Posture affects memory recall and mood

This blog has been reprinted from: Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood.  Biofeedback, 45 (2), 36-41.

When I sat collapsed looking down, negative memories flooded me and I found it difficult to shift and think of positive memories. While sitting erect, I found it easier to think of positive memories.               -Student participant

Charlie BrownThe link between posture and mood is embedded in idiomatic phrases such as walking tall, standing proud, and an upstanding citizen, versus collapsed, defeated, or in a slump–Language suggests that posture and mood/emotions are connected. Slumped posture is commonly observed in depression (Canales et al., 2010; Michalak et al., 2009) and adapting an upright posture increases positive affect, reduces fatigue, and increases energy in people with mild to moderate depression (Wilkes et al., 2017; Peper & Lin, 2012).

This blog describes in detail our research study that demonstrated  how posture affects memory recall  (Peper et al, 2017). Our findings may explain why depression is increasing the more people use cell phones. More importantly,  learning posture awareness and siting more upright  at home and in the office may be an effective somatic self-healing strategy to increase positive affect and decrease depression.

Background

Most psychotherapies tend to focus on the mind component of the body-mind relationship. On the other hand, exercise and posture focus on the body component of the mind/emotion/body relationship. Physical activity in general has been demonstrated to improve mood and exercise has been successfully used to treat depression with lower recidivism rates than pharmaceuticals such as sertraline (Zoloft) (Babyak et al., 2000). Although the role of exercise as a treatment strategy for depression has been accepted, the role of posture is not commonly included in cognitive behavior therapy (CBT) or biofeedback or neurofeedback therapy.

The link between posture, emotions and cognition to counter symptoms of depression and low energy have been suggested by Wilkes et al. (2017) and Peper and Lin (2012),  . Peper and Lin (2012) demonstrated that if people tried skipping rather than walking in a slouched posture, subjective energy after the exercise was significantly higher. Among the participants who had reported the highest level of depression during the last two years, there was a significant decrease of subjective energy when they walked in slouched position as compared to those who reported a low level of depression. Earlier, Wilson and Peper (2004) demonstrated that in a collapsed posture, students more easily accessed hopeless, powerless, defeated and other negative memories as compared to memories accessed in an upright position. More recently, Tsai, Peper, and Lin (2016) showed that when participants sat in a collapsed position, evoking positive thoughts required more “brain activation” (i.e. greater mental effort) compared to that required when walking in an upright position.

Even hormone levels also appear to change in a collapsed posture (Carney, Cuddy, & Yap, 2010). For example, two minutes of standing in a collapsed position significantly decreased testosterone and increased cortisol as compared to a ‘power posture,’ which significantly increased testosterone and decreased cortisol while standing. As  Professor Amy Cuddy pointed out in herTechnology, Entertainment and Design (TED) talk, “By changing posture, you not only present yourself differently to the world around you, you actually change your hormones” (Cuddy, 2012).  Although there appears to be controversy about the results of this study, the overall findings match mammalian behavior of dominance and submission. From my perspective, the concepts underlying Cuddy’s TED talk are correct and are reconfirmed in our research on the effect of posture.  For more detail about the controversy, see the article by Susan Dominusin in the New York Times,  “When the revolution came for Amy Cuddy,”, and Amy Cuddy’s response (Dominus, 2017;Singal and Dahl, 2016).

The purpose of our study is to expand on our observations with more than 3,000 students and workshop participants. We observed that body posture and position affects recall of emotional memory. Moreover, a history of self-described depression appears to affect the recall of either positive or negative memories.

Method

Subjects: 216 college students (65 males; 142 females; 9 undeclared), average age: 24.6 years (SD = 7.6) participated in a regularly planned classroom demonstration regarding the relationship between posture and mood. As an evaluation of a classroom activity, this report of findings was exempted from Institutional Review Board oversight.

Procedure

While sitting in a class, students filled out a short, anonymous questionnaire, which asked them to rate their history of depression over the last two years, their level of depression and energy at this moment, and how easy it was for them to change their moods and energy level (on a scale from 1–10). The students also rated the extent they became emotionally absorbed or “captured” by their positive or negative memory recall. Half of the students were asked to rate how they sat in front of their computer, tablet, or mobile device on a scale from 1 (sitting upright) to 10 (completely slouched).

Two different sitting postures were clearly defined for participants: slouched/collapsed and erect/upright as shown in Figure 1. To assume the collapsed position, they were asked to slouch and look down while slightly rounding the back. For the erect position, they were asked to sit upright with a slight arch in their back, while looking upward.

Figure 1 body positionFigure 1. Sitting in a collapsed position and upright position (photo by Jana  Asenbrennerova). Reprinted by permission from Gorter and Peper (2011).

After experiencing both postures, half the students sat in the collapsed position while the other half sat in the upright position. While in this position, they were asked to recall/evoke as many hopeless, helpless, powerless, or defeated memories as possible, one after the other, for 30 seconds.

After 30 seconds they were reminded to keep their same position and let go of thinking negative memories. They were then asked to recall/evoke only positive, optimistic, or empowering memories for 30 seconds.

They were then asked to switch positions. Those who were collapsed switched to sitting erect, and those who were erect switched to sitting collapsed. Then they were again asked to recall/evoke as many hopeless, helpless, powerless, or defeated memories as possible one after the other for 30 seconds. After 30 seconds they were reminded to keep their same position and again let go of thinking of negative memories. They were then asked to recall/evoke only positive, optimistic, or empowering memories for 30 seconds, while still retaining the second posture.

They then rated their subjective experience in recalling negative or positive memories and the degree to which they were absorbed or captured by the memories in each position, and in which position it was easier to recall positive or negative experiences.

Results

86% of the participants reported that it was easier to recall/access negative memories in the collapsed position than in the erect position, which was significantly different as determined by one-way ANOVA (F(1,430)=110.193, p < 0.01) and 87% of participants reported that it was easier to recall/access positive images in the erect position than in the collapsed position, which was significantly different as determined by one-way ANOVA (F(1,430)=173.861, p < 0.01) as shown in Figure 2.

Figure 2 emotional recallFigure 2. Percent of respondents who reported that it was easier to recall positive or negative memories in an upright or slouched posture.

The difficulty or ease of recalling negative or positive memories varied depending on position as shown in Figure 3.

Figure 3 access to memoriesFigure 3. The relative subjective rating in the ease or difficulty of recalling negative and positive memories in collapsed and upright positions.

The participants with a high level of depression over the last two years (top 23% of participants who scored 7 or higher on the scale of 1–10) reported that it was significantly more difficult to change their mood from negative to positive (t(110) = 4.08, p < 0.01) than was reported by those with a low level of depression (lowest 29% of the participants who scored 3 or less on the scale of 1–10). It was significantly easier for more depressed students to recall/evoke negative memories in the collapsed posture (t(109) = 2.55, p = 0.01) and in the upright posture (t(110) = 2.41, p ≦0.05 he) and no significant difference in recalling positive memories in either posture, as shown in Figure 4.

Figure 4 least most depressedFigure 4. Differences is in memory access for participants with a history of least or most depression.

For all participants, there was a significant correlation (r = 0.4) between subjective energy level and ease with which they could change from negative to positive mood. There were no significance differences for gender in all measures except that males reported a significantly higher energy level than females (M = 5.5, SD = 3.0 and M = 4.7, SD = 3.8, respectively; t(203) = 2.78, p < 0.01).

A subset of students also had rated their posture when sitting in front of a computer or using a digital device (tablet or cell phone) on a scale from 1 (upright) to 10 (completely slouched). The students with the highest levels of depression over the last two years reporting slouching significantly more than those with the lowest level of depression over the last two years (M = 6.4, SD = 3.5 and M = 4.6, SD = 2.6; t(46) = 3.5, p < 0.01).

There were no other order effects except of accessing fewer negative memories in the collapsed posture after accessing positive memories in the erect posture (t(159)=2.7, p < 0.01). Approximately half of the students who also rated being “captured” by their positive or negative memories were significantly more captured by the negative memories in the collapsed posture than in the erect posture (t(197) = 6.8, p < 0.01) and were significantly more captured by positive memories in the erect posture than the collapsed posture (t(197) = 7.6, p < 0.01), as shown in Figure 5.

Figure 5 Posture dependent ratingFigure 5. Subjective rating of being captured by negative and positive memories depending upon position.

Discussion

Posture significantly influenced access to negative and positive memory recall and confirms the report by Wilson and Peper (2004). The collapsed/slouched position was associated with significantly easier access to negative memories. This is a useful clinical observation because ruminating on negative memories tends to decrease subjective energy and increase depressive feelings (Michi et al., 2015). When working with clients to change their cognition, especially in the treatment of depression, the posture may affect the outcome. Thus, therapists should consider posture retraining as a clinical intervention. This would include teaching clients to change their posture in the office and at home as a strategy to optimize access to positive memories and thereby reduce access or fixation on negative memories. Thus if one is in a negative mood, then slouching could maintain this negative mood while changing body posture to an erect posture, would make it easier to shift moods.

Physiologically, an erect body posture allows participants to breathe more diaphragmatically because the diaphragm has more space for descent. It is easier for participants to learn slower breathing and increased heart rate variability while sitting erect as compared to collapsed, as shown in Figure 6 (Mason et al., 2017).

Figure 6 collapse and physiologyFigure 6. Effect of posture on respiratory breathing pattern and heart rate variability.

The collapsed position also tends to increase neck and shoulder symptoms This position is often observed in people who work at the computer or are constantly looking at their cell phone—a position sometimes labeled as the i-Neck.

Implication for therapy

In most biofeedback and neurofeedback training sessions, posture is not assessed and clients sit in a comfortable chair, which automatically causes a slouched position. Similarly, at home, most clients sit on an easy chair or couch, which lets them slouch as they watch TV or surf the web. Finally, most people slouch when looking at their cellphone, tablet, or the computer screen (Guan et al., 2016). They usually only become aware of slouching when they experience neck, shoulder, or back discomfort.

Clients and therapists are usually not aware that a slouched posture may decrease the client’s energy level and increase the prevalence of a negative mood. Thus, we recommend that therapists incorporate posture awareness and training to optimize access to positive imagery and increase energy.

References

Babyak, M., Blumenthal, J. A., Herman, S., Khatri, P., Doraiswamy, M., Moore, K., … Krishnan, K. R. (2000). Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosomatic Medicine, 62(5), 633–638. 

Canales, J. Z., Cordas, T. A., Fiquer, J. T., Cavalcante, A. F., & Moreno, R. A. (2010). Posture and body image in individuals with major depressive disorder: A controlled study. Revista brasileira de psiquiatria, 32(4), 375–380.

Carney, D. R., Cuddy, A. J., & Yap, A. J. (2010). Power posing brief nonverbal displays affect neuroendocrine levels and risk tolerance. Psychological Science, 21(10), 1363–1368.

Cuddy, A. (2012). Your body language shapes who you are. Technology, Entertainment, and Design (TED) Talk, available at:  www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are

Dominus, S. (2017, October 18). When the revolution came for Amy Cuddy. New York Times Magazine, https://www.nytimes.com/2017/10/18/magazine/when-the-revolution-came-for-amy-cuddy.html?_r=0

Gorter, R. & Peper, E. (2011). Fighting Cancer-A Non Toxic Approach to Treatment. Berkeley, CA: North Atlantic Books

Guan, X., Fan, G., Chen, Z., Zeng, Y., Zhang, H., Hu, A., … He, S. (2016). Gender difference in mobile phone use and the impact of digital device exposure on neck posture. Ergonomics59(11), 1453–1461.

Mason, L., Joy, M., Peper, E., & Harvey, R, A. (2017). Posture Matters. Poster presented at the 48th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback, Chicago, IL March, 2017. Abstract published in Applied Psychophysiology and Biofeedback, 42(2), 148.

Michalak, J., Troje, N. F., Fischer, J., Vollmar, P., Heidenreich, T., & Schulte, D. (2009). Embodiment of sadness and depression: Gait patterns associated with dysphoric mood. Psychosomatic Medicine, 71(5), 580–587.

Michl, L. C., McLaughlin, K. A., Shepherd, K., & Nolen-Hoeksema, S. (2013). Rumination as a mechanism linking stressful life events to symptoms of depression and anxiety: Longitudinal evidence in early adolescents and adults. Journal of Abnormal Psychology122(2), 339.

Peper, E. & Lin, I-M. (2012). Increase or decrease depression: How body postures influence your energy level. Biofeedback, 40(3), 126–130.

Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood.  Biofeedback.45 (2), 36-41.

Singal, J. and Dahl, M. (2016, Sept 30 ) Here Is Amy Cuddy’s Response to Critiques of Her Power-Posing Research. https://www.thecut.com/2016/09/read-amy-cuddys-response-to-power-posing-critiques.html

Tsai, H. Y., Peper, E., & Lin, I. M. (2016). EEG patterns under positive/negative body postures and emotion recall tasks. NeuroRegulation, 3(1), 23–27.

Wilkes, C., Kydd, R., Sagar, M., & Broadbent, E. (2017). Upright posture improves affect and fatigue in people with depressive symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 54, 143–149.

Wilson, V.E. and Peper, E. (2004). The effects of upright and slumped postures on the generation of positive and negative thoughts. Applied Psychophysiology and Biofeedback, 29(3), 189–195.

We thank Frank Andrasik for his constructive comments.

 


Exercise:  Improve your health, mood, and cognitive function

Through millions of years, movement was part of our biological necessity..  Movement was necessary to hunt, to escape predators, to explore and to find a mate. Organisms developed a brain (nervous system) to coordinate movement as eloquently explain by neuroscientist Daniel Wolpert in his 2011 TED talk, The Real Reasons for Brains.

It is only recently that we limit movement by sitting, driving, taking the escalator, or controlling equipment that performs the actual physical labor. We interfere with our evolutionary developed physiology when we reduce or even eliminate movement for the sake of efficiency. Lack of movement, “sitting disease”, is a significant contributor and causal factor in illness. It also increases the stress response, negative mood and depression and reduces cognitive activity. Take charge and reduce illness when you integrate purposeful exercise (walking, running, dancing, etc.) into your life style.

we fucked up

Exercise is the most effective behavioral technique for self-regulation of mood in healthy people as summarized in the superb article, The Effects of Acute Exercise on Mood, Cognition, Neurophysiology, and Neurochemical Pathways: A Review, Dr. Julia C. Basso and Wendy A. Suzuki of the  Center for Neural Science, New York University, New York, NY, USA.  The robust research findings show that acute exercise improves mood, significantly reduces depression, tension, anger, fatigue, and confusion.  In addition, acute exercise improves symptoms associated with psychological disorders such as depression, anxiety, schizophrenia, and post-traumatic stress disorder.  Exercise decreases the risk of type 2 diabetes, coronary heart disease and stress-related blood pressure response by inhibiting the sympathetic nervous system response to stress. For a detailed summary, see the blogs, What is the best single thing we can do for our health and Healthy movement is the new aging.

Finally, the authors also review the relevant neurophysiological, and neurochemical processes that are affected by exercise. What is most interesting are the findings that “acute exercise primarily enhances executive functions dependent on the prefrontal cortex including attention, working memory, problem solving, cognitive flexibility, verbal fluency, decision making, and inhibitory control. These positive changes have been demonstrated to occur with very low to very high exercise intensities, with effects lasting for up to two hours after the end of the exercise bout.”

As the authors state, “We show that the three most consistent cognitive/behavioral effects of a single bout of exercise in humans are improved executive functions, enhanced mood states, and decreased stress levels.”

Even though the findings are clear that movement/exercise is a powerful “drug” to improve our health, most health professionals focus on sitting treatment and prescribing pharmaceutical agents. Possibly, a treatment session should start with fun physical exercise and followed by therapy. Remember, if you feel blah, have lower energy, feel frustrated or irritated, get up and move.  Movement and exercise will change your mood. You will experience what Peper and Lin (2012), have shown that less than minute of skipping in place will significantly improve your subjective energy level and mood. Get up and skip in place, then observe how much better you feel. Then sit again read the article by Dr. Julia C. Basso and Wendy A. Suzuki, http://content.iospress.com/download/brain-plasticity/bpl160040?id=brain-plasticity%2Fbpl160040

 


Millennials and the impact of technology

Technology connects us 24/7. Like a drug it provides instantaneous reinforcement when searching for information and sending or receiving social messages.  Millennials are the first generation of digital natives who are always connected–from being jarred awake by their cellphone alarm to checking email or Facebook just before sleep. They are unlike their parents who are digital immigrants and have experienced face-to-face communication instead of virtual/digital communication. The video below, Simon Sinek on Millennials in the Workplace, offers an interesting insight of in the lives of millennials.


Your body “tells” of your emotional state

Sweating, finger temperature, muscle tension, breathing, heart rate, posture and other body signals covertly and overtly display your emotional state. The feedback from these signals can facilitate awareness and control to promote your health. Watch my presentation, The skin you’re in and other signals “Tells” of emotional state,   presented at the  TransTech-Transformative Technology Conference, Sofia University, Palo Alto, CA, Oct 14, 2016.

 


Evolutionary approach to return to health

Many  illness may be prevented or reversed when we life in harmony with our evolutionary origins such as diet, movement, and circadian rhythm. The focus is to teach skills and not pills; since, many medications have long term negative side affects. By applying behavioral life style changes that supports our evolutionary patterns, we may be able to prevent or even reverse numerous illnesses such as epilepsy, eczema, diabetes, Crohn’s disease, allergies, ADHD, depression, anxiety,  cancer, stress related symptoms.

Enjoy the wide ranging lecture presented at the 2012 meeting of the International Society for Neurofeedback and Research.


Health: Belonging to a tribe

How come rampage killings occur in affluent or upper middle class communities and in rural towns with low crime rate and not in high crime urban neighborhoods?

How come that most rampage shootings by a lone gunman continue to increase since the 1980’s?

How come suicide is extremely high in most modern societies (e.g., USA) while extremely low  in traditional tribal societies?

How come the depression and anxiety rates in wealthy countries are eight times that of poor countries?

How come people in countries with the largest income disparity such as the United States have the highest lifelong risk of develop depression as compared to countries with the smallest income disparity?

How come babies feel scared at night?

How come when people reflect back at their suffering during war it was simultaneous the worsts and the best of times?

How come after 9/11 or other major crisis, suicide and crime rates went down?

How come post-traumatic stress disorder (PTSD) is significantly higher for the rear based troops who suffer relatively few casualties as compared to the front line troops who engage in actual combat?

How come Israel Defense Forces have a very low PTSD rate compared to the USA military forces?

How come the elderly and so many people feel isolated, lonely and sad?

How come the streets and parks are covered with litter and buildings and surfaces are covered with graffiti?

The answers may not reside within the individual but in our pathological individualistic culture.  Through millions of years of evolution, we were a clan–a tribe.  And, as a tribe, we were mutually dependent and supportive. This is our biological and social DNA–we are social interdependent beings. The common theme underlying the questions above is that we are disconnected from others and our community. We are living apart from our evolutionary background where living together as tribe allowed us to survive and prosper for  thousands of generations. When we are part of a community and are welcomed back after  experiencing trauma, depression, anxiety, violence, PTSD,  and even littering is significantly lower.

The importance of community, being part of tribe, is superbly described by New York Times bestselling author, Sebastian Junger, in his book, Tribe-On Homecoming and Belonging.  This is a must read book to understand the hidden pathology created by our modern economic inequality American culture that worships the individual affluence over the common good. It suggests that we must return to our evolutionary origins, radically reduce economic inequality, work on community wide projects to enhance the common good, and actively participate in rebuilding our tribe. Being a meaningful part of a tribe can be much more healing than ingesting a profit based pharmaceutical drug for depression and PTSD. Let us support the common good over the individual increase in wealth.

Tribe by Sebastian Junger

As the poet John Donne wrote in 1624:

No man is an island,
Entire of itself,
Every man is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thy friend’s
Or of thine own were:
Any man’s death diminishes me,
Because I am involved in mankind,
And therefore never send to know for whom the bell tolls; 
It tolls for thee. 


The surprising and powerful links between posture and mood

Enjoy Vivian Giang’s superb blog, The surprising and powerful links between posture and mood,  published by Fast Company and reprinted with permission.   It summarizes in a very readable way how posture affects health and well being.

The Surprising and Powerful Links between Posture and Mood

Why feeling taller tricks your brain into making you feel more confident and why your smartphone addiction might be making you depressed.

The next time you’re feeling sad and depressed, pay close attention to your posture. According to cognitive scientists, you’ll likely be slumped over with your neck and shoulders curved forward and head looking down.

While it’s true that you’re sitting this way because you’re sad, it’s also true that you’re sad because you’re sitting this way. This philosophy, known as embodied cognition, is the idea that the relationship between our mind and body runs both ways, meaning our mind influences the way our body reacts, but the form of our body also triggers our mind.

In large part due to Amy Cuddy’s widly popular 2012 TED talk, most of us know that two minutes of “power poses” a day can change how we feel about ourselves. This isn’t just about displaying confidence to others around; this is about actually changing your hormones—increased levels of testosterone and decreased levels of cortisol, or the stress hormone, in the brain.

“The brain has an area that reflects confidence, but once that area is triggered it doesn’t matter exactly how it’s triggered,” says Richard Petty, professor of psychology at Ohio State University. “It can be difficult to distinguish real confidence from confidence that comes from just standing up straight … these things go both ways just like happiness leads to smiling, but also smiling leads to happiness.”

When it comes to posture, Petty explains that the way we ultimately feel has a lot to do with the associations we have with being taller. For example, if you take two people and you put one on a chair that’s above the other person, the one that’s looking down will feel more powerful because “we have all these associations” with height and power that “gets triggered automatically when certain movements are made,” he says. The function of your body posture tells your brain that you’re powerful, which, in turn, affects your attitude.

In a 2009 study published in the European Journal of Social Psychology, Petty along with other researchers instructed 71 college students to either “sit up straight” and “push out [their] chest” or “sit slouched forward” with their “face looking at [their] knees.” While holding their assigned posture, the students were asked to list either three positive or negative personal traits they thought would contribute to their future job satisfaction and professional performance. Afterward, the students were asked to take a survey where they rated themselves on how well they thought they would perform as a future professional.

The researchers found that how the students rated themselves depended on the posture they kept when they wrote the positive or negative traits. Those who were in the upright position believed in the positive and negative traits they wrote down while those in the slouched over position weren’t convinced of their positive or negative traits. In other words, when the students were in the upright, confident position, they trusted their own thoughts whether those thoughts were positive or negative. On the other hand, when the students sat in a powerless position, they didn’t trust anything they wrote down whether it was positive or negative.

However, those in the upright position likely had an easier time thinking of “empowering, positive” traits about themselves to write down while those in the slouched over position probably had an easier time recalling “hopeless, helpless, powerless, and negative” feelings, according to Erik Peper, professor of Holistic Health at San Francisco State University.

In a series of experiments, Peper found that sitting in a collapsed, helpless position makes it easier for negative thoughts and memories to appear while sitting in an upright, powerful position makes it easier to have empowering thoughts and memories.

“Emotions and thoughts affect our posture and energy levels; conversely, posture and energy affect our emotions and thoughts,” says one of Peper’s studies from 2012, and two minutes of skipping versus walking in a slouched position can make a significant difference on our energy levels. Like Cuddy, Peper’s research finds that it only takes two minutes to change your hormones, meaning you can basically change the chemistry in your brain while waiting for your food to heat up in the microwave.

Since posture affects our mood and thoughts so much, the increase of collapsed sitting and walking—from sitting in front of our computer to looking down at our smartphones—may very much have an effect on the rise of depression in recent years. Peper and his team of researchers suggest that posture is a significant contributor to decreased energy levels and depression. Slouching is also known to result in frequent headaches and neck and shoulder pains.

With so much research proving the influence posture has on our mind, Peper suggests hanging photos of people you love slightly higher on the wall or above your desk so that you have to look up. Also, adjust your rear view mirror slightly higher so that you have to sit up taller while driving. If you need reminders, Petty advises setting reminders on your phone, computer, or even a Post-It note. When you do have negative thoughts, instead of validating them by slumping over or bending your head, Petty says that you should write them down on a piece of paper, then throw that piece of paper away in the trash.

“People who throw those negative thoughts into the trash can are less affected by them then people who had the same thoughts but symbolically put them in their pocket,” he says. “It’s this idea that it’s not what we think that’s important; it’s how much we trust what we think.”

Reprinted by permission from Vivian Giang