How To Find Joy In Your Everyday Life, According To Psychologists

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The increasingly materialistic society we live in has led many of us to believe that happiness is something to be chased, to obtain. The ultimate end goal that leads to everlasting bliss and contentment. Paradoxically, research shows that the more people chase materialistic pleasures as a means to seek happiness, the more depressed, anxious and less satisfied with life they are.

“We get a lot wrong about what will make us happy,” says Dr. Samantha Boardman, New York-based positive psychiatrist and author of Everyday Vitality: Turning Stress Into Strength. “All too often we choose mind-numbing, effort-sparing options like scrolling through our phones or binge-watching shows instead of engaging in meaningful, revitalizing activities. These are uplift imposters.

Think of these as empty calories—the emotional equivalent of junk food,” says Dr. Boardman. True happiness is not a goal or an outcome, rather, it’s a byproduct of how we live our life and interact with the world around us.

How much control do we have over our happiness?

“It can be helpful to think about emotions as being either primary or secondary,” says Dr. Vaile Wright, clinical psychologist and senior director of health care innovation at the American Psychological Association.

“We don’t have much control over primary emotions—those that happen automatically. For example, feeling immediately irritated if a stranger bumps us on the street or feeling afraid if we hear an unexpected noise in our house. But we can exert some control over how we interpret those feelings and whether we want to maintain them or try to replace them with something else—a secondary emotion, that is.

So, while it isn’t possible to feel happy all the time or to completely eliminate negative emotions experienced throughout the day, we can choose to engage in thoughts and behaviors that foster joy,” says Dr. Wright.

Many factors that are linked with happiness lie beyond our control such as genetics and life circumstances, but there are certain mindful techniques well within our reach that can reliably provide a boost, Dr. Boardman concurs.

Mindful Strategies For Creating Joy That Lasts

True, lasting happiness or joy is a state of mind. It stems from within ourselves. A deliberate, learned response to life that can be consciously and proactively cultivated, regardless of the forces outside of ourselves.

Here are eight intentional strategies for creating lasting joy in your daily life, according to psychologists:

Set realistic expectations. “Emotions ebb and flow and no feeling, positive or negative, lasts forever,” says Dr. Wright. Therefore, it’s important to have realistic expectations in the first place—to avoid resentment, frustration and disappointment that arises from unmet expectations.

Don’t dismiss bad feelings. Suppressing or denying negative emotions not only lowers your sense of contentment but also puts a lot of stress on your body, which can manifest as physical symptoms over time, like headaches, hypertension, palpitations, digestive problems, etc. This is why acknowledging and accepting the full spectrum of emotions, including negative ones, is crucial for our well-being.

“We have a lot to learn from negative emotions and stressful situations,” says Dr. Boardman. Learning to allow and accommodate an array of emotions, rather than aiming to eliminate negative emotional experiences entirely, can help us become more resilient and experience the fullness of life, Dr. Boardman explains.

Embrace yourself with compassion. “Many of us are too self-critical and that perfectionism interferes with our ability to fully experience joy,” says Dr. Kathryn Gordon, licensed clinical psychologist and author of The Suicidal Thoughts Workbook: CBT Skills to Reduce Emotional Pain, Increase Hope, and Prevent Suicide.

Instead of beating yourself up over everything or obsessing over every minute detail that didn’t match your expectation, Dr. Gordon suggests giving yourself the gift of grace. However, practicing self-love isn’t always easy. There’s more to it than bubble baths and herbal teas. And it doesn’t always come naturally to everyone. Here are the biggest self-love saboteurs and how you can overcome them.

Forge meaningful connections. “Our connections and interactions are the most reliable wellspring of joy and well-being,” says Dr. Boardman. According to a study published in the Psychological Science journal, investing in social relationships is the most successful way to boost happiness when compared to other strategies such as healthy eating, getting a better job, etc.

Moreover, another study found that yearning for social interaction evokes a neurological response similar to a hungry person craving food. Something as simple as spending time with a loved one, joining a hobby club or volunteering at a local soup kitchen may help you experience greater joy.

Be ‘un-you.’ When it comes to finding happiness, ‘be yourself’ is the advice we hear all the time. “I take a counterintuitive approach. To help open the mind, I often tell patients to ‘be un-you.’ This is because we often have fixed ideas about ourselves. So who we think we are can get in the way of growth and genuine happiness,” tells Dr. Boardman.

“I encourage patients to expand how they think about themselves by behaving in ways that may seem out of character for them,” she says. “Simply put, doing things that are unlike you can get you closer to the version of yourself you would ultimately like to be,” tells Dr. Boardman.

Watch your thoughts. “Our thoughts and emotions influence our behavior, which in turn, affect our physical health,” says Dr. Gordon. For example, if we are depressed, our thoughts may be self-critical and our emotions might be shame-related.

If we feel self-critical and ashamed, we may be less likely to spend time with friends, engage in physical activity or take care of ourselves (e.g., sleeping and eating well), Dr. Gordon explains. In addition, this may also result in unhealthy coping behaviors such as binge eating, impulsive spending, substance use, etc. If you’re feeling overwhelmed, here are a few positive coping mechanisms to try instead.

Balance hassles with uplifts. “Research shows us that chronic unmanaged stress can lead to negative physical and mental health consequences including hypertension, obesity, cardiovascular disease, depression and anxiety,” notes Dr. Wright. While stress is an inevitable component of daily life, “the key is to balance hassles with uplifts,” says Dr. Boardman.

“It might be something as simple as holding a door open for someone. It might be learning something new, working with your hands (eg: knitting, candle making, origami, painting, pottery, etc.), reading a few pages of a book, chatting with the taxi driver, giving directions to a stranger or cooking dinner for your family,” Dr. Boardman suggests. “These small moments of grace or goodness are the essence of finding happiness in everyday life,” she says.

“I make a point of cultivating or noticing at least two ordinary moments each day that are uplifting,” tells Dr. Boardman. “If I’m not deliberate about seeking delight, I might miss it,” she adds. It’s important to know that “thinking happy thoughts doesn’t qualify as an uplift. Nor does passively scrolling through social media or flipping through TV channels,” Dr. Boardman points out. “For an uplift to provide a genuine boost, it requires one’s full attention and involves at least a micro-moment of connection or engagement with something or someone,” she explains.

Don’t wait until you figure everything out. While it’s important to take the time to figure out who you are and how you identify yourself, it’s not a precondition for happiness. In fact, this approach can hold you back from experiencing joy, says Dr. Boardman. “This is because it encourages ‘as soon as’ thinking and a fixed mindset—by assuming that you’re fully formed rather than in the process of becoming,” she notes.

If you continue feeling overwhelmed and finding it difficult to function despite trying everything, please reach out to a mental health professional at the earliest.

I’ve been a lifestyle journalist for over half a decade, primarily covering all things food, culture, and wellness.

Source: How To Find Joy In Your Everyday Life, According To Psychologists

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4 Ways To Identify High Conflict People Before It’s Too Late

High-conflict people are identified by their blaming of others, all-or-nothing thinking, unmanaged emotions, and extreme behaviors. (Credit: Alexandra Mirghes / Unsplash)

Some people seem predisposed to cause chaos and conflict in their lives. Their every discussion regresses into an argument. Everywhere they go, something goes wrong and someone else is to blame. And they can’t let anything go, seeing even the smallest mistake as an affront to their worthiness.

These are some of the signs of what lawyer and therapist Bill Eddy calls “high-conflict people,” and chances are you’ve encountered one before. They could be that coworker whose ego you have to tiptoe around at the office, the family member who adds drama to every holiday visit, or the friend who reacts explosively to the mere suggestion that they’ve misremembered some trivial fact.

The question is: How do you tell the difference between a high-conflict personality and simply two personalities that conflict with each other? In an interview, Eddy shared the four key characteristics you can use to identify such personalities.

How to identify high-conflict personalities

The first of these characteristics is a preoccupation with blaming other people. When something goes wrong or a fault is revealed, the high-conflict personality will set their crosshairs on a “target of blame” and launch all the responsibility their way.

“The target of blame […] could change over time, but [a high-conflict person] sees that person as the cause of all their problems,” Eddy said. “And so they want to control or eliminate or destroy or humiliate that person.” While the target can be anybody, Eddy adds, it is typically an intimate relation or someone in authority.

The second characteristic to look for is all-or-nothing thinking. From the high-conflict person’s perspective, there are good people and bad people. Blame is absolute, or it is moot. And there is only one way to solve any conflict: Their way.

Third, high-conflict people may display unmanaged emotions, and those emotions roll straight into the fourth characteristic, which is extreme behaviors. A high-conflict person may yell, start crying, punch a hole in the wall, or storm out of the room for reasons that cannot be discerned by others. It just seems to happen because the triggers are so minute. Even so, the emotional outburst is unrestrained.

“HCPs are in every occupation, every culture, and every country. This has nothing to do with intelligence. Some HCPs are very smart, while others are not — like the whole population,” Eddy writes. “They tend to have more substance abuse, more depression, more anxiety, and other problems. This is often because their ways of interacting don’t work, which frustrates them as well as everyone around them. Yet, they aren’t able to reflect on themselves, and you can’t make them.”

With that said, it’s important to note that “high-conflict” isn’t a personality disorder — that is, a long-term pattern of feelings and behaviors that differ significantly from what’s expected. Psychologists currently recognize — and debate over — 10 personality disorders. These can be informally catalogued into three groups: Cluster A (eccentric), Cluster B (erratic), and Cluster C (anxious). While high-conflict people do share certain traits with Cluster B disorders — such as volatile emotions and inappropriate behaviors — they are also distinct….

Continue reading…..

Source: 4 ways to identify high-conflict people before it’s too late – Big Think

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This Simple Morning Habit Can Help You Sleep Way Better at Night

Valery/Adobe Stock

When it comes to sleep, I subscribe to the “listen to your body” mindset. I’m a freelance writer, meaning I can go to bed whenever I want and wake up either on my own or whenever my emergency alarm finally jolts me awake (assuming I remembered to set one). There’s little consistency, and I feel little shame in hitting the snooze button five times. I’ve never really questioned my process—even though I regularly fall victim to a presleep toss-and-turn and wake up feeling sluggish.

After talking to Jade Wu, PhD, a board-certified behavioral sleep medicine specialist and author of the new book Hello Sleep, I’m inspired to make my sleep habits a little more routine. A consistent sleep-wake schedule, Dr. Wu tells SELF, is incredibly important when it comes not only to sleeping soundly at night, but keeping a number of body functions—like digestion, hormone regulation, and body temperature—in check.

One simple way to get into a groove of sleeping better: Wake up at the same time every morning. “The reason you want to get up around the same time every day is because the body functions best when it runs consistently on a rhythm,” Dr. Wu says. Here’s why it’s a great idea for so many health and happiness reasons (regardless of whether you actually have to)—plus how to make it happen if you’re getting sleepy just thinking about it.

Waking up at the same time each morning can help you sleep better at night—and make it easier to get out of bed in the morning.

Your body clock, or circadian rhythm, is the system that regulates your sleep-wake cycle. It’s heavily dependent on clues from your environment, says Dr. Wu, which is why light makes you feel alert and awake, and why you start to feel sleepy around dusk. The light you see when you wake up essentially tells your body it’s morning, meaning it’s time to get out of bed and start your day.

By opening your eyes like clockwork every morning, you’re essentially programming your body for better sleep. “Consistently having that light cue at the same time in the morning will go a really long way in anchoring your 24-hour clock,” Dr. Wu says. Over time, your body will automatically know when to release melatonin—a hormone that induces sleepiness—at night and when to stop producing it in the morning, she explains, which can make it easier to both fall asleep at night and wake up ready to go in the morning.

Inconsistent wake-up times can really mess with your body clock.

If you wake up at different times each day—or even if you keep a pretty consistent sleep schedule during the week but sleep in every weekend—your brain will get confused and start to release melatonin at weird hours. It’s kind of like constantly traveling to different time zones and getting jet-lagged, Dr. Wu explains. If your wake-up times are all over the place, it’ll likely be harder to get a good night’s sleep, she says, and you may have issues concentrating the next day.

After an unrestful night “we’re slower and more sluggish,” Dr. Wu adds. Over time, an inconsistent waking schedule can contribute to a host of health concerns; it can strain your heart, interfere with your metabolism, impair immune functioning, and increase your risk for mental health issues like depression and anxiety. “When your circadian rhythm doesn’t run well, nothing in your body really runs well,” as Dr. Wu puts it.

Sometimes life gets in the way of your best-laid plans (heh), and you may wonder if it’s more important to get enough sleep or wake up on schedule. You don’t want to be sleep-deprived, but you want to try to maintain some consistency, says Dr. Wu. “Let yourself wiggle by an hour,” she says. If you usually wake up at 8 a.m., but had a late night and want to sleep in, make sure you’re up by 9 a.m.

so you don’t throw your body clock off too much. If you still feel groggy, pencil in a 20- to 30-minute midday nap (before 3 p.m. is ideal so it doesn’t mess with your nighttime sleep). If you can’t fit in a nap, try to relax or shut your eyes for 10 minutes (even if it’s at your desk on your lunch break), Dr. Wu suggests—simply resting can restore and reenergize your brain without throwing your circadian rhythm off, she says.

Training your body to wake up at the same time every morning might take some work, but it’s worth the effort.

Getting into the habit of waking up at the same time every day may take some practice and dedication, says Dr. Wu. As you’re adjusting to your new rise regimen, she recommends letting yourself hit snooze one time max (!!) and trying not to linger under the covers once you’re actually awake. If you seriously struggle to get out of bed, try scheduling something to look forward to once you do—a new type of coffee or your favorite podcast, perhaps. (If you consistently have trouble sleeping or waking up despite your best efforts, consider talking to a doctor to see if there’s an underlying health issue contributing to that).

If you get nothing else out of this article, expose yourself to some light as soon as you can after waking. Sit by a window, get a light box, walk your dog, have tea on your porch or balcony—whatever you can do to brighten your morning will likely help regulate your sleeping patterns and make you feel less groggy. “The more light you can get in your eyes the first thing in the morning, the easier it will become to continue to be up early,” Dr. Wu says.

Setting an alarm for the same time every day and adding a little brightness to my breakfasts feels like a low-stakes, high-reward way to make my days run better. I’ve never been a morning person, but for once it doesn’t seem entirely out of reach. Setting a daily alarm for 7:45 a.m. right now. (Okay—maybe 8. Either way, I’m doing it!)

Source: Waking Up at the Same Time Every Morning Can Lead to Better Sleep | SELF

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The Power of Social Touch: How a Loving Caress Really Can Ease Anxiety

(George Wylesol for The Washington Post)

When Valentine’s Day arrives Tuesday, many people will show their love and affection with cards, chocolates and gifts, but there is another way to make your partner or family member feel good — through touch. Studies show that social touch is essential to our mental well-being and can reduce stress and pain while helping us bond with one another.

Physical isolation during the coronavirus pandemic led many to develop “skin hunger” and resulted in an uptick in mental health problems. One 2021 study surveying almost 1,500 participants reported that deprivation of intimate touch from close family and partners was associated with worse feelings of anxiety and loneliness.

Lack of friendly or professional touch from friends, acquaintances or work colleagues did not have the same impact on mental health.How we can feel social touch. Social touch is so important for our well-being that we have specific cells in our skin to detect it. Our skin gives us the power of discriminative touch, which allows us to feel the pressure, texture and vibration of objects.

But our skin also has sensors known as C-tactile fibers or afferents that are specifically sensitive to social touch from people and the caress of a loved one. C-tactile fibers innervate hairy skin and are optimized to detect the gentle stroking touch of 1 to 10 centimeters (half- to four inches) per second that many people say is pleasant. If the movement is too fast or too slow, not only are the C-tactile fibers less responsive but people also find the sensation less pleasing.

Interestingly, they are also more attuned to warmer temperatures of around 32 degrees Celsius (almost 90 degrees Fahrenheit), akin to the warmth of a person’s skin. There are individual differences, however, in the need and craving for social touch. “I think touch is very important,” said Mariana von Mohr, a researcher specializing in social cognition at Royal Holloway University of London.

“But at the same time, we have to be a bit careful about these individual differences because there are people that might prefer to connect in some other way.” But in general, intimate touch between loved ones is important for emotional regulation and social buffering, where being together with others helps us handle and recover from stress.

The benefits of social touch

Social touch causes the release of the social-bonding hormone oxytocin in the brain, which is thought to reduce anxiety and pain. Von Mohr’s research has found that romantic partners felt less pain when receiving a slow, stroking touch compared with a faster touch. Other studies have found that touch enhances intimacy between couples.

In one study, 84 adult women participated in an experiment showcasing the soothing power of affective touch on feelings of social exclusion. Each participant played Cyberball, an online ball-tossing game, with two other players who, unbeknown to the subjects, were bots that would eventually stop throwing the virtual ball to the participant.

When that happens, it can produce a profound sense of social exclusion, and even led to “one participant actually smashing the computer,” von Mohr said. But when half of the participants received a slow, affective touch from the experimenter afterward, their feelings of social exclusion were partially mitigated. The other half of participants who received a fast-stroking touch, which would not activate C-tactile fibers, did not experience similar relief.

This is akin to a mother comforting a child after a similar experience of social hurt, von Mohr said. “We do this sometimes without realizing how good it is,” she said. All mammals that have been studied have C-tactile fibers, suggesting that these sensory cells — and the ability to detect social touch — are evolutionarily conserved and essential, said Ishmail Abdus-Saboor, a biological scientist specializing in touch research at Columbia University’s Zuckerman Mind Brain Behavior Institute.

From skin to brain for pleasurable social touch

Research suggests that social-touch-sensitive neurons may be key for making the touch of a loved one feel good, which in turn helps bind us. A study in Cell this month found that directly stimulating neurons in female mice — similar to C-tactile fibers in humans — can release dopamine, a neurochemical associated with reward, in their brains. These Mrgprb4 neurons are also necessary for female mice to be receptive to sexual advances from male mice.

Using optogenetics, a now-mainstay neuroscience technique that allows researchers to manipulate the activities of specific neurons by shining a light on them, researchers activated the Mrgprb4 sensory cells on the back, an important area for social touch in mice where they groom and huddle together. The researchers saw that the female mice would lower their backs in response to the light, which is lordosis, a female mouse sexual behavior indicating receptivity to a male mouse.

The finding that activating cells in the skin can trigger a “social touch-like behavior even without other sensory cues” such as the presence of another mouse “was pretty surprising,” said Abdus-Saboor, who was an author of the new study. Stimulating Mrgprb4 neurons was pleasurable, and female mice spent more time in designated sections of the cage where researchers activated the cells.

Intriguingly, stimulating these sensory neurons and engaging in sexual behavior both released dopamine in the nucleus accumbens, a key brain area associated with reward. But when the researchers genetically ablated these Mrgprb4 sensory neurons, sexual experiences no longer released dopamine and the female mice began rejecting the male mice’s advances after their first experience.

The male mouse’s touch was no longer rewarding, and the male’s advances were no longer welcome. The female mouse would even become combative with her paws up, making herself inaccessible to the male. “I sometimes think she throws a punch,” said Leah Elias, a postdoctoral researcher at Johns Hopkins University who conducted the study as a graduate student at the University of Pennsylvania.

Though this study examined the importance of pleasurable touch to sexual behaviors in mice, the researchers say the Mrgprb4 cells also play a role in other forms of affiliative social touch such as play. Before the touch signals reach the brain, “even at the first relay station in the skin, there are already dedicated cells that are competent to engage social stimuli,” Abdus-Saboor said. Their research opens up a potential target for future therapeutics that can use the skin to access reward circuits to help treat trauma or depression.

“Just by activating these neurons in the skin, you kind of have a highway to the brain,” Elias said. “It’s kind of a gold mine.”With just a hug, a caress or a gentle squeeze of the hand, we can already take advantage of the power of social touch. To feel better, healthier and more connected, skin deep is a good place to start.

By

Source: The power of social touch: How a loving caress really can ease anxiety – The Washington Post

.

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Misophonia: How Sound Rage Destroys Relationships and Forces People To Move Home

Woman blocking ears with fingers Photograph: Jamie Grill/Getty Images/Tetra Images RF

Sent into apoplexy by whistling noses? Can’t bear the sound of people eating? You could be one of the many people affected by this potentially debilitating condition. As a teenager, I remember being moved almost to tears by the sound of a family member chewing muesli. A friend eating dumplings once forced me to flee the room.

The noises one former housemate makes when chomping popcorn mean I have declined their invitations to the cinema for nearly 20 years. I am not proud of myself for reacting like this – in fact, I am pretty embarrassed – but my responses feel unavoidable. It is probable that I have misophonia. According to a scientific paper published last year, so do 18% of people in the UK.

Otherwise known as “sound rage”, misophonia is “a decreased tolerance to certain sounds” says Jane Gregory, a clinical psychologist at the University of Oxford who co-authored the paper and counts herself among the 18%. Sound triggers are usually repetitive, she says. It is not about “the volume of the sound or necessarily the acoustic pattern”, but what it means to the observer.

Eating sounds are most commonly reported, closely followed by so-called throat sounds. (Gregory is driven spare by the sound of pigeons.) “Chewing, crunching, snorting, sniffing, throat clearing, nose whistling, heavy breathing,” rattles off Dr Zach Rosenthal, who runs the Centre for Misophonia and Emotion Regulation at Duke university in Durham, North Carolina. “These are all relatively ordinary everyday things that people need to do, but in people with misophonia they are experienced as highly aversive.”

That “aversive reaction” can take the form of physical changes such as increased muscle tension or heart rate, or emotional responses such as irritability, shame and anxiety. It brings on a fight, flight or even a freeze response where, according to Gregory, “you get a really strong adrenaline reaction and it tells you that you’re either in danger or you’re being violated”.

Only about 14% of the UK population are aware of misophonia, according to Gregory’s paper, a collaboration with King’s College London. Perhaps one of the reasons, she suggests, is simply that it is hard to talk about. “You are essentially telling someone: ‘The sound of you eating and breathing – the sounds of you keeping yourself alive – are repulsing me.’ It’s really hard to find a polite way to say that.”

Maybe the movie Tár will help: its protagonist, played by Cate Blanchett, has an extreme reaction to the sound of a metronome. Theories about how misophonia develops are exactly that. “A lot of people say they had always been a little bit sensitive to sound, but then they remember a certain time when it suddenly got a lot worse,” says Gregory. Rosenthal says it typically presents itself in late childhood or early teens and is often associated with family members.

“People ask me all the time: ‘Why my family? Why my parents?’” The explanation feels comfortingly logical: “You’re not blaming, you’re not judging – you were probably just around them the most.” You might have clocked a sibling eating baked beans, say, then once you have noticed it your brain begins to look out for it.

Rosenthal describes the whirlpool: “It starts to be aversive and then I pay more attention to it, and then the more attention I pay to it the more I notice it, and then the more I notice it the more aversive it becomes …”

The impact can be severe. Gregory knows of relationships that have ended over misophonia; she has encountered people who have moved several times to escape triggering neighbours. Others must pick careers based on where they can work without being bothered by sounds. “If you don’t get any respite from it, you can get desperate,” she says.

You get a really strong adrenaline reaction and it tells you that you’re either in danger or you’re being violated…Jane Gregory

Strategies might help, however, such as introducing background noise when eating. Gregory’s husband, who knows better than to eat Monster Munch at home, can tell if she is bothered by a sound, because she will suddenly call out: “Siri, play Taylor Swift!”

Sometimes the best option is to walk away. Gregory suggests then “slowing down your breathing, or just giving your mind a little job to do”, such as playing a game for a minute. By the time you re-enter the room, the sound might be gone, or you might feel better equipped, “because you know what’s coming”.

She also recommends “opposite action – this idea that sometimes the more we avoid something or block it out, the more harmful it feels to us. In CBT [cognitive behavioral therapy], we do the opposite of what you feel like doing.” In this vein, she tries to fight her instinct to glare at her husband, gazing adoringly at him instead: “It’s a way of tripping up your brain and saying: remember that you love this person, remember that you’re not actually in danger.”

I make a note to try this the next time I hear someone eating scrambled eggs.

By:

Source: Misophonia: how ‘sound rage’ destroys relationships and forces people to move home | Life and style | The Guardian

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Related contents:

“Familial misophonia or selective sound sensitivity syndrome : evidence for autosomal dominant inheritance?”. Brazilian Journal of Otorhinolaryngology. 84 (5): 553–559. doi:10.1016/j.bjorl.2017.06.014. PMC 9452240. PMID 28823694.Cavanna AE, Seri S (August 2015).

Misophonia: current perspectives”. Neuropsychiatric Disease and Treatment. 11: 2117–23. doi:10.2147/NDT.S81438. PMC 4547634. PMID 26316758.Swedo S, Baguley DM, Denys D, Dixon LJ, Erfanian M, Fioretti A, Jastreboff PJ, Kumar S, Rosenthal MZ, Rouw R, Schiller D (2021).

A Consensus Definition of Misophonia: Using a Delphi Process to Reach Expert Agreement”. medRxiv. doi:10.1101/2021.04.05.21254951. S2CID 233152520. Retrieved 11 April 2021.Brout JJ, Edelstein M, Erfanian M, Mannino M, Miller LJ, Rouw R, et al. (2018).

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