Category Archives: Living with a Neurological Condition

This post is about the book “Mindfulness: An Eight-Week Plan For Finding Peace In A Frantic World.”  The author of this book was interviewed on last Friday’s radio show “Science Friday,” which aired on KQED.  As part of the 22 minute interview, the book’s author, Mark Williams, guides the radio audience through a three-minute meditation.  The goal is to prove that you don’t need to dedicate a lot of time to mindfulness to be successful and see improvements.  Mark Williams talks about using mindfulness to reduce stress and ward off depression.

I’ve copied below a link to the radio program as well as a transcript.

Robin

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Be Here Now: Meditation For The Body And Brain
Talk of the Nation/Science Friday
January 20, 2012

In his book Mindfulness: An Eight-Week Plan for Finding Peace in a Frantic World, Oxford University clinical psychologist Mark Williams talks about the brain and body benefits of mindfulness meditation, a cognitive behavioral therapy that can be as effective as drugs at staving off recurring bouts of depression.

www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=145525002&m=145524987

[Robin’s note:  you can find the meditation at 6:46.  It ends at 10:14.]

Here’s a transcript:

www.npr.org/2012/01/20/145525002/be-here-now-meditation-for-the-body-and-brain

IRA FLATOW, HOST:

Up next, mindfulness. Ever find yourself going through day stuck in autopilot mode, waking up at 7:15, wolfing down your usual hot cereal, really, without really tasting it, while you read the paper, your emails, your Facebook feed.

Then it’s off to work, sitting in traffic on the bus or train, consumed by thoughts of that electric bill – oh, I forgot to pay that; the birthday call you have to make; that confrontation you want to avoid at work today; or what you’re cooking for dinner tonight. Any of this sound familiar? Would you like, instead, to turn off those stressful thoughts of the day and just concentrate on what’s going on around you right now? Relax, enjoy the moment and worry about that stuff later.

That’s what my next guest advises, what he calls mindfulness based cognitive therapy, or mindfulness meditation, a practice, he says, can sometimes be as effective as drugs and staving off recurring bouts of depression. What’s the science behind meditation therapy and what are the connections between body and brain? Mark Williams is here to explain and he’s actually going to guide us through a mini meditation session. We wouldn’t want you to do this while you’re driving so a little bit later we’re going to do a little meditation and maybe you’ll pull off the road or listen to it later on the podcast.

Mark Williams is the author of “Mindfulness: An Eight-week Plan For Finding Peace in a Frantic World.” He’s also professor of clinical psychology at the University of Oxford in England. He joins us from BBC Radio (unintelligible) in South Hampton, England. Welcome to SCIENCE FRIDAY.

MARK WILLIAMS: Hi. Thank you very much indeed.

FLATOW: Could you explain – is there a nutshell you can explain what mindfulness is?

WILLIAMS: Well, mindfulness is a form of awareness, really, so we’re all aware sometimes that just as you’re wonderful description of getting up in the morning and as you were driving to work with all these things going through your head, we also know that sometimes we can naturally switch that off sometimes if we take the time to take a walk with a youngster, you know, three or four-year-old, and they’re going very slowly along the road and they’re looking at things.

And sometimes you just have this capacity to slow down at their pace to see what they’re seeing as if through their eyes and to see little tiny details of life as if for the first time. So we know rushing around, but we also know how to slow down sometimes. It’s just that slowing down is actually very difficult to do.

FLATOW: Yeah, especially in this age. Our number is 1-800-989-8255. You can call us to talk about mindfulness. Maybe you practice it yourself. You can go to our Twitter, tweet us at scifri. Is this an especially challenging time with all the distractions from our cell phones and tablets and things like that?

WILLIAMS: There’s no doubt that we have always lots of new challenges. Now, whether cell phones and emails and stuff, which, of course, most of us find get us down from time to time, whether that’s something which is a passing phase in terms of perhaps the new generation coming up will learn how to cope with that better than we who’ve been around a while without it and then find it very overwhelming.

But certainly the 24 hour, seven days a week connectivity, as my colleague John (unintelligible) UMass Medical Center has pointed out, that sense of connectivity means that we have to take special measures to know how to slow down and how to take a brain break, if you like.

FLATOW: Yeah. We’re going to talk about those special methods for slowing down and taking a brain break. We’re going to try and take one right here on SCIENCE FRIDAY, after the break when we come back and have Mark Williams give us a little demonstration of how to practice mindfulness. Our number is 1-800 – this is something, Michael – 1-800-989-8255. 1-800-989-8255 is our number.

Also, you can tweet us at scifri, @S-C-I-F-R-I, and we’ll try a little mindfulness during the break. Stay with us. We’ll be right back.

(SOUNDBITE OF MUSIC)

FLATOW: You’re listening to SCIENCE FRIDAY. I’m Ira Flatow. We’re talking with Mark Williams, author of “Mindfulness: An Eight-week Plan For Finding Peace in a Frantic World.” Our number is 1-800-989-8255. You can tweet us or on Facebook, go to our Facebook site at scifri and tell us, do you meditate, why you do it, what do you get out of it. You can tweet us or leave us a little note there in our SCIENCE FRIDAY Facebook page.

Mark, who is this book for? Is it for people who suffer bouts of depression? Is it for people who – is it for everyone? Is it to teach you how to focus on what you want to focus on instead of all those other things?

WILLIAMS: Absolutely. If you start with that last question, most of us find that our attention is often hijacked by our current concerns so our attention just wanders all over the place and it’s very difficult to focus. So one of the first things you learn in mindfulness meditation is how to just settle the mind, how to focus, not to clear the mind. So it’s not the idea that you try to switch off all these thoughts going through, but that you see them passing through the mind like clouds in the sky.

And that already gives you a greater sense of balance and control in your life. And the reason why it’s relevant for everybody and not just people who get depressed is because both getting caught up in the constant spin of rushing around in a frantic world needs some addressing for many, many of us, most of us indeed. But also, we find that exactly the same strategies, the same skills we find in our research actually reduces the risk of depression.

So those how would get depressed in life many times, especially those with three or more previous depressions, it halves the risk of depression coming back.

FLATOW: So this is actually measurable, the effects.

WILLIAMS: Indeed, indeed. So there would be now six trials around the world starting off with the trial at (unintelligible) in Toronto and (unintelligible) in Cambridge and I did now 10 years ago. And that was the first trial to establish that eight weeks of this training could reduce depression. And we measured it both with questionnaires, but also with very careful interviews based on the American Psychiatric Association’s interview to diagnose depression. And the interviewers were blind.

They didn’t know whether people had had the meditation or not, so they couldn’t, as it were, make up the results to try to make the results better. And they found this really striking reduction in the risk of future depression.

FLATOW: Mark, can you give us a little taste of the sort of meditation you teach in the book, a little session here?

WILLIAMS: Yeah. So here’s a two or three minute meditation that people can try out. As you quite rightly said, it’s not wise to do it if you’re in your car and you’re doing lots of things that need your full attention. But if you can, you can become aware of your posture and just if you’re in a sitting position, you might want to just sit up straight so you’ve got a straight spine. But not stiff, not sort of like a sergeant major.

Just with the back straight, the head balanced, the shoulders can be quite relaxed and dropped. And even this sense of changing your posture already signals your intentions to step out of autopilot. And then, there are three steps now that people can try for themselves. The first is just to notice what’s going on in mind and body right now. So in the silence that comes up, just notice any thoughts that are around, any feelings or emotions there may be, any body sensations that are around.

Notice any tendency we have to want to change what we discover and seeing if it’s possible to simply allow it to be just as it is, just as it already is. And then, moving to step two of this short meditation, to gather your attention, to let all that fade into the background, gather the attention and place it lightly on the breath. So just noticing the sensations of the breath moving in and out of the body, and it may be convenient just to focus on the sensations down in the abdomen.

You can put your hand on the abdomen, if you like, and just notice the rising of the in breath and the falling away of the out breath. And just paying attention as best you can to that sensation of breathing in and breathing out. Not trying to control the breath in any way, simply allowing the breath to breathe you. And if the mind wanders at all, just notice where it went, and very gently escort it back to the breath, the sensations of in or out breath.

And now, taking step three of this short meditation and expanding attention to the body as a whole, sitting here. So simply noticing the whole body, all the sensations in the body from the surface of the skin and right deep inside as if the whole body was breathing now and allowing the sensations in the body to be just as you find them. A sense of coming home to the body. And then, when you’re ready, beginning to move fingers and toes, opening your eyes, if they’ve been closed, and taking in wherever you are, all of your surroundings, and allowing thee meditation to pass and coming back to this moment.

So that’s it, Ira.

FLATOW: That’s nice. Is this something that you have distilled from other meditation techniques or something you’ve…

WILLIAMS: Yeah. I mean, right in the beginning of our research in the beginning of the 1990s, we were very, very helped by a tremendous breakthrough that had been made by John Cabbot Zen(ph) and his colleagues at the UMass medical center in Wooster. And he developed mindfulness based stress reduction for chronic pain and people whose illness was caused by stress or who were stressed by their illness. And he developed an eight-week program in which he’d taken some of the essence of these centuries old – I like to call them spiritual exercises.

They exist in all religions and they exist in secular context as well. And he’d put them in the heart of a general hospital for chronic pain and he generously allowed us to use that as a format for applying mindfulness to our problem that we had as psychologists, which was the gradual realization that had come to the fore at the last part of the 20th century that depression was getting more and more common and recurrence was very, very in the minds of clinicians, because people were getting depressed earlier in life so they’re having a whole lifetime where they were at risk of a new episode of depression.

So the emphasis changed from treating depression to preventing depression. And so we distilled from John Cabbot(ph) in using many of the meditations he used. And the three minute breathing space, which is what we’ve just been through, was a distillation even further down so that people could have a mediation which was very portable, that they could take around and do it any time of day whenever they felt they needed to gather themselves.

And you notice the very first step of the breathing space is not actually going to the breath at all, but just checking in with what’s the weather pattern like in your mind and body, a sense of – what is this? What’s arising from me right now? And that itself is a huge gesture of openness to yourself, of friendliness towards yourself, and for people who are depressed or frantic all the time, we’re not very much friends with ourselves. You know, we tend to beat ourselves up all the time.

FLATOW: 1-800-989-8255. Let’s go to the phones and see some questions we’ve gotten. Robin in Brumfield, Colorado. Hi, Robin.

ROBIN: Hi.

FLATOW: Hi, there.

WILLIAMS: Hi, Robin.

ROBIN: Am I on the air?

FLATOW: You certainly are. I know you probably put yourself very much at ease at that mindful session we just had.

ROBIN: Well, I can tell you firsthand that mindfulness works and it absolutely changed my life. I am so excited that you’re running this program. Thank you for running this program to make people more aware of mindfulness. I am in the process through my nonprofit organization to launch a program for children, teaching children mindfulness in the schools. And it’s such an amazing thing for kids. And I’m doing all this research to that, how it’s helping children with impulse control and more focused and assured in their ability to just help them to redirect their thoughts and be more clear.

And when you clear away the stuff, it’s a lot easier for them to do that and take in and retain information.

WILLIAMS: Absolutely.

ROBIN: So it’s really exciting.

WILLIAMS: Yeah. Thanks, Robin. Absolutely. We’ve got some schools program over in the United Kingdom as well and it’s extraordinary how children get it so quickly. Do you find that?

FLATOW: Oh, we lost her. I think she…

WILLIAMS: Okay.

FLATOW: …she…

WILLIAMS: She’s gone.

FLATOW: But you have experience with kids and…

WILLIAMS: Yeah. We mostly, in our Oxford mindfulness center deal with adults, 18 to – towards older age adults, but we support various other groups that are looking at children, and we also do, even earlier than that, for mindfulness-based childbirth and parenting to prepare for a new baby based on the Californian work going on by Nancy Bardacke, a nurse midwife in California who’s developed childbirth and parenting programs with Mindfulness.

But the school’s work that Robin has alluded to: Goldie Hawn’s doing a lot of work with her Mind Up program in the States. That’s also come into the U.K. And I mean, the whole idea of brain breaks, for example, is from the Goldie Hawn Mind Up program, where she just – is very much a fact about the way in which kids are able to take these short breaks, and it really helps them focus their attention.

FLATOW: Talking with Mark Williams, author of “Mindfulness: An Eight-Week Plan For Finding Peace In A Frantic World.” Can people get frustrated trying to do this correctly during your instructions?

WILLIAMS: Oh, absolutely. And in fact, the frustration is a real good opportunity during meditation to notice all the adverse sort of little reactions that happened, like I noticed you say to doing it correctly. And there’s a great emphasis in our world – isn’t there – on making sure you do things well.

FLATOW: Exactly.

WILLIAMS: And, you know, we don’t ever heed that wise advice that says if a thing is worth doing, it’s worth doing badly. And I think in one sense, with meditation, the sense of having the intention to be – to give yourself a little break, to be with yourself as you are, that’s already enormous. It’s an enormous act of generosity towards yourself. And then, you can watch all these thoughts coming up like, am I doing it correctly, or maybe I’ve done it wrong. I’m not trying hard enough.

Oh, I went to sleep. Oh, my mind wandered. And that’s exactly the stuff of meditation. Meditation is not sitting blissfully at the top of the mountain with a mind clear. It’s actually noticing all the stuff that we don’t normally notice going through our mind, and then learning to relate differently to all of the stuff. We notice that sense of failure. We notice the sense of frustration, and we notice the sense of I must always get things right or it means I’m a bad person.

We notice that and then gradually, sort of, step back a little, not in an avoidant way, but see it like standing behind the waterfall, seeing its force but not getting dragged down by it.

FLATOW: In your book, “Mindfulness,” one of the things you recommend is being more spontaneous. Tell us about that.

WILLIAMS: Well, one of the things we ask people to do, week by week, is not just to meditate, but do things in their daily life which just, sort of, shake up the habits a bit. So, for example, we suggest just sitting in a different sort of different chair at meetings, occasionally and – or at home, just to get that different perspective. Or maybe doing, sort of, going to a movie theater without planning – with a friend – perhaps without planning beforehand what you’re going to see. So you just turn up at seven in the evening or eight in the evening, and you just watch what’s there, just choose when you get there.

Now, most movie theaters often have a big choice, so it’s not a disaster to do that. But there is a, sort of, sense of spontaneity, a sense of reclaiming the life that you’ve probably, you know, lost when you moved out – teenager or early 20s. Many of us are very cautious. We want to plan our times to the last second, and that means not going to see anything that we didn’t plan beforehand and know what it was. So that sense of just shaking up and being a little more spontaneous can help reclaim your life a bit more.

FLATOW: But if I – the idea of living for the moment, I mean being – actually being in the moment that you’re living in, a very interesting and worthwhile pursuit. I’m Ira Flatow. This is SCIENCE FRIDAY from NPR. Talking with Mark Williams, author of “Mindfulness: An Eight-Week Plan For Finding Peace In A Frantic World.” To follow up on that thought, just to be able to sit there and say this is the moment, and I’m going to enjoy this moment because I can’t control what’s going to happen in the future…

WILLIAMS: Exactly.

FLATOW: …but I can control what’s happening right now.

WILLIAMS: That’s right. That the only time that that we really make our choices is in the present moment. And it doesn’t mean that you have to suspend all your planning, sometimes you have to plan for the future. But most of us are pre-living the future. We’re not really planning the future now. We’re just pre-living it and all the worries and things that might go wrong. And we’re reliving the past. So, you know, sometimes, we have to remember what happened in the past.

And – but can we remember knowing that we’re remembering? Can we plan knowing that we’re planning? And that brings the remembering and the planning into the present moment. And the science, the neuroscience is really interesting. The brain changes when you do that in really interesting ways.

FLATOW: In what way – can you describe that for us?

WILLIAMS: Well, there are a number of things. One of the things that my colleague David Creswell, in UCLA, found. When he put people in a brain scanner, and he took people who are either high or low on a mindfulness scale. So if you’re low on that scale, it means that you’re rushing around all the time. You don’t taste your food. You know, you’re always listening only with one ear to what people are saying because your other ear is off doing something else – that sort of sense of rushing all the time.

So he had people that varied on that dimension, that mindfulness dimension, and he put them in a scanner and looked to see what their brains were doing. And what he found was a pretty characteristic feature of people who are always rushing around, is the part of the brain that is usually in fight-and-flight mode – is called the amygdala – was actually in a sort of chronic state of over activity. So when we rush around, we may believe that we’re rushing around to get things done or that we’re being very creative. But that is – it’s an illusion of productivity. And as far as the brain is concerned, it’s like as if we’re running away from a tiger.

FLATOW: Wow. So…

WILLIAMS: And that’s really interesting. Now, when he puts them people through an eight-week course, you’ll find that the amygdala actually settles down. It normalizes. It switches off. It – instead of running around as it were away from a tiger all the time, it addresses the reality of the situation rather than the constants or looking for threats. So that’s one very important part of neuroscience. Another is the work by Sara Lazar at Mass. General. She’s found that people that meditate for over a long period, actually have structural changes in their brain.

In very interesting parts of the brain, that are about attention, attention control and also part of the brain called the insula, which others have found even short-term changes. And we know the insula is active in empathy. And it also switches on for a lot of other things as well. But one of the critical factors here is it seems to be active in when we have an emphatic response, like feeling the feelings of other people, the insula switches on. That is changed by mindfulness meditation.

And what also other people have found – is this Toronto group, Norman Farb and his colleagues in Toronto, found that this is sort of a moving – an uncoupling of our ability to appreciate the body with thoughts about things…

FLATOW: All right…

WILLIAMS: …and we switch off the stories.

FLATOW: If you want to read the rest of what’s going on, read Mark Williams’ book “Mindfulness: An Eight-Week Plan For Finding Peace In A Frantic World.” Thank you for joining us.

WILLIAMS: Thank you, Ira.

FLATOW: We’re going to have this up on our Facebook page as a SciFri snack, the whole meditation that we went through will be up there at the end of the show. So if you missed it, you can check it out then. I’m Ira Flatow. This is SCIENCE FRIDAY from NPR.

Copyright © 2012 National Public Radio

Local support group member Ellen shared this Morningstar article with me at Sunday’s caregiver support group meeting.  The article doesn’t contain investment advice, but rather contains info on “key actions to consider that can help protect you or an aging parent from the financial pitfalls associated with cognitive decline.”

The sections on “Documenting Decline” and “A Sensitive — and Critical — Issue” discuss the issue of cognitive decline and poor financial decision-making.

After digging around, I found parts of the article on two different websites:

cawidgets.morningstar.ca/ArticleTemplate/ArticleGL.aspx?id=387767

louroy.blogspot.com/2011/07/eight-steps-to-wealth-protection-for.html

The Smart Investor
Eight steps to wealth protection for aging investors
By Mark Miller
07-21-11

Happy reading,
Robin

 

Ann Harrison lives in Boston.  Her father died in March from pneumonia.  Her father participated in dementia research studies at Mass General, and his brain was donated there upon his death.  (It’s the only way she will learn which progressive dementia he had.)  This week, Ann posted to an LBD-related online support group a list of things she learned along the way that helped her father.  She gave me permission to share her list, and two subsequent email exchanges about one item on the list (the 24-hour clock) and one item not on the list (brain donation).

– Robin

Posted by:  Ann Harrison
Date:  3/31/11

Here are some things, large and small that I learned [that helped my father.]

Find a neurologist you trust. The disease changes over time and the medications to make the patient most comfortable also change. We saw a “geriatric specialist” first, who put Dad on five or six different medications all at once. Some were good, some were not, but adding them all at once was bad. Then we saw a highly regarded geriatric neurologist who did all the right tests and was slow about adding medications, but who constantly broke appointments and was hard to reach. Then I took [a local support group leader’s] recommendation and saw Dr. Gomperts at MGH. He never decided which of the untreatable progressive dementias Dad had, but was always available within a few hours and worked with me to balance medications as Dad’s parkinsonianism and fears got worse.

Second, watch all medications. Dad’s serious problems started after he was put on vesicare by his urologist. Who would guess that medications for urinary frequency could have terrible effects on cognition? If I had known about this [online support group], Dad might have had another year or eighteen months of slowly declining normality, instead of a rapid decline into dependency. Later, he had a bad reaction to Benedryl – something you can give to babies.

At first, Dad’s worst problems were confusing times of day. Even before he was in serious trouble, he would show up for PT in the middle of the night. We started with caregivers from breakfast until afternoon nap, then from dinner time to bed time, leaving him alone while he normally slept. If he awoke, he had no way to orient himself in time. I built him a 24 hour, single-handed clock that showed when he should go back to sleep and when he should expect someone to be there. Here are the instructions:

pragmaticcaregiver.blogspot.com/2007/05/id-like-to-buy-clue-part-1.html

[Robin’s note:  In an email exchange with Ann, I noted that probably once a month I recommend the 24-hour clock from the pragmatic caregiver to people in the local support group.  I think it’s a great idea but I’ve never heard from anyone other than the “pragmatic caregiver” that it worked.  I asked Ann if the clock addressed her father’s confusion.] [The 24-hour clock] helped some.  We also put a big cardboard box in hall with a sign saying “It’s night time, go back to bed!”  Sometimes he would call me at 1 or 2 AM and I’d tell him to look at the clock to and see that no-one was supposed to be there.  So, yes, I think it helped, for a while.  Then he needed 24 hour care …

Dad’s temporal disorientation lead to his calling me at all times of the day and night, which got to be a problem as he forgot phone numbers and called other people by mistake. I got him a memory phone without number buttons. He was able to read long after he was able to talk coherently, so I just put names on the buttons rather than pictures.

Learning to adapt to his condition was really hard – from the moment when a shoe-store clerk suggested shoes with velcro closing that I thought he would hate, but the person he’d become found them fascinating and wonderful, to the moment when I realized that he really didn’t need his partial plate – nobody cared if he had front teeth or not … a whole series of letting-go incidents. But so many voices on the [online support group] kept saying that we the caregivers need to move into the world our loved ones now inhabit because they can’t come back to ours … and I learned to live with it. There were bad times when other people had to remind me that he couldn’t come into my world, even if it was Christmas and I just wanted him to go downstairs for dinner.

The voices on this [online support group] also helped me understand that the hospice doctor’s recommendation for a stair lift was good, even though I thought climbing stairs kept him strong and he had never fallen there. Safety is more important than strength when you’ve got a disease that’s going to be fatal.

The [online support group] also helped with legal issues. Before his serious decline, Dad had given me power of attorney, added my name to his bank accounts, and made me his health care proxy. It was on this [online support group] that I learned about what Massachusetts calls the “Comfort Care / Do Not Resuscitate” form. I signed them during hospitalizations in the first few years, but those forms were only binding during the hospital stay. The official form had to be signed by his regular physician. I also got a letter from that doctor saying that he was incompetent due to dementia, which I needed once or twice to get a bank to accept my power of attorney.

After he got so unstable on his feet that he shouldn’t try to walk alone, I found a motion sensor alarm for his bed. His caregivers added a baby monitor, so they could go downstairs to make meals without worrying that he would try to get up and fall.

And then there was Capgras. His problem was more about being in a house that looked like his house than thinking that people were not themselves. By the time that symptom arose, he had great difficulty getting out of the house, so driving him around the block wasn’t a good solution. Generally, talking about the pictures of his parents, my mother, and his boat would convince him that if he wasn’t at home, he was still in a good place.

And all the bathroom stuff – the toilet seat booster, the booster with arms, depends, commode… constantly letting go of who he was, and adapting to who he was becoming. One non-toilet related bathroom accessory was a long shower bench that he could sit on outside the tub, then slide across into the tub and swing his legs in. Even with grab bars all around, the step into the tub was frightening – to him and to his caregivers. The long bench solved that problem without having to redo the bathroom.

Some messages I took selectively, deciding that the quality of Dad’s life mattered more than keeping him completely safe. So he ate whatever he wanted because texture is a lot of the pleasure of food and food was something he enjoyed to the last day of his life. No thickened liquids, no pureed diet. Maybe his pneumonia was caused by aspiration, maybe he would have lived long enough to be completely bedridden, sucking on a bottle if I hadn’t been stubborn about food, but I can live with my decision there.

And hospice and staying at home to the end. He didn’t go to a doctor’s office for the last eighteen months of his life. Regular visits from the hospice nurse kept minor problems from flaring up, and knowing that we had a doctor who would come to the house if something went wrong was a huge relief – to him and to all of us.

Sincerely,
Ann

Robin’s note:  I asked Ann why she hadn’t added “brain donation” to her list, as this was something she had learned about along the way.  She replied that her father was not part of the decision to donate his brain and therefore it was not something that benefited him directly.  She said that there are lots of benefits to her, but were none to her father.  I know that when individuals donating their brains are involved in that decision, they feel that something good is coming out of something bad.  And they are often proud for making such a decision.  This doesn’t work for every family (as many wait until the family member is on his/her death bed before making the decision) but, when it does, it can be a point of pride for the entire family.