Why Should Doctors Care About our Attitude?

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Parents Are Hard To Raise® S03 Episode 128 Transcript

Announcer 0:00

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Announcer 0:37

Can the simple act of smiling, even when you don't mean it, reduce physical pain, relieve stress and impact our overall health? Find out this week as Diane has an eye opening conversation with smiles expert, Dr. Sarah Pressman. Join 180 million monthly subscribers who can now listen to parents are hard raised on Spotify.

Diane Berardi 1:13

Welcome to parents are hard to raise, helping families grow older together without losing their minds. I'm elder care expert Diane Berardi.

Diane Berardi 1:23

Should doctors care about our happiness? Scientists call it PA or positive aspect and its effect on our bodies and physical health is nothing short of amazing. My special guest expert this week is here to tell us why.

Diane Berardi 1:40

Dr. Sarah Pressman is an associate professor of psychology and social behavior at the University of California Irvine. Her work examines how positive emotions are beneficial for physical health and how they can protect us from the harmful effects of stress in the face of adversity. Dr. Preston's research findings have been published in top psychology journals and featured in media outlets like the New York Times, The Wall Street Journal, and the Colbert Report. Dr. Sarah Pressman, welcome to parents are hard to raise.

Dr Sarah Pressman 2:13

Thank you so much for having me.

Diane Berardi 2:15

You know, I'm thinking about any doctor that I've ever been gone to. No one ever asked me how happy are you? Right? And I think they would be scared if I said, I'm not.

Dr Sarah Pressman 2:31

Well, I mean, I think if you say you're not, the initial thing, they'll do is assume you're depressed, right? Which is a whole different question.

Diane Berardi 2:38

Yeah. So why should doctors care about our happiness?

Dr Sarah Pressman 2:43

Well, as your introduction so eloquently stated, I mean, I've been doing this work for almost 20 years and many people have been doing it for longer than me. And you know, the connection between feeling more positive, feeling more excited, feeling more happy, and our physical health, it's unquestionable. You know, there's dozens and dozens of studies showing that people who are more positive live, you know, potentially years longer than people who don't. And beyond that, that there's a host of other health benefits, you know, they experience less pain, if we expose them to a cold virus there, you know, 30% less likely to get sick. You know, even things like, Yeah, not even if you put a droplet of cold virus in their nose or flu virus and their nose, they're less likely then they're less happy counterparts to get sick. And, you know, even things like your likelihood of tripping and falling is related to your positive emotions. And so it seems to have a very broad effect on a lot of health in a very real way.

Diane Berardi 3:45

So tripping and fulfilling, huh?

Dr Sarah Pressman 3:49

Which is definitely relevant to you know, the older listeners are people with older parents. Yeah. And there have been studies done in older samples for precisely that reason. You know, looking at what, you know, what are you know, it's kind of surprising you assume that people took from fall because, you know, it's an accident. But you know how much of that is, you know, their lack of energy or, you know, maybe something about how they view the world around them as they're being conscientious that they're paying attention. And those things may very well be related to positive emotions.

Diane Berardi 4:22

Now, why don't doctors relate to this?

Dr Sarah Pressman 4:27

It's a great question. And it's something I struggle with. And I go and I try, I've spoken at many medical conferences, to try that talk to them about it. And I think there's a few reasons. I mean, I think first off, a lot of them don't know this literature. You know, I've been in the fields of psychoneuroimmunology for, you know, decades, but they might not even know that that field exists. And so medical curriculum is so overloaded with the biological aspects that they have to learn that there just isn't time to fit these kinds of topics into the curriculum and you know, my own experience having taken some medical school classes is, you know, you might get a couple of points thrown in like, Oh, yeah, stress damages the immune system or disrupts the immune system or depression is related to, you know, your likelihood of surviving heart disease or something like that. But you know, it's even not work is very rarely discussed in the medical curriculum. And then on top of that, you know, the thing that that really happens when I talked to doctors about this is they're like, Well, so what do I do? So I asked my patient, if they're happy, and they tell me that they're not, but they're not depressed? You know, what do I do? And there's no prescription that they can hand out that says, Go be happy?

Diane Berardi 5:38

Yeah. Right.

Unknown Speaker 5:40

You know, and, you know, there's no pill that they can take that makes them happy. An antidepressant doesn't make you happy. Right? And so I think that's the biggest picture, or the biggest piece that's missing with why they won't care about it is, you know, they don't have a next step to do.

Diane Berardi 5:53

And, yeah, we need a next step.

Dr Sarah Pressman 5:57

Yeah. And I mean, I think there are companies working on this. Right? So there's a lot of happiness Apps now. And and they're trying to kind of fill that gap, I think where you know, the same way that there's a lot of mindfulness apps right now where they're trying to beep you every day and encourage you to take a moment of calm in a moment of being thoughtful and peaceful. You know, there are happiness apps that do the same thing that try to encourage you to, you know, take a moment and reflect on what you're grateful for. Yeah, take a moment and, you know, try to think about, you know, your goals and strive towards them. So there is there is some movement, but it's that peace between medicine and those apps is lacking, you know, and certainly, there's not a lot of research out there to suggest that using that app has a downstream benefit on how long you live or something. So that piece is definitely missing as well.

Diane Berardi 6:46

And I guess, physicians, they separate the mind from the body.

Dr Sarah Pressman 6:51


Diane Berardi 6:53

And so they just look at, you know, the external factors of the disease. They don't look at the mind at all. So this is what we have to... gear them [laughing], I know we have to. There's so many, so many shows we've done in so many things, you know, I guess I guess it's the training, right?

Dr Sarah Pressman 7:11

It's the training.

Unknown Speaker 7:12

I think that's where it has to start. And, you know, there is some movement to try to get doctors. I'm in a society called the American Psychosomatic Society, which is really a group of both psychologists and MDs who do this kind of mind body work. And, you know, they're trying to give medical schools, you know, support and resources to have journal clubs to teach medical students about this and to bring medical students for free. So these kinds of conferences because I think patients want their doctors to know this work and they want them to... You know, when you go to your doctor, and you're convinced that you have an illness, or you're overwhelmingly stressed and you think it's affecting your health and they deny you that you know, and they say, No, no, there's nothing wrong. You know, I think that's very upsetting as a patient and i think that i think Again, I mean, it's that doctors aren't trained about all of the interconnections between mind and body that the psychologists are doing research on. And so it's, it's just a gap in their knowledge and it's affecting patient care. And so I think training is really where it would have to start. But you know, is that the trick is what do you take out to put this in? Or do we make medical training longer? So it's definitely a difficult question.

Diane Berardi 8:22

You know, when I think about, you know, the caregiver, you know, with their parents and going to the doctor, and you can just look at them and say, Oh, my gosh, every time they come in, you know, you can see they have things going on that they're deteriorating physically. And so doctors don't ask, you know, Well, at home, what's the situation? or you know, What else what other responsibilities you have or different things like that? I guess they don't realize there's so many things that play into a person's well being

Dr Sarah Pressman  9:04

For the caregiver, you mean?

Diane Berardi 9:05


Dr Sarah Pressman 9:06

Absolutely. And I mean, caregivers for psychologists who studies stress, you know, caregivers are one of our go to population to study chronic stress, because, you know, it's just, it affects every single part of your life when you know, your entire world revolves around taking care of this person who is deteriorating, and, you know, we know that, you know, their immune systems don't function as well, they're more likely to have all sorts of health problems because of this chronic stress. But yeah, we don't do that much for them to help make them more resilient. And, you know, it's a it's a very interesting question of whether or not some positive psychology types of interventions would help this population, you know, to help them find those moments of joy, or at least moments of peace while they're facing this chronic stressor. And I would expect it would be really helpful because one of the things that positive emotion seems to do best is help undo the negative effects of stress, you know, so yeah, you know, it's not that it's this magic, you know thing but you know, what it does do and I think this is very intuitive to a lot of people is it's very hard to be extremely stressed and extremely happy at the same time.

Diane Berardi 10:11


Dr Sarah Pressman 10:11

You know, one is gonna win. And so what research has shown is that it helps our bodies kind of undo the stress a little bit, you know, to have our heart rates drop to have our stress hormones drop, and that's exactly what caregivers need. I think we'd have to be sensitive to... I mean, this is kind of a trick with a lot of positive psychology researches. You know, I think a lot of people assume that it's “happyology” and we're just telling you to be happy all the time and of course, that's not at all what we're saying, you know, negative emotions are very functional. And certainly, in the in the situation of a caregiver who has chronic stress, we would never expect them to be happy all the time. But if you can just break up some of the negative effects of stress just for to give him a break. You can imagine that that gives their body a chance to kind of go back into homeostasis and you know, do the things that supposed to do you know, positive emotion. For example, has been shown to be really effective at helping you sleep better at night

Diane Berardi 11:03


Dr Sarah Pressman 11:05

You know, and it Yeah, in my own work, you know it helps people have higher quality sleep, fall asleep faster, stay asleep longer. And that's exactly what a caregiver needs, right they need yes useful sleep that's undisturbed by all the thoughts of this sort of hassles that are going on in their life.

Diane Berardi 11:21

You know, I think of myself when my mom first got sick, and I was, you know, taking her to doctors and I was going up going, I'm like two hours away and running up every weekend and I kept getting sick, I kept getting a cold. And I'm saying why is that? But I guess you know, I mean, when you think about it, and now that she passed now I'm doing the same for my dad. I mean, my dad is not, you know, he's not suffering you know from cancer, but he has his own problems. And so my journey continues as so many caregivers. You know, there's just a never ending... There's no break. And I think I sit there and you know, the middle of the night you don't sleep and you think, Oh my gosh, you know, how do you live your life? And how do you find that peace or that happiness or that relaxation? You know? This would help so many caregivers. And, and happiness, I guess, you know, what is it? It's subjective.

Dr Sarah Pressman 12:30

It's highly subjective. And it doesn't have to be haphazard, right?

Dr Sarah Pressman 12:33

I mean, there's a lot of different positive emotions. And I think that's something that a lot of people also get confused about when they think you know, when we're saying you have to be happy. We're using happy, you know, more colloquially as a way of talking about positive emotions more broadly, a positive emotions that are good for us can include feeling active and vigorous. That can include feeling excited, it could include feeling peaceful and calm. It can include feeling content, it doesn't have to be slap a smiley face sticker on it. And, um, you know, there's a lot to be said for Eudemonic well being, which is also a big area that's growing in the health literature, which is, you know, having life purpose, or having life meaning, you know, those aren't things that again are like the typical happy face. I mean, you could be you could have one of the hardest, most difficult jobs, but it's giving your life meaning.

Diane Berardi 13:22


Diane Berardi 13:23

And that's tied to a lot of health benefits as well. And so a lot of the, you know, positive psychology interventions out there are targeted at things like that, you know, it's, you know, trying to help people find meaning in their lives are trying to help them find purpose in their lives or align their goals to, you know, or their their activities to meet their long term goals, which again, does give you that sort of sense of purpose and achievement, that can be related to positive emotions like happiness as well.

Diane Berardi 13:53

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Diane Berardi 14:12

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Diane Berardi 16:42

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Diane Berardi 18:41

So, you are the smiles expert. [laughing] Talk to us about you know, Can, the simple act of smiling...

Dr Sarah Pressman 18:53

Yeah, and I gotta say that one of the one of the times I was on a radio interview talking about that work they played the song, Sarah Smile. And I couldn't stop laughing for the 10 minutes of the interview. So thank you for not doing that.

Diane Berardi 19:06

I'm surprised they did not do that.

Dr Sarah Pressman 19:11

And there was no warning and it Yeah, it was it was pretty funny.

Dr Sarah Pressman 19:15

Yeah, so smiling is an interesting area. And it's something that I think a lot of people have a hard time believing and it's even a little bit of a controversial area in psychology, believe it or not, but there's Long, long standing beliefs, long, long standing research, that our facial expressions aren't just an outward expression of how we're feeling, but it actually changes how we feel. So this literally dates back to Darwin.

Dr Sarah Pressman 19:41

So Darwin said things like, you know, if we, if we conjure up an expression that it changes how we feel, and this work has been done by psychologists for a long time where they do these clever research studies where people think they're doing something else for the research project, you know, they think they are multitasking or they think they're trying out You know, new device with their mouth but what we're actually doing is is tricking them into making some kind of expression you know sometimes that's not smiling. smiling we typically put something in their mouth. there's actually a device now called the smile stick that you put in your mouth to make yourself smile and but then we might also do something like

Dr Sarah Pressman 20:19

you know, have you hold a what's it called this thing that you put a golf ball on the little stick

Diane Berardi 20:26

The tee?

Dr Sarah Pressman 20:27

The tee. You put it between your your your eyes and have you tried to hold it and that activates negative emotion related muscles in your face? Or we study people who have had Botox for the opposite reason because, you know, they can't move certain muscles in their face and not might also affect how they feel. And what we see is that the term you know, the the kind of colloquial thing like fake make it, fake it fake it and you'll feel it. Yeah, you know, fake it till you make it or you know, those kinds of you know, fake it till you feel it expressions, that those are true and that if you have someone you know, actually activating a smile, even if they don't know that they're smiling, that it changes their behavior, it changes their perception, it changes how they feel in a positive way. And vice versa. You know, if we block your ability to, you know, for example, scowl by blocking that muscle that in between your eyebrows that you use, kind of it's called the Currugator muscle, it's your frown muscle, you know, if you block that with Botox, that those people don't actually perceive negative emotions in the same way and don't respond to negative emotions the same way so there's actually a lot of clinical trials going on right now using that as a potential treatment for depression. So this research is you know, long standing it's a huge area and you know, my my perspective on it, my interest in it has really been in not so much the emotion side of you know, I don't really believe that. Well, maybe I mean, there's a if you ever heard that this is dating me, but I used to watch Ally McBeal and they used to talk about like smile therapy and like Ally would have to walk around with a smile on her face all day. You know, I don't think there's any good evidence that that would work. And you know, we know that when people are in customer service jobs where they are forced to smile all day that can actually lead to like the opposite effect on your mood. But what I do think it can be useful for is the same thing that we were talking about before with the caregivers and the positive emotions kind of breaking a negative emotion giving you a break from it, giving you kind of a rest from your stress. I feel like smiling is kind of ideally suited in that situation where, you know, if we're sitting in traffic and we're scowling, or we're sitting over some really hard work and just really angry about it, and then we like take a break for a minute and just like put on a really cheesy, big smile. That is we're going to look and same to our friends especially if we're in an open office space. You know, for the people driving next to us on the highway. But you know it what we've seen in our lab is that something about doing that is sending a message back to your brain and back to your body. You're actually happy you're not stressed. And so we don't need to have those high levels of heart rate activity and high blood pressure, we can kind of reduce that because you're not actually in danger, you're not actually under threat. And so, you know, in our work, what we've done is we've shown that if you have your hand in a bucket of ice water, which is a very painful task, if you're doing like a really difficult dexterity task that's impossible and frustrating, or even if you're getting a needle, that if we just make you smile, even if you don't know that you're smiling, that we can improve how quickly you recover from that pain. And we can actually or that stress, and we can actually make needles hurt about 40% less by having you simply smile while you're doing it.

Diane Berardi 23:45

It's amazing.

Dr Sarah Pressman 23:47

I will say not all smiles are made equally. So there are actually lots and lots of different kinds of smiles, you know, their smiles of pain and discomfort and embarrassment, right? So the smiles that are most Effective or what we call Duchenne smiles named after one of the earliest researchers on this topic, but essentially it's when you smile when someone smiles at you and you can really tell it sincere is when their eyes are activated as well. So you get like the crow's feet around your eyes and kind of around your eyes. That plus the you know, typical, you know, teeth, cheek raised kind of, you know, smile, that that's how you can tell it sincere as if their eyes are involved in it. You know, it's not this Starbucks barista kind of smile, where it's just their mouth. They're like, Yeah, get out of here. You're you're holding up the line kind of smile.

Diane Berardi 24:35

Wow. Yeah. When you think about it, yeah, you that is a great way to tell and we're would you get those smile sticks? [laughing]

Dr Sarah Pressman 24:46

Google it, you'll find it. They have a website for it.

Dr Sarah Pressman 24:49

So yeah, we actually did a research study with a smile stick company. You know, their hope was to kind of, you know, in our research studies, what we, what we commonly use is just like an old pen or a pair of chopsticks like it's not the most sanitary, you know thing to do. I mean, obviously, we throw away the chopsticks and get a new pair [laughing] But, you know, it's not like the kind of thing where it's like, you're going to give this to your mom and be like, Hey, hold these. But if you had a device that said smile stick and you said, Hey, hold this in your mouth while you get a needle. Like that seems a little bit more appealing and so and the smile stick absolutely works just as well as you know, chopsticks or pens or whatever.

Diane Berardi 25:23

I would like to give them out this Christmas. [laughing] to spme people Actually,

Announcer 25:30

Excellent. [laughing] We'll get it on Oprah's must, must buy gift list this year.

Diane Berardi 25:37

That's right. Oh my gosh. I guess there's a company that invented them. Right? Now what about if you go to your doctor and you know, let's say then you see the nurse first and she's smiling. You know, talking to you, taking down information. Is that... would a person tend to be more relaxed and smile? Because, you know, that other person is doing that. And it's...

Dr Sarah Pressman 26:13

Whether or not smiles are contagious?

Diane Berardi 26:15


Dr Sarah Pressman 26:15

Absolutely they are. I mean, it's one of the most fundamental human reflexes, right? I mean, the one so when we study emotion and in psychology, you know, a lot of the time we're kind of thinking in the back of our heads. Okay, well, what is the evolutionary function for this? You know, why would smiling? Why would we smile, right? Like, right, what's the point of it? And so the the best guesss, I mean, it's hard to prove any evolutionary theory. But the best guess, is that smiling is something that is easy to see from far away, to tell another person that you're not a threat, you know, and then it would be adaptive if we had this kind of contagious ability for us to kind of signal from far away. Oh, you know, this is someone who I can gather with, potentially mate with I mean, who knows, right?

Diane Berardi 27:00

Right. [laughing]

Dr Sarah Pressman 27:01

And so you know, to have that, you know, both be easy to see, and to have it be contagious so that we do it back with each other. And then on top of that, to also have that concomitant sort of reduction in our arousal so that we're calm and we're not, you know, about to attack this person, right? smiling is having this relaxing effect on the body. It's enabling us to make these social connections that were essential to human survival. And so, you know, that's why you do see that most of the time. I mean, obviously, there's huge cultural variation and smiling. Yeah, you know, some countries are actually very smile averse, very happiness averse. There's actually a fear of happiness scale, where certain countries see it as kind of a sign of foolishness or a sign of, you know, sinfulness or something like that. And so they they really don't like smiling and I think the really interesting unanswered question is, so if they smile, would we see the same stress effects for example, you know, if even if they hate smiling, And so we don't really know the answer to that. Yeah. But fortunately, you know, smiling is, you know, there's lots of cross cultural research around the world that shows that is this universal expression of positive emotion. And to that, to the extent that that's true, we would expect that it would be helpful, you know, and and, you know, stress reducing for everyone.

Diane Berardi 28:19

Yeah, I think about you know, caregivers whether, you know, you're taking care of your parent or you work, you know, as a caregiver and thinking, you know, if you smile and approaching a patient, you know, how that would relax them and maybe help them smile, you know.

Dr Sarah Pressman 28:42

Absoutely. Yeah. I mean, to make, you know, I mean, the doctor patient relationship, the caregiver patient relationship to that extent to I mean, it's so important, right? And, you know, often it's just kind of rushed, and professional and there is it time to be nice, and that's something that takes no time at all. And absolutely, I think That, you know, having, you know, even just having doctors trained to kind of smile at people more could potentially reduce a little bit of stress in the medical establishment. I mean, we know that people get white coat hypertension.

Diane Berardi 29:11

Right, yeah.

Dr Sarah Pressman 29:12

You know, where their blood pressure goes up just by seeing a doctor. And, you know, maybe if the doctor was more positive and more smiley, and friendly that they would, you know, reduce that. And I think, you know, honestly, I think nurses get this a lot, you know, because they're the ones who spend more time with the patients. I think they're doing it intuitively, to a great degree, you know, even without necessarily knowing the research just because they see that it helps. And, you know, from the perspective of caregiving as well, I mean, my own experience, my grandmother had very serious dementia, and, you know, didn't know who I was right? If I smiled at her, she would smile back, you know, and she got that positive emotion and that contagion of emotion was still there, even to the end. And so, I feel like that is such a simple, positive behavior that actually can have a physiological benefit and an emotional benefit.

Diane Berardi 29:57

Oh, most definitely. Yeah. Now how can people find out about your research?

Dr Sarah Pressman 30:04

They can Google me and I have a TED talk on why doctors should care about happiness. And I have a website as well. You know, again, if they just google Sarah Pressman at https://sarahpressman.wixsite.com and they can read a lot of my papers you know for free there and learn a little bit about it and see the link to the the TED talk as well. And also I looked it up just so that you have it for your Christmas list or your Hanukkah list or whatever. list It's thepowerofsmiling.com is where you buy smile sticks. [lauging]

Diane Berardi 30:41

[laughing] This is great... Thank you so much! [laughing]

Dr Sarah Pressman 30:44

I don't wanna I don't want you to miss out on that opportunity. Because I think that's like it sounds like a great idea.

Diane Berardi 30:49

It is a great idea. I know. Thank you so much, Sarah, for being here today.

Diane Berardi 30:55

Absolutely. And I also just wanted to say it's national or international random act of kindness day so go out and do some nice things for other people and that'll raise their positive emotions.

Diane Berardi 31:05

Oh, that's wonderful.

Diane Berardi 31:07

And parents are hard to raise family. I love getting your emails and questions so please keep sending them You can reach me at Diana parents are hard to raise.org or just click the green button on our homepage. Parents are hard to raise as a counter sync media production. The music used in this broadcast was managed by Cosmo music, New York, New York. Our New York producer is Joshua Green, our broadcast engineer is Well Gambino, and from our London studios, the melodic voice of our announcer, Miss Dolly D.

Diane Berardi 31:34

Thank you so much for listening. Till next time, may you forget everything you don't want to remember. And remember everything you don't want to forget. See you again next week.

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