to depression and anxiety, and, significantly, it can also increase male suicide risk. 

In 2020, white males accounted for 69.68% of suicide deaths, with middle-aged white males accounting for the greatest number of suicides. The symptoms of depression look different for men and women. Men who feel depressed may appear to be angry or aggressive instead of sad, making it difficult for their families, friends, and even their doctors to recognize the anger or aggression as depression symptoms. 

Giving the boot to the “strong, silent’ myth 

The first step toward male mental wellbeing is to encourage all children and teens, regardless of gender, to express their emotions in healthy ways. Emotional Intelligence can be learned, along with stronger communication and interpersonal skills. Parents can start by raising boys who freely express emotions and can question masculinity stereotypes. Older family members can also work on recognizing and unlearning some of these stereotypes themselves. 

Men need to know that they aren’t alone, and that expressing emotions is natural, normal, and healthy. It also helps to hear stories from men in their midlife who have overcome mental health disorders. The more men hear  stories  from different social groups, sexualities, ethnicities, and ages, the more they will feel seen, understood, and supported.  

Men’s Mental Health Resources 

Movember Men’s Stories: https://us.movember.com/story?tag=mental-health 

Movember:  https://us.movember.com/mens-health/mental-health 

Young Adult Therapy: https://thebougainvillahouse.com/programs/specialty-treatments/  

Need more help? 

If you or a loved one feel depressed or are having a hard time expressing emotions, consider talking to a mental health professional. Find a safe person and space in which to talk. The Bougainvilla House is here for you, with an understanding and welcoming environment for you and your family. Take that important first step and ask for help.   

The Bougainvilla House also offers Parenting Workshops to provide tools and strategies that support healthy families and nurture future generations as they grow.    

Call now to find support that works for you and your family: (954) 764-7337. 

De-stress tips that work for students during finals week

End of school year + final tests = Stress 

As the end of the school year approaches many students are experiencing more stress, not less.  Time is getting short to tackle late assignments, write those end-of-year papers, hand in those final projects, give presentations, and prepare for exams.  

At the same time, many are taking part in sports, recitals, theater productions, and other end of the year activities, and looking for summer jobs as well.  No wonder many students feel overwhelmed and exhausted.  

In fact, three quarters (75%) of American high schoolers and half of middle schoolers described themselves as “often or always feeling stressed” by schoolwork.

Stress is your body’s response to pressure. It is often triggered when you’re experiencing something new and have little control over a situation, or when you encounter something that threatens you. Stress is something we all experience. However, too much stress can affect your health, escalating anxiety, depression, headaches, muscle tension and pain, and more. That’s why it’s so important to learn healthy ways to cope with life’s stressors. 

Is there such thing as good stress?  

Yes! “Good stress,” or what psychologists refer to as “eustress,” is the type of stress we feel when we’re excited. For example, that feeling you get at the top of a roller coaster, poised for a wild ride ahead, or the energy you feel when you’re near the finish line during a race. These exciting moments are what make us feel vibrant and excited about life. Without good stress, our lives might be bland, boring, and even unhappy.  

When you view stress as a challenge instead of a threat, this change in perspective allows you to more easily manage the pressure. Think of your stress as an opportunity to prove to yourself what you’re capable of accomplishing. Knowing how to overcome your stress during difficult situations helps you focus on your tasks, stay calm, and avoid focusing on all of the bad things that could happen.  

De-stress tips  

When it comes to relieving stress, it’s about figuring out what works for you. Here are some suggestions to try out:  

  1. Get organized. We understand that getting and staying organized can be hard work but creating a to-do list will help reduce the sense of drain and chaos that you feel as due dates approach. Note the due dates of all your tasks and add them to your calendar, together with your schedule. Don’t forget to include class time, assignment preparation, study time, tests, group meetings, and extra-curricular obligations like practices, babysitting, job shifts, home chores, etc.
  2. Manage your time. Your organizational efforts will pay off with a visual aid to help you plan your work time, avoid overbooking yourself, and find time to hang out with friends, exercise, and do other activities. So instead of waking up without a plan and spending your day doing things whenever you feel like it, try time blocking. Time blocking helps you make productive use of your day, by working during the hours when you feel most focused and engaged. As you plan your time, think realistically about how long each task will take, and schedule studying, papers writing, and assignments for a time of day when you work most effectively. Use other less effective times of the day for exercise, chores, or fun with friends. If you are a morning person, schedule those hours to produce your best work, and vice versa if you feel most focused after lunch. This way, time will always work with you and not against you.
  3. Practice deep breathing. The symptoms of stress can vary depending on the person, but in periods of high stress, be mindful of your body’s needs. Deep breathing strengthens full oxygen exchange and helps slow down your heart rate. The result? Relaxation. Even though breathing comes naturally to us, exercising deep breathing takes practice and conscious effort. Here are some techniques to try at home or during a walk.  
  4. Keep it positive. When you are stressed, how do you talk to yourself and others? Does being stressed turn you into a jerk? If your stress causes you to take out your frustration on others and sometimes yourself – that is not okay. When you feel like your stress is about to burst out of control, try taking a deep breath and remember to adjust your tone and your self-talk. You can say things like “Thank you for your help, but I just need to be alone for a minute” when you’re talking to others or “I can do this” when talking to yourself.  
  5. Exercise. No surprise here! Exercising is a great way to release tension and stress. When you exercise, your focus on something other than your stressful work or school day, allowing you to return to your tasks with a clear head. Exercise also releases endorphins (feel-good chemicals in the brain) which is why you feel good after working out. So next time you’re stressed out, try going for a walk or run, doing yoga, kickboxing, or whatever form of exercise helps you blow off that steam.  

Stress videos to watch: 

  1. How we cope with anxiety & stress by MTV’s Teen Code https://www.youtube.com/watch?v=0qnYXCLk5bQ  
  2. How to make stress your friend by Kelly McGonigal https://www.youtube.com/watch?v=RcGyVTAoXEU 
  3. Relieve stress & anxiety with simple breathing techniques https://www.youtube.com/watch?v=odADwWzHR24 

Need more Help? 

If you or a loved one are overwhelmed and having a hard time coping with stress, consider talking to a mental health professional. Find a safe person and space in which to talk. The Bougainvilla House is here for you, with an understanding and welcoming environment for you and your family. Take that important first step and ask for help.  

The Bougainvilla House also offers Parenting Workshops to provide tools and strategies that support healthy families and nurture future generations as they grow.   

Call now to find support that works for you and your family: (954) 764-7337. 

ADHD & Productivity – How to Get Things Done

ADHD (Attention-Deficit Hyperactivity Disorder) is often the subject of jokes, quips, and casual excuses, but living with the real thing is no joke at all. 

ADHD is most often diagnosed in children and teens, but symptoms can continue or even manifest themselves into adulthood. Experts aren’t sure what causes ADHD, but research shows that genetics plays an important role. Know that if you have an ADHD diagnosis, you’re not alone and it’s not a “new” condition – in fact, descriptions of the disorder date to as early as 1902. The good news is, today we better understand the condition and how to help manage it. 

ADHD has nothing to do with how smart you are. A study in Germany found that some characteristic traits, such as hyperfocus, make those with ADHD great entrepreneurs. However, if you aren’t aware of the symptoms, ADHD can make even the routines of life into a daily struggle.

Many people with ADHD face tough challenges staying on task without being distracted.  It may be hard to complete day-to-day tasks on time, like schoolwork or chores. They may hyper-focus on one task or aspect of a task (for example, one paragraph of an essay) and struggle to move on.  

It’s hard to stay ‘in the zone’ and to work efficiently. It’s hard to listen carefully, to take your time, to wait. People living with ADHD may make careful to-do lists but have trouble estimating time commitments and following through to get jobs done, even with the best of intentions.   

Not surprisingly these minute-to-minute and day-to-day challenges and perceived failures can lead to feelings of guilt, stress, anxiety, and depression.  

Over time, the ADHD community has identified and developed a number of coping mechanisms and strategies that help people to live and function successfully with the disorder.  Here are a few tips that might help to boost productivity and concentration. Even if you do not have ADHD, this advice may be useful! 

How can you increase productivity?

  1. Avoid Multitasking – Try focusing on one task at a time. While this may be difficult in some situations, there are ways to avoid multitasking and get things done. Create a list of all your tasks and rank them by priority from most to least important.  This may help you to stop jumping from task to task, becoming overwhelmed, and ultimately succumbing to paralysis and procrastination. You can use this strategy not only at school or work, but also for house chores, appointments, event planning, and all the other small tasks that make up a day. If you tend to misjudge how long something will take, check with someone who can help you make more accurate time estimates. 
  2. Manageable intervals- Did procrastination kick in? Manage your workload in intervals. In track and field sports, intervals are a series of high-intensity workouts interspersed with rest or relief periods. You can apply this approach to your to-do list. Try breaking down tasks into 45 minutes of full focus, followed by a short break to recharge and repeat. The goal is not to speed through your work, but to make steady progress and also to take time for a self-care break, so you can come back fresh and focused! This will help you manage big workloads, get stuff done, and avoid procrastination.  
  3. Set up a work zone – If you attend classes remotely, have a lot of homework, or work from home, you probably already know how difficult it is to work without a designated area. Having a work zone helps you not only feel comfortable while working, but it also helps with productivity. This dedicated space will help your mind to transition into focus mode. Your work zone doesn’t have to be fancy as long as you keep it organized and neat to keep your mental space from feeling cluttered. We recommend that you avoid working from your bed, as it can signal your brain to think about work when you’re trying to sleep. This will only decrease your sleep quality as well as your energy level.  
  4. Devices – If devices are too distracting, perhaps a friend or family member can take charge of them for you while you work. Perhaps you just want to turn off notifications or set your device somewhere out of your line of sight. If procrastination is a problem, decide in advance what strategy will best help you manage device use while you are in work mode. Learn more about how your phone is a roadblock to productivity.  
  5. Hand-Held Fidgets – Do you find yourself scratching, rubbing, picking at your fingers, fidgeting, or engaging in other repetitive behaviors? Having an object like a fidget toy can help you manage small hand/foot movements and calm your thoughts without self-harming. These movements allow people with ADHD to feel focused and to boost their alertness. A fidget toy can be anything from a small ball to roll in your hands, a ball to squeeze, or a pen to play with. See the best ADHD fidget toys for adults here.  
  6. Find an accountability partner- It’s hard to stay disciplined, so ask someone close to you to help you stay accountable regarding goals, routines, and habits. Pick someone who is consistent, and who you can trust. Talk to them regularly about your progress and be honest. Whether you’re trying to be more productive at work, school, or in daily life generally, having someone to help you through it will make it easier to meet your goals. Remember to celebrate every success, small or large!  

ADHD productivity tools 

These additional tools may help people with ADHD to manage their days, routines, and tasks more easily.  

Some helpful tools include: 

  • Lo-fi music: lo-fi music helps the front lobe in our brain to focus – those low hums can also help the brain to focus. Here is a 24/7 lo-fi stream.  
  • Brain Focus: a time management app to block apps and quiet notifications 
  • Calendars: calendars provide a ‘visual’ sense of the passage of time and help you stay organized. You can use physical monthly calendars or digital tools like Google calendars to set reminders and events on your smartphone.  
  • Brain dump: helps declutter your brain by having a place for your thoughts. You can brain dump by writing all of your thoughts in, a notebook or use your notes app on your computer.  
  • Todoist: a checklist app with recurring due dates and the ability to share or delegate tasks to others.  
  • Productive: a habit tracker app to set personal goals, track your progress, and focus on what makes you more productive.  

How can we help?  

If you or a loved one are overwhelmed and having a hard time staying focused, consider talking to a health professional. A good first step is to look for a safe person and space in which to talk. The Bougainvilla House is here for you, with an understanding and welcoming environment for you and your family. Take that important first step and ask for help. 

The Bougainvilla House also offers Parenting Workshops to provide tools and strategies that support healthy families and nurture future generations as they grow.  

Call now to find support that works for you and your family: (954) 764-7337.

“The voice inside my head” How to quiet your inner critic

Ever find yourself thinking things like “I shouldn’t have said that!” or “Why did I do that?” or, more positively, “I nailed it today!”? 

What are you thinking right now, as you’re reading this?  

What you’re experiencing is an internal thought monologue, also known as “the voice inside your head,” or your “inner voice.” It’s perfectly normal.  Think of it like the Netflix show You, where the protagonist Joe narrates his thoughts –but without his creepy intentions. This internal conversation might be nothing more than mundane observations or self-queries like “Did I turn off my flatiron?” when leaving the house or “What’s for lunch?” when you’re hungry. Or more emotional concerns might be on the internal agenda.  

This inner conversational capability is thought to develop during childhood, at the same time as external communications skills begin to flower. However, not everyone experiences an internal monologue — others think in a more visual way.  It’s perfectly normal if you don’t experience an inner monologue as described here. 

Your inner voice is actually helpful for problem solving, critical thinking, emotional self-management and behavior regulation. Because the voice inside your head can sound like your own, it is usually tied to your sense of self.     

Your inner voice can serve as a cheerleader, encouraging you to persevere or reinforcing feelings of accomplishment. Unfortunately, it can also be a harsh critic, exacerbating mental health issues like anxiety and depression.   

What kind of messages is your inner voice feeding you, and how do they make you feel? 

Inner Critic  

Your inner critic voice may surface in times of stress and doubt, pummeling you with extremely judgmental messages about your capabilities, looks, or actions, making you think that “I’m not smart enough” while studying, or calling you names (“stupid,” “fat,” “failure,” “ugly”).  

Pediatrician and teen health expert Dr. Anisha Abraham says, “With constant exposure to social media, pressure to fit into a peer group, demands from parents and coaches, and other stressors, teens nowadays are particularly vulnerable to being self-critical.”  

A constant inner stream of criticism isn’t normal or healthy. This destructive inner commentary negatively affects your self-esteem, confidence, and performance at school and work, causing you to quit when things are hard, or to not try at all. However, it’s important to recognize these hurtful thoughts when they surface — because ignoring them just doesn’t work. 

If you push aside negative thoughts or emotions rather than addressing them, they are more likely to recur and to intensify.  If you’re constantly battling your inner critic, here are some suggestions to help you quiet this negative monologue — to say, as Alberto teaches the title character in the Pixar movie Luca, “Silenzio, Bruno!” 

 4 ways to silence your inner critic  

Acknowledge your thoughts – Our brain is a busy place.  As well as running our body systems 24/7, thousands of not-very-organized thoughts swirl around our mind every day. “By one estimate, each day, an average person thinks fifty thousand spontaneous thoughts…chaotic and mostly repetitive from one day to the next,” says Dr. Amit Sood of the Mayo Clinic. 

 As mentioned, it’s important to recognize self-critical thoughts when they surface and to maintain a healthy balance, by separating the facts from exaggerated reactions and feelings that are simply not true. Most importantly, don’t let these thoughts bully you. It might also help to identify the source of and possible motivation for these negative thoughts (for example, an incident from childhood) as a way to keep them in their place.

Change the narrative – When your inner critic starts to kick in, replace the negative thought with a positive one. This practice will be hard at first. Start by questioning your thoughts. If you’ve been thinking, “I’m not good enough to make the team” you can say, “How do I know? I’m trying my hardest and maybe I AM good enough.” In other words, reroute the inner critic with a positive affirmation, keep your inner monologue light, and actively try to go easier on yourself.

What would your friends say? – This is a serious question you should ask yourself! If you talk to a friend about your feelings of doubt, they will respond with compassion and words of encouragement because they believe in you and they care about you. So be a friend to yourself. Live by the rule “If I wouldn’t say these hurtful things to a friend, then I shouldn’t say them to myself either.”  

Use your inner voice for the better – Your inner critic has a positive role to play, protecting you from danger and helping you to set standards and stay on track. Once you learn how to silence your negative thoughts, you can learn how to use your inner critic to help you choose your path and make better decisions in life. Reframe your inner comments with thoughts like “I’m capable of achieving my goal.  What do I need to do or change to be successful?” 

How can we help? 

If you are having a hard time navigating your inner critic and maintaining positive thoughts, consider talking to a health professional. A good first step is to look for a safe person and space in which to talk. The Bougainvilla House is here for you, with an understanding and welcoming environment for you and your family. Take that important first step and ask for help if you or someone you love needs to overcome anxiety and depression or work on skills that help tame the inner critic and build self-confidence.   

The Bougainvilla House also offers Parenting Workshops to give you the tools that will support healthy families and nurture future generations as they grow. 

Call now to find support that works for you and your family: (954) 764-7337.