I baked a cake! It wasn’t too good, I had a ton of fun, and you should do something, too

Behold! Behold! A Schloss Cake!!!

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The cake I baked: It’s Schlosstastic

What you are looking at is a red velvet hilarity. It took me about four hours to bake and was largely inspired by the Great British Bake-Off. My wife and I have been binging on it lately, and that can only end hilariously.

I’m not a complete noob at baking. I’ve baked some pretty good cookies and brownies, but a CAKE. Man, that’s a whole different level.

And how did it go? Well, poorly. Everyone LOVED the cake. No one liked the icing. Want proof? Here was the cake when I got back from work:

Cake With Icing.jpg

Now, to answer the question which may have popped into your head: Why the hell am I writing about a cake on a blog about depression?

Welp, because it was fun. And engaging, and I mean ALL ENGAGING. And that was really good for me.

Let me explain.

When I was a kid, I remember my Mom telling me that when she was down, she loved to bake. She said it was all engaging and really absorbed her attention. As an adult, I’ve found that she was completely right.

This jives with my efforts to fight depression. I’ve noticed that, the more absorbed I get in an activity, the less time I have to think about depression. Indeed, this is something I’ve written about before: The key role that rumination has in depression. This is something which has a large role in the book The Depression Cure: Fighting rumination means finding an engaging activity to absorb your attention and break the cycle of rumination.

And, let me tell you, when you bake, your attention is absorbed. Or, at least, it better be. Otherwise, your icing may suck…I mean, otherwise, things won’t come out as good. And I have to say, I really enjoyed it. I think there’s a piece of me…a very large piece…which is still a little kid. You want me to play with food AND bake something which could be very tasty? I’m in! Where do I sign up? And yes, there is a sense of pride that goes with baking. It’s kind of fun to know that I made something which is at least a little bit tasty.

Should you bake? Maybe. I mean, if it isn’t for you, don’t – but, if you want to try, I say it’s totally worth it (start with cookies, those are simpler and harder to mess up). But, if you don’t want to bake, do something else. Do something engaging, something that will swallow you whole. Do something fun. Just do something. It’s really important to beat depression.

And, as always, if you have any comments or thoughts, please let us know below!

A review of The Depression Cure and Therapeutic Lifestyle Change: Is beating depression REALLY that simple?

I recently finished The Depression Cure by Dr. Stephen Ilardi. It was…interesting. A unique blend of common sense, historical perspective and medical research, boiled into a six-step process which claims to be able to beat depression. My summary? A lot of merit in here, albiet maybe too simplistic. And I plan on incorporating some of what I learned into my life.

For starters, here’s the crux of the book: Depression is a disease of civilization. Ilardi argues that we’ve seen a rise in depression because of the way we have become civilized and socialized. We don’t get enough exercise, enough sunlight, enough of the right kind of food, enough sleep or enough social connections. We have broken away from the way our bodies and minds have evolved, and as a result, we’ve broken down.

Even more interesting: The book came out in 2009, well before iPhones became hugely ingrained in our lives. During that time, depression and rates of mental illness have only increased.

So what’s the cure? According to Ilardi, we need to do six things:

  • Get at least eight hours sleep.
  • Get more sunshine/natural light – including with a lightbox.
  • Improve our social connections.
  • Stop ruminating.
  • Improve our consumption of certain nutrients, like Omega-3s.
  • Get more exercise.

Ilardi claims that these steps combined – which he describes as Therapeutic Lifestyle Change – can dramatically reduce, if not outright eliminate, depression.

What does the research say? Well, that’s the thing, actually: This stuff isn’t psuedo-science. Each and everyone of the six steps above is backed up by real research which shows that these items can help reduce depression. Heck, I’ve written on many of them long before I read this book, including sleep and rumination.

How about the overall TLC package? TLC’s website provides a link which shows the effectiveness of each of these items individually, although I couldn’t find anything which evaluates the package as a whole. Still, it makes sense that they would work when used together, with the effectiveness of each individual element hopefully reinforcing each other.

My greatest issue? It just seems…too easy. Ilardi argues that, in many cases, sunshine can beat depression. I just cannot imagine it’s that simple. I also know how difficult it can be to do some of these items. When you are severely depressed, you may lose the ability to care for yourself or work towards self improvement. To his credit, Ilardi recognizes this: He breaks down each of these steps into small, easy to swallow, achievable items. He also acknowledges that there can be many causes of depression for which TLC is inadequate, including PTSD, brain damage and other medical changes.

If this is all real, I’d argue it could be a paradigm shift in depression. We wouldn’t need therapy or drugs: We’d need sleep or sunshine. It seems too easy and I’m skeptical. I’m very pro-medication (when necessary), and this book just seems to simplistic at times.

Still.

I’m going to give some of this stuff a shot, starting with the Omega 3 supplements, and I highly recognize you do the same (if you’re doing anything physical, like a lightbox or supplements, you should talk with your doctor first – I did!). At the worst, this stuff is harmless or good for you anyway. At the best…who knows.

If you’ve had any experience with TLC, please let us know in the comments below!

Using creative arts to combat depression

If you follow my Facebook page, you might have noticed that I posted this article the other day. It’s an NPR story about a photographer named Tara Wray who used photography to combat her depression. Said Wray:

“Just forcing myself to get out of my head and using the camera to do that is, in a way, a therapeutic tool. It’s like exercise: You don’t want to do it, you have to make yourself do it, and you feel better after you do.”

According to the story, this effort resulted in Wray launching the Too Tired Project, which bills itself as, “a photo initiative and traveling slideshow series that aims to help those struggling with depression by offering a platform for collective creative expression and community.”

Creative arts have been used to fight depression throughout history; indeed, creative arts and depression are often linked. Many of history’s greatest artists have struggled with their own demons.

So, why is it that creative arts can help people with depression?

Well, I think the quote above is at least a piece of the answer. Engaging into some other hobby – getting into a sense of flow, if you will – can get you out of your head. I firmly believe that escaping yourself is a key part of beating depression. Even if it’s for a little bit, you can trick your brain into thinking you are somewhere else, and when you “return,” things just don’t seem as bad.

Wray also notes that the arts can provide an incredible sense of relief and accomplishment: “When I’ve made what I think is a good picture, I can feel it, and everything else momentarily falls away.”

I’ll add two personal experiences. Redemption started for me during a very down period. I was struggling at work (for those of you who follow Pennsylvania politics, it was 2015 and we were just starting a rather infamous budget impasse which was very stressful). My wife had just started at a new school and she was struggling as well. As a result, I needed an escape. And thus, Redemption was born.

Second is the simple fact that it gives you an alternative perspective that is still within you – one that you can still apply to your normal life. Redemption has a few plot threads going on, but it’s core is a twenty year old named Ash, trying to deal with his inner demons, beat his depression and live his life (and save the world but that’s a whole other story!). The book features a cast of characters who help him cope.

This may be an obvious point but for the purposes of this discussion I have to make it: I wrote all of the characters. They are all my voice, my perspective and my experience. But there was something deeply therapeutic about putting that level of advice and support into another character. It reminded me, in a sense, that all the hope, words and inspiration I need are inside of me to begin with.

Creative arts – writing, drawing, photography, whatever – I think they allow you to expunge and make sense of everything ugly inside of you. They force you to think of a perspective outside of yourself. And in that sense, they can help save you.

If you have any other thoughts or experiences, I’d love to hear them.

Your smartphone can tell if you’re depressed

person using phonwYou know how I’ve written about how social media and phones can cause depression? Well, it turns out, your phone can also tell if you are depressed.

The study, from the University of Stanford, shows that face and speech software on your phone can detect depression based on your facial expressions and speech patterns:

The researchers fed video footage of depressed and non-depressed people into a machine-learning model that was trained to learn from a combination of signals: facial expressions, voice tone, and spoken words. The data was collected from interviews in which a patient spoke to an avatar controlled by a physician.

In testing, it was able to detect whether someone was depressed more than 80% of the time. The research was led by Fei-Fei Li, a prominent AI expert who recently returned to Stanford from Google.

The article did caution that, due to the way the study was conducted, the therapeutic applications aren’t clear. According to David Sontag, an assistant professor at MIT:

…that the training data was gathered during an interview with a real clinician, albeit one behind an avatar, so it isn’t clear if the diagnosis could be entirely automated. “The line of work is interesting,” he says,“but it’s not yet clear to me how it’ll be used clinically.”

I have two thoughts about this type of treatment. First, this is fascinating – and this type of technology be helpful in terms of closing the gap between those who have access to treatment and those who don’t. In addition to studies like the one above, Stanford has also developed apps which can be used to treat depression – and which apparently work. I’ve touched on this topic in previous entries as well: Apps which treat depression can work.

In other words, apps and automated programs can help to treat depression. That’s fascinating to me – I never would have believed that depression could be treated without a live, human person, but apparently it can work.

On the other hand, there are some rather frightening potential applications of this sort of treatment. First is privacy: I am sure that any app working right now is operating with the strictest of privacy measures and data safeguards, but as we have seen repeatedly, data hacks and breaches occur with relative consistency. This has some very serious implications for something like text therapy or therapy which occurs over a device, because it begs the question: What data is recorded, and how could it potentially be accessed? I mean, I’m pretty open about the fact that I receive treatment, but even I wouldn’t want the items I discuss with my therapist broadcasted to the whole word. Is that possible with these apps? I don’t know, and it may not be. But there are real privacy and technological concerns which must be addressed when it comes to therapy delivered electronically.

Second: Can someone be diagnosed against their will? I don’t think so. Not yet, anyway. Later down the line, programs like the one discussed above may also have issues with consent. It seems to me that the Stanford program is not yet ready to be used in a public or even therapeutic setting. But, when it is, will people be able to use it on others without their consent? That…that’s kind of a scary thought.

These are questions which are only somewhat hypothetical. Technology is clearly advancing, and I can only hope privacy and ethical safeguards can advance with it.

Let us know your thoughts in the comments below!

Do mental health apps work?

One of the things I have seen a lot of lately is apps that claim to be able to help you improve your mental health and get treatment. There are a bunch out there – this includes apps like What’s Up, Mood Kit and MY3, among many, many others.

Here’s the important question: Do they work?

I bring this up because there’s been a bit of controversy with one app, BetterHelp. The App says that it will hook users up with licensed therapists. The controversy, however, emerged with many YouTubers who had engaged in sponsored ads with BetterHelp.

As long as the sponsorship is transparent, I don’t personally see an issue, but problems emerged with BetterHelp itself. First, it’s terms of services explicitly couldn’t guarantee placement with a qualified, licensed professional:

We do not control the quality of the Counselor Services and we do not determine whether any Counselor is qualified to provide any specific service as well as whether a Counselor is categorized correctly or matched correctly to you. The Counselor Services are not a complete substitute for a face-to-face examination and/or session by a licensed qualified professional.

Umm…..that’s a major, major problem. That’s beyond not acceptable. Any app that claims it will provide mental health professionals to users has a moral obligation (and I hope a legal one!) to ensure that the counselors themselves actually are licensed professionals, or at least disclose in a VERY publicly way when they are not.

This entire incident got me wondering about these apps. How good are they? Do they work? Are they substitutes for seeing a counselor in a face to face setting?

First, the obvious: Answers to the questions I posed above will vary widely. It all depends, of course, on the quality of service offered.

The most comprehensive answer I could find was in this paper, published in March 2018. The answer varies, of course, but in sections, it seems to be yes:

  • Depression: ” A meta-analysis of 18 randomized controlled trials (RCTs) covering 22 mobile apps revealed that using apps to alleviate symptoms and self-manage depression significantly reduced patients’ depressive symptoms compared to control conditions (g=0.38, P<0.001).” However, the apps work best when depression is mild to moderate, not severe.
  • Anxiety: “A meta-analysis of nine RCTs that evaluated the effects of smartphone-delivered interventions on symptoms of subclinical and diagnosed anxiety disorders revealed that users experienced reductions in total anxiety after using anxiety treatment apps (g=0.33, P<0.001). Additionally, anxiety-focused mobile apps delivered the greatest reductions in anxiety symptoms when paired with face-to-face or internet-based therapies. In fact, replacing outpatient patient-therapist sessions with a mobile app resulted in no significant loss of treatment efficacy.”
  • Schizophrenia: “Self-reported patient experience survey results revealed high adherence, positive user experience, and broad-ranging clinical benefits.”

Wow. So, yes, theoretically, these can work!

I have two additional thoughts. First, hey, if it works, it works. The mental health practitioner shortage is, in my opinion, the greatest crisis affecting mental health, and if apps can help close that gap at an affordable rate, it’s worth using.

Second. however, is this: It has to be a real app, with high quality and scientifically based therapies and design. In the digital day and age, it can be all too easy to design a subpar treatment program that can scam users out of money and provide no clinical benefit. I hope, in the long run, that the federal government will step in and better regulate these apps in order to protect users from negative experiences that can damage their mental health and sap their limited resources.

Do you have any experiences with mental health apps that you want to share? Please let us know in the comments below!

The futility of gratitude – and why it’s so important

I had an interesting realization in therapy the other day, and it led to this blog entry. Stay with me for a second.

My therapist and I were talking about trying to change my mindset from both a depression and anxiety perspective. I think a great deal of anxiety comes from a fear of “not being able to handle” any given situation – be that going to school, work, travel, whatever. I’m not quite sure what “not being able to handle” means, save for turning into a blubbering ball of sad and fear, but whatever. Now, by and large, that’s a silly fear. There’s no such thing – not really – as “not being able to handle” something. Sure, there are some life events and experiences that go better than others, but short of dying, you get through life.

This sort of fear in stressful situations can manifest itself in many ways. One of them is that it causes a shift in mindset. You no longer engage in new experiences to enjoy them or learn from them – instead, you do so in order to say “I survived” them. This mindset can be damning for so many reasons. You start an experience not looking to enjoy it, but to get through it. This kind of bunker-mentality can absolutely destroy your ability to get any joy. To try new things. To adventure or gain new experience. Indeed, it makes you afraid, and it makes you far less willing to be adventurous. You live in a constant state of looking over your shoulder, wondering when the anxiety attack will hit. Wondering when you will get cripplingly sad. Wondering what goes wrong next.

This way of thinking, of living – survival versus gratitude – can be absolutely crippling. And it leads me to the point of today’s entry: I don’t want to just survive. I want to thrive. I want to learn and to live. Don’t you?

How do you do that? Hahaha, yeah come on, you know I don’t have an answer. I only have a piece of one. That’s this: Try to change the way you approach new situations. Approach them from a perspective of gratitude and gaining new experience. Instead of entering an anxiety-provoking situation from the perspective of, “Oh, God, how am I gonna get through this?” ask yourself, “Okay, what can I learn from this?” or better yet, “How can I be grateful for this experience?”

Now, I titled this entry, “The futility of gratitude” because I am not an idiot. When you are depressed or anxious and someone tells you to “Be grateful,” you probably want to punch that person in the face. Grateful? For the crippling fear and sadness? That’s madness.

But, that’s exactly why it’s so important.

The only way to break anxiety and depression is to change the way you think. The way you process thoughts and emotions. And the only way to do that is to shift your mindset. So, just try this. Try, every now and then, asking yourself this question: “How am I learning from this new and difficult situation?” or “What can whatever I am experiencing right now teach me so I don’t encounter these problems in the future?” Fear is only crippling is it denies you the chance to grow, to learn. And there’s no such thing as an experience you can’t handle.

So, try to ask yourself that. Try to ask yourself what you can be grateful for. What you can learn. Shift your mind, and maybe you can shift your emotions too.

“A woodpecker on steroids” – My experience, so far, with Transcranial Magnetic Stimulation

So, for the first time in my multi-decade battle with depression, I’m trying a new type of therapy (other than talking and taking pills). It’s Transcranial Magnetic Stimulation (TMS), and I’ve written about it before.

Here’s the basic gist of how it works:

Transcranial magnetic stimulation (TMS) is a method whereby an electromagnet placed on a scalp transmits magnetic pulses or waves to a small portion of the brain. Repetitive transcranial magnetic stimulation (rTMS) delivered at a low frequency (once per second) has been shown to reduce the reactivity or excitability of the part of the brain stimulated and other brain regions functionally connected to the region stimulated.

I started it Monday, and it is time intensive – not so much in how long you have to sit there (my sessions are only twenty minutes), but in terms of how long you have to do it – for me, it’s six weeks, five days a week. I had to wait until vacation was over and for a break in my calendar to make it happen.

As for how it works: Honestly, it’s not hard. You sit there. You get yourself into a nice and comfy chair and they adjust a couple of things by your head. The right side of your head is lined up with a pad to keep your head still. The left side of your head is where the action is at – a magnet, enclosed in some equipment, is aligned in the right spot. It’s desired location is your frontal cortex, which is the area of your brain where depression apparently can be adjusted. They send one magnetic pulse into your head, and if your hand twitches, they have the right spot.

Once they have the right spot, they save the settings and that’s where you sit. If it’s aligned right, you may feel a little discomfort or pressure during the actual treatment. The actual treatment consists of your head being tapped with a magnet (not directly, but through padding) for four seconds, followed by a rest of twelve seconds. That continues for twenty minutes.

Is it painful? No. The first alignment can be – if it’s misaligned, it hits a nerve and OUCH. It just stings for a few seconds. They readjust, and then it’s fine. Now, is it comfortable? Nah. But you do build a resistance to it. I had a headache and took Tylenol the first three days. By days four and five I barely noticed. They also give you earplugs. Those are optional, but if a Doctor gives you ear plugs, use them, okay?

It’s a strange experience, described to me by the nurse as being hit by a woodpecker on steroids. I love that description, and it’s accurate. I mean, you’re basically getting tapped by a magnet or roughly 30 times over four seconds. It’s weird, but not painful. I’ll putz on my phone, close my eyes and chill, whatever. Honestly, its not that bad. The session ends and you go back to work. There are no after effects, except for maybe a slight headache that Tylenol can bop right out. You can drive, think, function, etc. I’ve left therapy sessions where I’ve been more disoriented.

When am I supposed to see results? The literature I read said week four. They said they thought they had seen some people get more depressed as the placebo effect wore away in week two. I’m hoping I don’t go through that, because I have no illusions that this will work until at least week four.

So, one week down, five to go. Here’s to hoping.

As always, I’d love to hear your thoughts and experiences, and as the process goes on I’ll share more, including some pics. Let us know about your TMS experiences below!

SIDE NOTE: First, again, I’m not a doctor or medical professional – I’m a damn politician and writer. I’m certainly doing my best to write an accurate description, but if you have any questions or concerns, please contact a medical professional. Second, this probably goes without saying, but I’m going through this treatment like any other normal person and paying with my insurance. I am not receiving any compensation or consideration whatsoever for sharing my experiences.

Finding light in the darkness

I’m going to write about two things that personally motivated me to deal with my own demons in a very public way. The short-term inspiration for this is me rereading the acknowledgements section of Redemption. The longer-term inspiration for this is a public tragedy and a low period in my life.

Okay, first, here’s a small section of the acknowledgements in Redemption:

To Robin Williams. Yours was a life well lived, and I hope to be part of a positive story of those influenced by how it ended.

Let me go backwards. Robin Williams completed suicide on August 11, 2014. He had long suffered from a slew of mental health challenges, including depression and substance abuse. However, Williams was suffering from “diffuse Lewy body dementia,” which ultimately contributed heavily to his suicide.

William’s suicide ultimately inspired me to go public with my story. That started when some idiot on Facebook decided to spout off shortly after Williams’ death by saying something along the lines of, “So sad Robin Williams committed suicide. He just needed to pray to Jesus more!”

No, you schmuck, that’s not how it works, and that ignorant comment got me so damn fired up that I wrote an op-ed in my local paper, detailing my own struggles with depression, anxiety and suicidal ideation. That, in turn, set my career in motion in a very different way, making me become much louder about mental health issues. I’ve spoken at events detailing my own struggles, cofounded a mental health caucus, appeared in PSAs and introduced legislation designed to help those who are suffering from mental health challenges. I know that the work I’ve done in this realm has helped people – and I know I have a lot more to do to help more.

It also inspired this speech, the most difficult one I have ever made:

Fast forward about seven or eight months, and I’m struggling, in the midst of one of the most depressed periods of my life. I’m struggling at work, my wife is struggling at work, and life just generally sucks at the moment. I go back to see my therapist. I increase my medication. And then I realize something else: I desperately need an outlet. Something to help get me through everything I am suffering from. I decide to start writing again – I wrote fiction as a kid and had published the non-fiction book I wrote, Tweets and Consequences.

And I remember this goofy plot idea I had as a kid, twenty years ago, about kids getting trapped on a spaceship. And I realize something: That’s not a bad plot. But what if I could make it more? What if I could fold in a mental health message as well?

And thus, Redemption is born.

For what it’s worth: I have a character named Robin in Redemption. In all fairness though, that’s also my daughter’s middle name, so let’s call that character’s naming a 50% tribute to Williams and 50% tribute to my daughter.

The death of Robin Williams helped me and countless others find their voice and seek help. I know that this may be cold comfort to those he loved and those who loved him. But I sincerely hope that they can take some solace in knowing that Williams’ life and death helped so many, including me. His was a life well lived – and, as I said above, I hope to be a small part of that story.

You can always find light in the darkness. Pain makes us great, and with time and therapy, you can turn the most agonizing periods of your own life into something incredible.

As long as you breathe, there is hope. The trick is just finding it sometimes.

Transcranial Magnetic Stimulation?

You know, you first hear about something like this, and you think it sounds like some sort of witchcraft nonsense. Magnets? To help depression?

Apparently. And it’s scientific based.

I write about this now because I had an appointment last week to explore this as a treatment possibility, and it is likely something I’m going to pursue. Here are the basics, per the Mayo Clinic:

During a TMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. And it may activate regions of the brain that have decreased activity in people with depression.

 Though the biology of why rTMS works isn’t completely understood, the stimulation appears to affect how this part of the brain is working, which in turn seems to ease depression symptoms and improve mood.

The most important question, of course, is this: Does it work? According to the evidence I have seen, yes, and that’s in tests involving a placebo. More research is needed, but this appears to work.

Thankfully, the side effects are very mild, per the Mayo clinic.

Side effects are generally mild to moderate and improve shortly after an individual session and decrease over time with additional sessions. They may include:

  • Headache

  • Scalp discomfort at the site of stimulation

  • Tingling, spasms or twitching of facial muscles

  • Light headedness

The biggest drawback, as best I can tell? The Doctor I spoke with told me its most effective to do it every single day, for 4-6 weeks. Session, I think, are 30-45 minutes. That’s a heck of a time commitment. That being said, sucks for me. It’s not the Doctor’s fault that this is the way the brain works, but it’s certainly a challenge with my schedule – going to Harrisburg and vacation means I won’t have that kind of time until August.

So, let me conclude by asking you for your experiences. Have any of you out there had TMS? Any experiences to share? I’d love to hear them!

College and mental health

A friend of mine was kind enough to share with me this article in Time, an extremely eye-opening look at the massive spike in college students seeking mental health services – and college’s struggles to keep up with the demand. For those of you who are interested in this topic, I highly recommend that you read the entire article, because its a very comprehensive look at the issue.

The summary is this: More college students are in need of counseling services, but many colleges do not have the capacity to deal with these students mental health challenges. This shouldn’t be surprising: 75% of all mental health issues onset by age 24, and college is a time of transition where young adults are cut loose from all their previous moorings and experiences – thus shaking loose a good deal of mental illness, sadly.

Unfortunately, suicides in the United States have been on the rise since 1999, cutting across all demographics, and college is no exception. Even worse is that, many colleges do not actually track suicides, creating a major problem for dealing with this issue.

I will say that this is a deeply personal one for me. In the course of my mental health journey, I think I always suffered, even from the time that I was a little kid. It was my freshman year, however, when all hell broke loose. It was the first time I was away from home, from my family, my girlfriend and everything that I had previously known. I wasn’t ready for college and the experience of basically restarting my life, and I REALLY wasn’t ready for the “party” culture of college. I didn’t party – just the opposite – I was intimidated by everyone who did and didn’t know how to deal. As a result, my depression and anxiety exploded. Freshman year became the turning point for me – it’s the year I first started to suffer, but thanks to the counseling center at Muhlenberg, I had access to a great therapist who helped save my life by helping me develop strategies to deal with my depression and referring me to a psychiatrist who put me on the medication I still take to this day.

This issue is one of the reasons that, in my legislative career, I introduced legislation which would require colleges to develop and disseminate plans on dealing with mental health and suicide prevention. It’s a small step, but one that I think is desperately necessary to deal with this issue.

This is a major issue from a mental health perspective in this country, and one that we desperately need to deal with. The good news is that people are paying attention – and hopefully will continue to do so.