The rise of technology has transformed various sectors, and healthcare is no exception. Virtual counseling, or online therapy, is reshaping how individuals access mental health care. This shift is crucial, especially as the demand for mental health services increases. With barriers to traditional therapy being lowered, we are seeing a promising evolution in how care is delivered. What is Online Therapy? Online therapy refers to mental health services provided through digital platforms. This includes video chats, phone calls, and messaging systems. It enables clients to connect with therapists from the comfort of their homes. The convenience of accessing care online has provided an alternative for those who may face barriers in seeking traditional in-person therapy. A person engaged in online therapy session via laptop One of the standout features of online therapy is its flexibility. Clients can schedule sessions around their work, family, and personal commitments. This adaptability is especially beneficial for those with busy lifestyles or those living in rural areas where mental health professionals may be scarce. Breaking Down Barriers to Access Virtual counseling has fundamentally changed how individuals access mental health care. Many people face barriers such as transportation issues, stigma, and limited availability of professionals. Online therapy eliminates many of these obstacles by providing a platform that is accessible to anyone with internet connectivity. Research indicates that approximately 1 in 5 adults experience mental health issues each year. Yet, many do not seek help due to various barriers. Virtual therapy creates an avenue that is more comfortable and private. People are often more willing to reach out for help with the option to remain in their own safe spaces. A computer displaying a virtual therapy interface Another critical element to consider is that online therapy facilitates access to professionals who may not be available locally. For instance, someone living in a remote area can consult with a therapist from a major city without the need to travel. This broadens the range of expertise available to individuals seeking help. The Privacy Factor Privacy is another significant advantage of virtual counseling. Online therapy sessions can be conducted in private settings, free from the anxiety of running into someone you know in a therapist's waiting room. This helps to combat stigma and makes clients feel more comfortable discussing personal issues. Confidentiality is ensured through secure platforms that comply with health regulations. Mental health professionals utilize encrypted communication methods to keep client information safe. The confidentiality aspect often encourages more individuals to seek help, knowing that their disclosures remain private. A serene home office ideal for virtual counseling Moreover, the availability of messaging and asynchronous communication via chat allows clients to express themselves without being face-to-face. This format can be particularly beneficial for those who find it challenging to convey their feelings verbally. Future of Virtual Counseling As technology continues to evolve, so does the landscape of online therapy. Innovations in artificial intelligence and machine learning are set to enhance the virtual counseling experience. Moreover, many platforms are integrating self-help tools and resources that allow clients to take an active role in their healing process. Apps and online materials for mindfulness, stress reduction, and cognitive behavioral therapy (CBT) exercises complement the therapist’s work. This blend of tools enhances the overall efficacy of therapy. The ongoing global situation has accelerated the adoption of telehealth services, with many services settling into a world where a hybrid model may become the norm. This advancement signifies a shift toward more inclusive, often more affordable, avenues of mental health support. While the transition to more virtual services can be overwhelming, it creates opportunities for individuals to re-engage with their mental well-being in a way that suits them best. For those considering seeking help, exploring options like online therapy in Texas can be a beneficial first step. Embracing Change The benefits that online therapy provides are reshaping how we approach mental health care. Increased accessibility, affordability, privacy, and future enhancements position virtual counseling as a viable solution for many in need of support. As society increasingly acknowledges the importance of mental health, online therapy presents a promising solution to bridge gaps in care. By understanding its offerings and potential, individuals can make informed choices about their mental health journey. In this transformative landscape, it is vital for users to stay informed and utilize resources that best suit their needs. Whether you are new to therapy or looking to continue your journey, consider embracing the shift to online counseling as a step towards improved mental wellness.

How negative thinking hinders our relationships. Perfectionists' negative thinking patterns contribute to their need to be perfect. Taking responsibility for one's mistakes tends to improve relationships. In learning how to tolerate their mistakes, perfectionists need to learn to trust others. Most of us dislike being criticized, whether the feedback is direct or indirect, as in the form of unsolicited advice. Some of us hate negative feedback so much that we skew it in our minds, complaining about its presentation and even the presenter when, in reality, we wish to banish it forever. Perfectionists struggle mightily with feedback. Sometimes, they even criticize themselves as a way to shield themselves from its blades: "I know I'm bad; but, please don't hurt me." They may fluctuate between denial , usually for something big, and exaggeration, usually for something small: "Oh, I’m the worst." Both tools, or coping mechanisms, are meant to protect one's self-image  and social standing. The problem becomes evident: There's no growth. Perfectionists struggle with several cognitive distortions. They tend to think in black and white, so they may believe that you either control or are controlled. They tend to personalize and overgeneralize, believing they're a terrible person for doing something unethical. They may catastrophize , terrorized by the idea of being abandoned for their innate badness. And they disqualify the positive, remaining certain that they're defined by their misdeeds because their good ones don't count. Yet, for any healthy relationship to work, there has to be a high degree of accountability. This means that perfectionists will have to explore why they want to be perceived as perfect in the first place and the effectiveness of their employed strategies. Perfectionism tends to connote control, security, self-esteem , admiration, and harmony. Yet, in reality, it means few of those things. Control is often perceived as overbearing, denial fosters rebellion and rejection, admiration falls apart under scrutiny, and harmony follows the path of entropy. At bottom, perfectionists don't allow themselves to be human. This means that humans admire and are admired in return. They share responsibilities. They empathize when they've caused harm. And they allow themselves to be vulnerable. Yet, perfectionists struggle with tolerating frailty, in themselves as well as in others. The question most asked by perfectionists: Won't they dislike me if they know who I really am? Like anything else, it depends. First, it depends on the general degree of tolerance of the other individual, in addition to their interests, values, and preferences. And, it depends on the overall image of what you have to offer. Because perfectionists tend to overperform, they usually build up so much goodwill that, contrary to their expectations, their employers, colleagues, and loved ones, feel relieved by their visible imperfections, now discontinuing to compare themselves to them and or feel immense internal pressure to meet their standards. Perfectionists also struggle with thinking, "What have you done lately?" And they often believe they're starting over with each new experience. Their deeds must be immaculate. However, most others tend to view us on the whole, meaning they tally up our successes and our failures while noting how we address each of them. The first step in addressing perfectionistic anxieties is attempting to cultivate an alternative perspective. Ask yourself: Is it possible that others don't expect or want me to always be perfect? Do they prefer I acknowledge my mistakes? Will they take advantage of me if I do? The last question is the most important because it elicits an exploration of what people are for and if they can be trusted. Perfectionists are often rugged individualists because they tend to think the worst of others, which is usually just a reflection of how they see themselves. To them, safety matters more than anything and they perceive most interpersonal risks as inevitable failures, again thinking poorly of themselves and others. Attempting to persuade them otherwise is frequently met with fervent resistance. Therapy  is often misunderstood as a means of cultivating positive thinking . However, fundamentally, therapy is about asking: Is my mental health struggle contributing to my perception of the world? For our patients, that may become the biggest mistake owned. For some, it's a relief to know they can now freely exhibit more personal aspects of themselves. While for others, there's a sense of grief  and shame  over the lives not lived. But, to take responsibility isn't the same as accepting blame. Blame says, "You deserve your punishment ." Responsibility asks, "How can we make this better?" The latter accounts for all of the factors of a predicament, those which are and aren't in your control. It's aid, which you may believe is a disguise for mistreatment. Leon Garber, LMHC - Blog

Which activities make people most (and least) happy? How we spend our time impacts happiness. Some activities make us happier than others. Simply knowing this can help you prioritize your resources and plan accordingly. Time is the great equalizer in life. No matter where you live, what you do for work, or how much money you have, we are all granted 24 hours in a day that we can choose to optimize accordingly. The sobering truth is that a lot of this time is spent on mundane activities ( sleeping , chores) and obligations (work). However, even the busiest of us have some free time to do with as we please. This raises the focal question of this post: What activities are best for making us happy? In a survey conducted for Our World in Data, a project published by the non-profit organization Global Change Data Lab , going to the theater, concerts, sporting games/events, playing with children , and going to restaurants/pubs were the top five activities that make people the happiest on average. Note that all five of these activities are both exciting and typically involve a social component. Seeing a performer we love or a sports team we support can be fun, memorable, and potentially a once-in-a-lifetime event that we cherish and will look back on with a smile on our face for weeks, months, or years. These findings support research showing that spending money on experiences (vs. material goods) boosts happiness . Concert tickets and dining out can be expensive. Activities that are a little lower on the list that are enjoyable without the price tag include sleeping, board games and computer games, religious services, playing sports, hobbies, and walking dogs. If you’re on a budget or looking for something more ordinary on any given day, consider spending time on one of these cheap or free activities to boost your mood . What about the activities that make us least happy ? The top five villains in this case were doing homework, looking/applying for a job, domestic chores (cleaning, laundry), commuting, and working. These activities all fall under the umbrella of tasks we must do. Although these tasks can be unavoidable in some cases, one can be creative in an attempt to make them more fun. Listening to music or an entertaining podcast can make homework, chores, and commuting more enjoyable when paired together. For particularly unpleasant yet important tasks, create a reward for yourself once you’ve finished. For example, plan a dinner out at a restaurant you love or a movie you’ve been wanting to see that evening to help get you through the task. Breaking up unpleasant tasks at home or at work can also be highly effective. Planning to sit down for 4-plus hours straight and work on a difficult or unpleasant task is extremely hard, especially if there is no concrete deadline. I recently bought a timer to track work time, which I usually set for 45 minutes for work tasks. Once the 45 minutes is up, I will go for a short walk, have a snack, or watch a YouTube video before getting back to work. This technique, similar to the Pomodoro method, can help increase enjoyment and motivation . Give it a try. The old adage “knowledge is power" rings true for understanding the activities we can spend our valuable resources of time and money on to increase happiness. By deliberately spending resources more on the positive, less on the negative, and exercising creativity  in finding tricks to make unenjoyable tasks a little more fun, we can become the architects of our happiness. Max Alberhasky Ph.D. , Blog References https://ourworldindata.org/time-use Gilovich, T., Kumar, A., & Jampol, L. (2015). A wonderful life: Experiential consumption and the pursuit of happiness. Journal of consumer psychology , 25 (1), 152-165.

Set and manage boundaries for your professional success and well-being. Boundaries build healthy relationships and are essential for self-care as an individual and as a leader. It is vital to consistently establish, control, and verbalize your boundaries. Effective leadership requires boundary skills to facilitate team, organization, and leader well-being. In today’s hectic workplaces, leaders are increasingly recognizing the importance of setting, communicating, and managing boundaries. These skills are essential, both for maintaining personal well-being and for fostering a productive, positive team and work environment. Overwhelm, burnout, having no time for yourself, daydreaming about running away, avoiding people who might ask for something, resentment, and anger are all signs that you may need to put a boundary in place. Boundaries are our rules of engagement in our relationships or in a given situation. They define what we are comfortable with and how we would like others to behave around us. They are a way to communicate our needs to others as part of creating and maintaining healthy relationships at work and at home. Boundaries facilitate our well-being and our leadership . Yet, many of my clients still struggle with boundaries, particularly with setting and communicating their own. Boundary challenges are often rooted in deep-seated normative and cultural stereotypes coupled with a lack of know-how and practice. One of my clients, a Gen Z Latina leader, has difficulty setting and communicating boundaries at work because she perceives this to be “not nice.” Consequently, she is overwhelmed, exhausted, and deeply unsatisfied with her post. Not only has she fallen victim to cultural and gender stereotypes of what it means for a woman to be “nice,” but this also affects her ability to establish and enact boundaries, leaving her without the boundary-setting experiences and skills she requires in her situation. 3 Steps for Mastering Boundaries at Work It is important that we know how to set, communicate, and manage our boundaries as part of exercising agency and choice. 1. Setting: What boundaries do you need or want to put into place? Start by identifying what you need, then move on to what you would like. Recognize what you are comfortable and uncomfortable with in terms of work hours, communication, and workload. My Gen Z client was constantly bombarded with emails, texts, and interruptions, but she recognized that she needs to have quiet thinking time in her day in order to focus on the creative and strategic work requiring her attention. Practically speaking, this would mean not answering emails and calls or tending to people during certain hours of the day. 2. Communicating: How, when, and with whom will you communicate your boundaries? Once you know your limits, explicitly communicate them to your colleagues and superiors. Be direct and specific about your needs and expectations, ensuring there is no ambiguity in your language. For my client, this meant communicating her boundaries to her boss and her direct reports. My client decided to meet with her boss and explain that in order to carry out the work required, each day she needed to carve out some “thinking time” when she wouldn’t be interrupted. She also assured her boss that she would review her communications as a priority once she had finished her thinking time. With her staff, she decided to share this boundary during one of their weekly meetings, when she explained that several of her responsibilities required deep reflection that she simply could not achieve with regular and multi-channel interruptions. She informed staff that she would not be available during this hour and that she would follow up after this designated time. 3. Managing: What, if anything, needs to be managed or negotiated? Just because we state a boundary, it doesn’t mean it will be acted upon or actioned immediately. In fact, there will be different reactions, ranging from pushback, testing, ignoring, questioning, defensiveness, silence, avoidance and ghosting through to acceptance. We often fall into the trap of thinking that stating something means it should immediately go into effect. In reality, that is usually not how it happens. For some boundaries, stating them might be the beginning of a conversation and even a negotiation. My client initially presented her boundary as two hours of offline time per day, which, for her boss, was “too much” during their peak season. The boundary statement opened up a discussion, which resulted in a win-win outcome for both parties. Tip: Be Consistent. Consistently uphold the boundaries you have set. This means asserting your limits, even when it’s challenging, or when others may not respect them. Consistency helps to establish these boundaries as a norm within your workplace. For my client, this step proved the most difficult. This meant turning off all mobile notifications, putting her phone away, and having to remind staff that she was not available when they “popped in.” Boundaries and Leadership Clear boundaries are essential for effective leadership, enabling leaders to delegate clearly and avoid ambiguity. When boundaries are unstated or vague, it can lead to confusion and unrealistic expectations within a team. Establishing clear boundaries fosters accountability among team members as they understand the leader’s expectations and the repercussions of boundary violations. Leaders who set clear boundaries empower their teams to take responsibility for their tasks. Through proper delegation and refraining from micromanagement, leaders cultivate trust and foster autonomy among team members. Boundaries play a crucial role in defining expectations for both leaders and their teams, promoting a harmonious and productive work environment. Boundaries also help leaders to manage their energy, focus, and time. Setting availability boundaries helps to create and protect time for key strategic activities like innovation and strategic reflection. Clear limits on work hours, communication, and availability promote health and well-being and are an important part of your self-care. Boundary setting is also essential for modeling healthy behavior to your direct reports and teams. For example, my Gen Z client was able to establish a precedent for others to manage their availability and workloads. Boundaries clarify expectations and open lines of communication. Remember—it is up to you to establish, communicate, and manage your boundaries. Practicing this is vital for creating a healthy and productive work environment in which you can enhance your interpersonal relationships, live and model healthy practices, and improve your and your team’s performance. This article originally appeared as a Psychology Today post Palena Neale, Ph.D., - Website - Psychology Today -

Personal Perspective: Our sense of "self" is an illusion. Dualistic thinking creates a self that does not exist in reality. Our brains are stimulus response organs, but we can seldom grasp that because our minds fight that. The illusory mind fights to survive even though it is a phantom. Although death is real, anxiety about death is a useless projection that only humans have. Much of my clinical practice was with individuals who had brain tumors and terminal neurological diseases. While I initially feared what it would be like to work with my patients during this phase of life, I was continually surprised that I found their company to be calming, if not inspirational, as they approached their deaths. At times, I found it to be exhilarating to be around them because there was no fluff or illusions; every moment seemed to count for them. Most of our minds (mine included) operate through dualism. In other words, we develop a sense of self that we believe is different from the cause-and-effect processing that truly is the way our brains work. I have learned this through studying non-secular Buddhism, which I like to call the science of the mind, as well as from my terminal patients. We think that our "self" is our body, perceptions, feelings, thoughts, or consciousness. In fact, we are none of these things. Our organs can survive in another person, our vision and hearing are only a projection of light or sound waves interacting with neuroreceptors, our personality will change if we lose part of our brains, and, most importantly, the process of thinking creates a model of the world that is culturally bound, influenced by a constant stream of environmental stimuli, and is literally not reality. Ancient monks would exhort us to “kill our minds” because they knew that the dualistic sense of self is not a real thing. Yet the mind comes to believe that it is real and that it must survive. It resists any effort that we make to live in the present. As an example, meditation trains the mind to function in the present moment, yet the mind sabotages the meditation process in any way it can. When we try to meditate, the mind says we are crappy at doing it or tries to derail us with boredom, anxiety , frustration, or countless other forms of distraction. We think that we have an "inner CEO" who can willfully produce our next thought, but that is part of the illusion. Thoughts have themselves. At any given moment, there are groups of neurons competing to have our next thought and that what arises is the result of some form of cooperation between committee-like structures; emotions, often hidden, frequently determine what thought comes next. I am often asked whether realizing that our minds are simply illusions is a dark way to look at the world. Why even try if our brains are simply a stimulus-response organ? My answer is that there is something truly liberating in giving up an illusion of control in order to have a deeper sense of it. Ninety-five percent of our brain processing is unconscious, and we make up our minds before having a thought. Fearing death is one of the ultimate examples of this, because once we realize that our minds are ruminating on an illusion of the future that is not real, we can simply observe the process rather than fight it. If our illusory minds fight giving up control through even meditation geared towards being in the present, imagine how our minds fight the concept of death. Anxiety about death is simply a concept. Animals do not sit around ruminating about death because they do not have a cerebral cortex that can anticipate the future (a process that often makes us humans miserable). Anxiety is a future-oriented concept that is simply not reality. There is certainly a great deal of sadness that comes with death, in terms of the loss of relationships and attachments. However, much of the anxiety that characterizes our ruminations is about something that is not real. Our minds do not want to give up control of the illusion they live in. With typical aging, most humans find themselves slowly giving up things that they cherish, including vitality, relationships, hobbies, and many of the things that make us happy. We have a gradual process during which we let go of things that we cherish. Many of my terminally ill patients do not fear death because they have already let go of many of the things that are dear to them. People who “have it all” in terms of family, wealth, possessions, and health often have stronger illusory egos because they have more to lose. Because they have more to lose, they ironically fear death more. If you find yourself fearing death, take heart in knowing that much of what you are afraid of does not exist in reality. David R. Patterson, Ph.D., ABPP, References Patterson, DR and Mendoza, ME. Clinical Hypnosis for Pain Control (2nd edition). American Psychological Association. November release, 2024 Wright, R. Why Buddhism is True. Simon and Schuster, 2018 THE GREAT DISCOURSE ON NOT-SELF (ANATTALAKKHAṆA SUTTA) Venerable MAHASI SAYADAW Translated from Burmese into English by U Ko Lay (Zeyā Maung)

Exposure and response prevention may be enough to treat OCD. Exposure and response (or ritual) prevention (ERP) alone is as effective as ERP with psychiatric medication. Exposure homework compliance is extremely important for treatment success. It's important to continue ERP until a client is confident that they can manage their OCD on their own. People who struggle with obsessive-compulsive disorder (OCD) experience intrusive thoughts accompanied by urges to engage in repeated behaviors to ward off something bad from happening or to relieve distress. For example, someone might check that their front door is locked when they leave so often that they are late for work, and they may jiggle the door handle so frequently that they damage the hardware. The treatment with the most research support for OCD is exposure and response (or ritual) prevention (ERP). In ERP, people learn to trigger obsessive thoughts and resist the urges to engage in compulsive behaviors or rituals. In the example above, someone might practice turning the lock once and walking away no matter how strong the urge they feel to return and double-check. There are different therapy models for guiding exposure. Traditional exposure focuses on symptom reduction, while newer models with strong research support, such as acceptance and commitment therapy and inhibitory learning, do not. Psychiatric medication—mainly antidepressants—is also an effective treatment for OCD. Psychiatric medication tends to reduce the intensity of OCD thoughts and urges. When clients come into treatment for ERP for OCD, a frequent question they ask me is whether they should also be on medication. My response has been that ERP is effective with or without medication and that ERP may be even a little more potent than medication alone. My recommendations were based on a meta-analysis Cuijpers and colleagues published in 2013. As that study is over 10 years old, I was excited when I came across a more recent study from 2023 by Wheaton and colleagues asking similar questions. The researchers wanted to know whether ERP alone or ERP-plus-medication is more effective. Study design For this study, the researchers combined data from two separate clinical trials of ERP for OCD. One study involved participants who were already taking an antidepressant before beginning ERP. The other study consisted of participants who were not taking medication before or during ERP. As both trials used the same manualized ERP protocol, participants in each received comparable versions of ERP for OCD. The manualized ERP protocol involved 17 sessions, meeting twice weekly with phone calls between sessions. As once-weekly sessions without phone calls are more typical in most practice settings, this manualized version of ERP is more intensive than one is likely to find in the community. One limitation of this protocol is that most OCD therapists use as many sessions as needed for clients to graduate treatment rather than limit treatment to 17, as in the study protocol. What did they find? Participants appeared to improve about equally as well from ERP, whether they were taking psychiatric medication or not. One important factor was what the authors called homework adherence. In ERP, people complete exposure exercises regularly—usually daily—between appointments. The researchers defined “homework adherence” as consisting of 3 parts: (a) quantity of practice (e.g., how often they engaged in exposure); (b) quality of practice (e.g., how well they engage in exposure); (c) and ritual prevention (e.g., resisting urges to engage in compulsions between sessions). Participants with higher OCD symptom severity and/or worse quality of life at the start of treatment showed less improvement overall. The researchers suggest these individuals may need more intensive treatment or more sessions than permitted in the study. As noted above, the study protocol was limited to 17 sessions of ERP. While 17 sessions may be enough for many clients, it's important to engage in as many sessions as necessary to work through relevant exposure exercises until someone can engage in daily life without compulsions. Consequently, limiting the number of sessions may mean treatment ends prematurely for some people. Here is one example where something that strengthens the integrity of a research study design is less applicable in a real-world setting. As I tell my clients, we will continue ERP until they are confident that they can manage their OCD on their own, without the structure of regular meetings. Conclusions This study supports what I’ve told clients all along: ERP is an effective treatment whether they are taking psychiatric medication or not. Anecdotally, if someone is struggling with ERP, sometimes psychiatric medication may help to reduce OCD symptoms just enough that they can better engage in exposure work. I want to stress another important conclusion of the study: how crucial it is that people complete ERP homework outside of session. Typically, an ERP therapist assigns daily exposure practice. For example, I might ask a client with health-related obsessions to spend 30 minutes repeatedly reading a triggering medical article (e.g., young people dying of cancer) each day between appointments until they can read the article more objectively and without engaging in compulsions. For someone afraid of accidentally hitting someone with their car without realizing it, they might practice driving through a heavy pedestrian area each day, perhaps on their way to or from work, resisting any urges to turn around and check that they did not hit someone. Regular and consistent practice is extremely important in ERP. I liken it to a musician practicing scales or a basketball player practicing free throws. Deliberate practice helps to reinforce learning so that people can respond more effectively in the moment, even under duress. As this study's authors note, improving homework adherence is an important target for improving outcomes in ERP. Brian Thompson, Ph.D., - Website - References Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds III, C. F. (2013). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: A meta‐analysis of direct comparisons. World Psychiatry, 12(2), 137-148. Jacoby, R. J., & Abramowitz, J. S. (2016). Inhibitory learning approaches to exposure therapy: A critical review and translation to obsessive-compulsive disorder. Clinical Psychology Review, 49, 28-40. Twohig, M. P., Abramowitz, J. S., Smith, B. M., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., ... & Ledermann, T. (2018). Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Behavior Research and Therapy, 108, 1-9. Wheaton, M. G., Rosenfield, B., Rosenfield, D., Marsh, R., Foa, E. B., & Simpson, H. B. (2023). Predictors of EX/RP alone versus EX/RP with medication for adults with OCD: Does medication status moderate outcomes? Journal of Obsessive-Compulsive and Related Disorders, 39, 1-9.

Is it true that people with borderline personality disorder can't change? Borderline personality disorder (BPD) is a condition characterized by emotional dysregulation. There is no quick and easy fix for BPD, although it can be managed with a number of different therapies. Contrary to popular belief, the prognosis for people with BPD is good, for those who are engaged in therapy. Borderline Personality Disorder (BPD) is a condition characterized by emotional dysregulation. There are a wide range of symptoms that differ across individuals, although the core traits of BPD include unstable personal relationships, fear of abandonment, an unstable sense of self, impulsivity , and self-harming behaviors. BPD is a chronic and debilitating disorder for sufferers, and often for those around them. Over five million people have been diagnosed with this disorder in the US alone, although the true numbers may actually be much higher. It can take a long time to obtain an accurate diagnosis, sometimes years or even decades. People with this condition are commonly misdiagnosed. BPD is often confused with bipolar disorder , ADHD , PTSD , anxiety , and depression , although it can be comorbid with these conditions. BPD is a complex disorder that is difficult to treat. In the past, many believed that BPD was untreatable, and lumped it together with harder-to-treat conditions, including narcissistic personality disorder (NPD) and antisocial personality disorder (ASPD). Even today, BPD is thought to have a gloomy prognosis. It’s often said that people with BPD “don’t change.” But is this true? Is there a cure for BPD? Unfortunately, there is no definitive “cure” for BPD. There isn’t a quick and easy fix, but there is hope. BPD can be successfully managed with a number of different therapies. Dialectical Behavior Therapy (DBT) is the first-line of treatment for BPD. (O’Connell, 2013) Developed by psychologist Marsha Linehan in the 1970s, who was herself diagnosed with BPD, DBT is an evidence-based psychotherapy that focuses on thoughts, beliefs, behaviors, and actions. It provides training in critical skills, especially mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation. There are other treatments too, notably cognitive behavioral therapy (CBT) and transference-focused therapy (TFP). There is no targeted medication for the condition, although antidepressants and mood stabilizers are often used in conjunction with therapy. In some severe cases, sufferers might require a period of hospitalization. Marsha Linehan herself revealed that she had been institutionalized as a teenager for self-harming and suicidal behaviors. What are the success rates for treatment? Contrary to popular belief, the prognosis for people with BPD is good, that is, for those who are actively engaged in therapy. In controlled clinical trials, DBT has been shown to be effective for reducing and managing symptoms with a success rate of 50-70 percent. (Álvarez-Tomás, et al., 2019) DBT has also been shown to reduce hospitalizations, substance abuse, self-injury, and suicidal behavior. Heartening research suggests that up to 77 percent of people no longer meet the criteria for BPD after one year of treatment. Alternatively, some people notice a natural reduction in their symptoms over time. (Biskin, 2015) These results are promising, although the road to recovery isn’t always easy. Many people with BPD are unlikely to ask for help or are in denial about their condition. The treatment is most effective for those who want to help themselves, rather than those who are forced into therapy. The treatment can be difficult too, for both the patient and the therapist. A commitment to recovery is important and people with BPD must do the work to see positive results. The takeaway message is that BPD is treatable. With the right treatment, a person who has this condition can definitely change, which will drastically improve their quality of life. Karen Stollznow, Ph.D., - Website - References O'connell, B. and Dowling, M., 2014. Dialectical behaviour therapy (DBT) in the treatment of borderline personality disorder. Journal of psychiatric and mental health nursing, 21(6), pp.518-525. Álvarez-Tomás I, Ruiz J, Guilera G, Bados A. Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies. Eur Psychiatry. 2019;56(1):75-83. Biskin RS. The lifetime course of borderline personality disorder. Can J Psychiatry. 2015;60(7):303-308.

Exploring the social influence on the brain signatures of self-esteem. The basis of self-esteem may be more related to others' opinions. Brain imaging reveals that lower self-esteem is linked to brain patterns more attuned to external opinions. If you have low self-esteem, it might be time to reflect on how much it is influenced by others' perceptions. What is self-esteem? Is it something related to how you evaluate yourself, or is it based on how others think about you? Well, there are numerous theories of self-esteem in psychological science, as well as criticism of the construct itself. While these theories often diverge on some points, they all share a common idea: in one way or another, our self-esteem is dependent on our social context and relationships (Stendel et al., 2024). In a word, what I will argue for here, is that our self-esteem is heavily influenced by two primary factors: a) our perceptions of how others view us, and b) the degree to which we depend on these perceptions. This idea isn't new. It dates back to at least 1902, when Charles Cooley, a prominent American sociologist, introduced the concept that our self-perceptions are shaped by our understanding of how others perceive us (Cooley, 1902). Known as the relational or interpersonal account of self-esteem, this concept was supported by research across various fields of psychology. Studies on the Social Aspects of Self-Esteem For instance, a research group led by Anne Reitz recruited over 1,000 teenagers to examine the relationship between their self-esteem and perceived popularity among peers. They found that an individual's sense of popularity within their social group was linked to increases in self-esteem (Reitz et al., 2016). Additionally, a 2020 meta-analysis on self-esteem and social relationships revealed a reciprocal link between the two. Positive social interactions tend to enhance self-esteem, while negative experiences can weaken it (Harris & Orth, 2020). The role of social media in shaping self-esteem has also gained attention in recent studies. For instance, Woods and Scott reported that social media use is often associated with lower self-esteem, primarily due to negative feedback and upward social comparisons stemming from online interactions (Woods & Scott, 2016). All these studies will not surprise a person familiar with Lev Vygotsky’s Sociocultural Theory (Vygotsky, 1978). His theory claims that human development begins at a social level (between individuals) before becoming internalized on a personal level (within the individual). This process, known as internalization, can be exemplified by a mother frequently telling her son he is a good boy, leading him to internalize this as "I’m a good boy." On a larger scale, consider how a person from childhood (who knows nothing about who they are) develops their self-concept through interactions, opinions, and expectations from others. Brain Scans Reveal Interesting Insights Recent brain imaging experiments have provided further insights into the social nature of self-esteem. Consistent research has identified the medial prefrontal cortex (MPFC) as a critical brain structure involved in self-evaluation (overview, Stendel et al., 2024). For instance, one study showed that individuals with lower self-esteem exhibit more intense MPFC activation in response to negative comments about them, whereas those with higher self-esteem show less activation (perhaps because they don’t care as much) (Somerville et al., 2010). Even more intriguing findings were published this week in the prestigious journal Communications Psychology. Using fMRI technology, researchers from the University of Oregon, led by Moriah Stendel scanned the brains of participants while they reflected on themselves and then the brains of other individuals while they reflected on the first person (Stendel et al., 2024). They discovered that individuals with lower self-esteem showed more similarity in MPFC activation patterns to those who thought about them, indicating that their brain activity is more aligned with others' opinions. Conversely, individuals with higher self-esteem displayed more independent brain activation patterns when others thought about them. In simpler terms, if you have low self-esteem, your brain is more attuned to others' opinions and even tends to mirror their brain activation. This study is important because it corroborates various existing theories, including Vygotsky's, and has potential implications for clinical research. Low self-esteem is a well-documented risk factor for numerous mental health disorders (e.g., Orth et al., 2009). It might be that in order to help individuals with low self-esteem, one needs to facilitate the separation of their self-perceptions from the opinions of others as an initial step in therapeutic intervention. What Does It Mean for You? Do you have high or low self-esteem? This might be a good moment to reflect on how much your self-perception is influenced by what others think of you or what societal frameworks you accept (e.g., “I'm pathetic because others had different expectations or hopes for me”). If you find that external opinions heavily impact you, it might be time to work on cultivating a more independent sense of self-worth. After all, developing your "unique brain activation patterns" and focusing on your own values can lead to greater personal growth. Nick Kabrél, MA, References Stendel, M.S., Guthrie, T.D., Guazzelli Williamson, V. et al. Self-esteem modulates the similarity of the representation of the self in the brains of others. Commun Psychol 2, 113 (2024). Cooley, C. H. Human nature and the social order. (Charles Scribner’s Sons, 1902). Reitz, A. K., Motti‐Stefanidi, F., & Asendorpf, J. B. (2016). Me, us, and them: testing sociometer theory in a socially diverse real-life context.. Journal of Personality and Social Psychology, 110(6), 908-920. https://doi.org/10.1037/pspp0000073 Harris, M. A. and Orth, U. (2020). The link between self-esteem and social relationships: a meta-analysis of longitudinal studies.. Journal of Personality and Social Psychology, 119(6), 1459-1477. Woods, H. and Scott, H. (2016). #sleepyteens: social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self‐esteem. Journal of Adolescence, 51(1), 41-49. Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes (Vol. 86). Harvard university press. Somerville, L. H., Kelley, W. M. & Heatherton, T. F. Self-esteem modulates medial prefrontal cortical responses to evaluative social feedback. Cereb. Cortex 20, 3005–3013 (2010). Orth, U., Robins, R. W., Trzesniewski, K. H., Maes, J., & Schmitt, M. (2009). Low self-esteem is a risk factor for depressive symptoms from young adulthood to old age. Journal of abnormal psychology, 118(3), 472.

The need to feel safe is a core driver of human behavior. Every person has a deep drive to feel safe. We are anxious when we feel unsafe. In the physiological state that accompanies feelings of safety, your body refuels, regenerates, and heals. Sustained stress breaks down your body—mentally and physically. There are many ways to create a sense of safety—and heal. The need to feel and be safe is a deep driving force of all life, including human. In the physiologic state ushered in by feelings of safety, the body refuels, regenerates, builds muscle and bone, empties waste products, fights off foreign invaders well—and the organism thrives. Consider newborn babies who are cared for and nurtured by their family, especially their mothers. They not only thrive as children but have better health in adulthood. A chaotic, even abusive upbringing predicts a harsh life. Many chronic mental and physical health issues occur that shorten lifespan and also markedly compromise quality of life. Raised in such an environment, a child cannot reach his or her full potential—so much energy is consumed by trying to survive. Consider a young plant in rich soil with plenty of sunlight and water. Compare it to the same plant in poor soil, limited sunlight, little water. It may even look like a different species. Feeling unsafe When we don’t feel safe, the state of threat is reflected in our physiology, with mechanisms of flight or fight (the stress response) turned on and preparing us for action. We’ll do whatever we can to restore a sense of safety. Feeling unsafe drives many, if not most destructive behaviors. Feeling trapped can cause us to react aggressively to resolve the situation. Anger represents the body’s powerful last-ditch effort to regain control. Since the most stressful problems are ones we can’t solve, sustained anger turns into rage and destructive behaviors,. What's more, the wear on tear on body tissue resulting from a sustained stress response causes physical breakdown leading to chronic illnesses. Consider how many life situations are unsolvable. One of the deadliest and universal problems is feeling trapped by our thoughts. We can’t escape our thoughts. Suppressing unpleasant thoughts fires up the threat response even more than experiencing such thoughts. Suppression causes the hippocampus (memory center) of the brain to shrink1 and increases craving for opioids.2 Distracting we also fires up the immune system.3 Coping behaviors Addictions. Addictions create a sense of safety but only temporarily, so they are obviously not long-term solutions. Addictions are so destructive because they temporarily mask mental and physical pain, and pursuing relief is compelling. Power. An outcome of feeling chronically unsafe is the relentless pursuit of power in order to gain more control. It can’t and doesn’t work, but few of us are taught alternatives. Means of control can vary but they can infiltrate every domain of our lives and relationships with others. No one wants to be controlled, Every child has anxiety when they leave home to begin school. They want acceptance but also need to diminish fear. This plays out in forming cliques, excluding others, and overt bullying. Nothing enhances our feeling of control more than by gaining power in some way. A study compared the physiological profile of bullied students versus bullies. 4 Researchers measured an inflammatory marker called C-reactive protein (CRP); it’s often measured to detect infection and also indicates a stressed, overactive immune system Bullied children were found to have elevated CRP levels compared to those who hadn’t been bullied. Even more disturbing was that CRP levels in bullies were lower than the norm. There is both a social and physiological reward for power. How all of this plays out in adulthood isn’t subtle. Why give up power and control when anxiety is the alternative? Every child has a strong need to be accepted, yet it gives him or her more power (and self-esteem) to reject someone else? This is an endless loop. Self-esteem. Much of our self-esteem is programmed in by people telling us who we should be or not be. The voices in our head become as concrete as any object. The “stories” are essentially cognitive distortions. Pursuing self-esteem as a means of feeling better about ourselves can't work; it is a gross mismatch of the unconscious brain overpowering the conscious brain. We expend a tremendous amount of energy building up our ego and then spend endless efforts defending it. Factors such as stress, past trauma, and perfectionism affect the frequency and intensity of self-critical thoughts. Since we cannot escape our thoughts, feeling safe can be challenging. What can you do? Learn to be emotionally vulnerable, which is at the core of meaningful human relationships, although there is no reward in nature for being physically vulnerable. The capacity for language creates emotional pain in humans that is much more complex than in other mammals. Since emotional pain is perceived similarly to physical pain, it hurts. Anger, as unpleasant as it is, is powerful, addicting, and masks being vulnerable. Anger is an attempt to create a sense of emotional safety—but no one around you feels safe. How do people learn to be vulnerable who are used to dealing with a lot of anger? Dynamic Healing. The need to pursue dysfunctional behaviors dissipates as you address anxiety, the source of sustained threat physiology (anxiety). You cannot control survival reactions but there are numerous ways to regulate them. Creating the condition of safety physiology—what I call “ dynamic healing ”— allows you to feel safe, connected, and relaxed: Dealing with life’s challenges in a manner that has less negative impact on your nervous system. Regulating the state of the nervous system—from threat to safety, hyperactive to calm. The focus is on learning skills to create cues of safety. It is embodied healing rather than “self-help." David Hanscom - Website - References 1. Hulbert JC, et al. Inducing amnesia through systemic suppression. Nature Communications (2016); 7:11003 | DOI: 10.1038/ncomms11003 2. Garland EL, et al. Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients. J Behav Med (2016); 39:128–138. 10.1007/s10865-015-9675-9 3. Cole SW, et al. Social Regulation of gene expression in human leukocytes. Genome Biology (2007); 8:R189. doi: 10.1186/gb-2007-8-9-r189 4. Copeland W, et al.” Childhood bullying involvement predicts low-grade systemic inflammation into adulthood.” PNAS (2014); 111: 7570-7575.

Ways to protect yourself from emotional mind games. There's a difference between casual phrases and patterns of manipulative behavior. Gaslighting can have serious consequences and leave emotional and psychological pain. Recognizing gas lighters can save you a lot of emotional pain and doubt. It’s concerning how certain psychological terms can quickly become fixtures in our vocabulary. Not only that, but they are also often misused. While it’s good to talk openly about our mental health issues, it’s problematic when those conversations are based on misinterpretations of psychological concepts—and even worse when we apply these terms to everyone we dislike. In our effort to destigmatize mental health, we may inadvertently make things worse. We are beginning to convince ourselves that we are all victims and therefore defective, broken, or mentally ill. Sympathy and validation have become the new currency of social interaction, often traded without scrutiny or reflection. While well-meaning, this trend risks perpetuating a culture where labeling someone as toxic, abusive , or dysregulated becomes an easy way to dismiss disagreements or discomfort. "Gaslighting" is one of those terms that has become overused and prevalent in passionate discussions. I notice how often the person using it doesn’t truly grasp its meaning when accusing others and describing themselves as victims of it. In this post, I’ll address a series of myths around the term to answer questions such as: What exactly is gaslighting, and how does it differ from a simple misunderstanding? Can gaslighting be both malicious and unintentional? Exploring these questions can help us understand this concept more accurately, distinguishing truth from fiction. This can help us understand the nuances of psychological manipulation in personal relationships, provide clarity in therapeutic contexts, and empower individuals to recognize and address manipulative behaviors. Myth: Gaslighting is simply denying something you said or did. Reality: While denial can be a part of gaslighting, it’s not the whole picture. Gaslighting is a pattern of behavior —not an isolated event—in which individuals attempt to confuse someone else’s sense of reality, memory, and judgment. It involves repeated actions, such as flat-out denying things that were clearly said or done, minimizing or dismissing the other person’s concerns as unimportant or exaggerated, turning the tables to make the other person feel responsible, and fabricating stories or twisting events to create doubt and confusion. Myth: Gas lighters are always conscious of their manipulation. Reality: Gas lighters are generally deliberate in their attempts to manipulate and deceive others. They may not be fully aware of the harm they cause because they may not very reflective or empathic people. They do gaslight with the intention to exploit vulnerabilities, using sensitive information such as identity, children, or self-worth as tools for control. It’s also possible that some individuals may unconsciously use similar tactics to avoid responsibility or conceal their insecurities. These individuals may not fully qualify as gas lighters in the strict sense, as their actions lack the frequency and intentionality that define true gaslighting. Myth: Gaslighting is always a deliberate act. Reality: While gaslighting is often intentional, there is nuance to this understanding. Abusers may not always be fully conscious of their tactics but are typically aware of the intention and the effects—such as causing confusion or shifting blame. Some abusers may rationalize their behavior, believing they are entitled to act as they do. Over time, gaslighting can become a learned skill, reinforcing the gas lighter’s sense of power when their manipulation succeeds. Myth: Gaslighting only happens between romantic partners. Reality: While gaslighting frequently occurs in romantic relationships, it can also manifest in other contexts, such as friendships, family dynamics, professional environments, and even interactions with strangers. Once an individual becomes adept at gaslighting, they may apply these tactics across various relationships, embedding them into their personality and behavior. Myth: Anyone who uses certain phrases is a gas lighter. Reality: Phrases like “You’re imagining things” or “You always blow things out of proportion” can be tools for gaslighting, but their use alone does not define the tactic. The key to identifying gaslighting lies in the context, intent, and frequency of these phrases. Are they being used to manipulate and control, or are they occasional remarks made during heated arguments? Isolated instances of such language do not qualify as gaslighting. Myth: Self-gaslighting is possible. Reality: The term "self-gaslighting" is a misnomer. Gaslighting requires an external manipulator. While you may doubt your own memories or perceptions, this is not the same as someone deliberately manipulating you to question your sanity. Myth: Gaslighting is always obvious. Reality: Gaslighting is often subtle and insidious. When a person is aware of the effects of the tactic, they may become skillful at it, making it difficult to detect, especially in the early stages of a relationship or when the victim has already internalized self-doubt, making it harder to recognize manipulative tactics, or when they "trust" the individual who is quietly abusing them emotionally. Myth: Gas lighters don’t know they are lying. Reality: True gas lighters lie blatantly and deny things even when presented with clear evidence. We are assuming that a gas lighter is an emotional abuser. They may dismiss evidence as a mistake, fabrication, or something else entirely, but they are not doubtful of their lies. They may also "forget" events or rewrite history to suit their narrative, making the victim question their perception and lose confidence. Recognizing Gaslighting If you’re questioning whether you have been gaslit, here are some signs to watch for: You constantly feel confused and off-balance. You find yourself apologizing frequently, even when you’ve done nothing wrong. You second-guess your decisions and doubt your own judgment. You question your memories, perceptions, and interpretation of events. You’re afraid to express your feelings for fear of being ridiculed or dismissed. If you notice someone engaging in behaviors that resemble gaslighting, consider addressing it directly. Calling them in gives you the opportunity to understand the intention behind their actions and to determine whether the behavior is truly manipulative or a misunderstanding. It also allows them the chance to recognize the harm their actions may cause and take accountability, which can potentially lead to growth and change for both parties. Gaslighting is a serious issue, but you don’t have to either remain a victim or assume you are one if there’s no real reason for it. Trust your instincts: If something feels off, pay attention to patterns of behavior rather than isolated incidents. Stay grounded in reality by practicing objectivity, reflecting on your triggers and trauma responses, and seeking support when needed. Avoid engaging in conversations that consistently leave you feeling confused or diminished. And remember that you deserve relationships that empower and uplift you. Take the first step by believing in yourself. Antonieta Contreras - Website -

Your dream's setting might help you find peace. Look at all the aspects of a dream, as the solution to the problem often sits in plain sight. The location where a dream occurs may point you to the solution to your current issue. How you feel in a dream can be the quickest way to connect to the subject of a therapeutic discussion. Hanna dreamed she was searching frantically for her friend in a retreat center. While her panic and anxiety evoked a waking-life situation in which she felt overwhelmed and resentful, the dream’s location offered her the first step in making her situation more livable. The Dream In my dream, my friend Mary and I were at a retreat center. I couldn’t find her and began to look for her, going through hallways, into rooms, and into a dining area. I became frantic because I had no idea where she was. Later, I was sitting and talking with (actor) Liam Neeson. I saw my mother at another table, and I was relieved to see Mary sitting in a wooden chair by the door to the outdoors. The Discussion I began by asking Hannah, “How did you feel in the dream? Was your panic immediate? Hannah answered, “No, I didn’t feel frantic at first. I was frantic and upset while searching for her, and this was the feeling I woke with, even though I found her before I woke up.” Needing more detail, I inquired, "Can you describe a retreat center for me?" Hannah offered, "A retreat center is a place where people go to get away from their daily lives and stresses, to experience fun or learn something. Often, the retreat center is located in a country setting with a calming sense of nature all around.” Wondering about Hannah's associations with Neeson, I asked, "What comes to your mind about him? Do you like him?" She responded, "Liam Neeson may be a symbol of a traumatizing time in my life because I know he lost his wife in a tragic accident." I then asked, "What kind of person is Mary?" Hannah replied, "My friend Mary has been a victim of bad luck in life and overprotective parenting that stunted her growth and potential. Despite this, she is very compassionate, intelligent, and kind. She lived as she chose to rather than living up to her actual potential or parental expectations. Mary has suffered silently but always remained in good cheer and has been a very supportive friend." Hoping to help Hannah connect the dots, I asked, "Can you connect Liam to a traumatizing time in your life or a recent trauma ? Since your dream story is about Mary and you describe her as a victim, do you also feel victimized recently?” Hannah made some connections. "You are spot on, Layne. When I described Mary as a victim, I felt like I had just given you a description of myself. "My mom passed on four years ago from Alzheimer's disease. I see myself as a victim because I was her sole caretaker. My father was in complete denial of my mother's illness , and my sister, with legal power of attorney, couldn't face the changes and stayed away. Neither of them offered me any help whatsoever. "Your questions resonate deeply with me, not only because I feel like a victim, but also how I associate Liam Neeson with trauma. Being the sole caregiver for my mom was a trauma, and I am now inside another trauma every day. "I’m again the sole caregiver, this time of my father. My unresolved anger with my sister has me feeling resentful and hopeless. The toll of caregiving has been enormous, but very little compassion comes back to me. "In these last few days, I have been anticipating how I will have to deal with their house after my father passes away, including repairs he refuses to address. "Finally, I can't leave out how, at 63 years old, I am victimized by myself as I struggle to get out of the loop of negative, hopeless thinking and find purpose besides taking care of people. I am very kind to others but not to myself." I shared some of my impressions. "Thank you, Hannah, for your honesty. I am impressed with your great feelings and great responsibilities, all sitting under an umbrella of disappointment, frustration, and anger . Mostly, I’m struck by how overwhelming it all is. "This is where I see a strength inside your dream. Without discounting the difficulty, let's look at some achievable solutions. To get yourself out of the loop of negative, hopeless thinking, think of a relatively small, practical action you can do for yourself. "Think of Mary at the end of the dream, sitting by the door that leads to the outdoors. A small ‘retreat’ to nature might help in alleviating your daily suffering. “Perhaps the 'retreat center' offers a concrete suggestion. How would you feel about taking a break at an actual retreat center? Follow your own dream's advice." Smiling, Hannah responded, "I am already in motion on this idea. There’s a retreat and yoga center very close to my home. I am definitely going to begin the process of having my sister, who has power of attorney anyway, step in here or arrange for a caregiver for a 10-day break for myself." What We Can Learn All parts of a dream lead back to the dreamer. In Hannah’s dream, her friend Mary brings her right back to her own sense of victimization. Her emotions also evoke her waking-life feeling of anxiety, which she anticipates will only worsen after her father’s death. However, other parts of this dream show movement in a positive direction. The final image of her friend seated by the door to the outside offers a vision of greater freedom. The dream’s setting at a retreat center provides a concrete path toward taking greater care of her own mental and physical health. Hannah’s experience shows how all parts of a dream can help us analyze its meaning and then allow us to access more of our own thoughts and feelings as we resolve difficult issues in our lives. Layne Dalfen, - Website -

Early intervention and appropriate treatment are essential for managing PTSD effectively. Raising awareness of post-traumatic stress disorder, or PTSD, is crucial to eliminate stigma around it and support the recovery and well-being of those affected. Spreading awareness also plays a vital role in encouraging timely treatment. Early intervention and appropriate treatment are essential for managing PTSD effectively. When people are aware of the signs and symptoms, they are more likely to seek help promptly, reducing the risk of prolonged suffering and potential negative outcomes. There are many effective treatment options and resources available to help those with PTSD. What Is PTSD? PTSD is a mental health condition that can develop in individuals who have experienced or witnessed a traumatic event that posed a serious threat to their life or safety. It can also occur when someone learns about the unexpected death or severe injury of a loved one. It is estimated that 8 million people in the US are living with PTSD. Many sufferers of this disorder are not getting the help they need . One of the reasons why many individuals with PTSD do not seek treatment is due to the stigma surrounding mental health conditions. Some people may feel embarrassed about their symptoms, while others may not even realize that what they experience is PTSD. Lack of awareness and understanding about mental health issues can also contribute to the underutilization of treatment resources. PTSD Symptoms The symptoms associated with PTSD can be distressing and may persist for months or even years after the traumatic event. Individuals with PTSD may feel stressed or anxious even when they are not in danger. PTSD symptoms fall into four categories: Flashbacks: Re-experiencing the trauma through intrusive distressing recollections of the event and nightmares, and experiencing the same bad feelings you felt when the traumatic event took place. Flashbacks are sometimes caused by a trigger. Avoidance: Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma. Hyperarousal: Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered. Being on high alert or on guard without being in any danger. Negative changes in beliefs and feelings : Individuals with PTSD may develop a negative outlook on themselves, others, or the world in general. They might blame themselves for the trauma or feel a pervasive sense of guilt. They may also experience self-doubt, feelings of worthlessness, a loss of trust in others, a loss of interest in activities and hobbies, and emotional numbness. Living With PTSD PSTD can have a significant impact on various aspects of a person's life. Here are some specific ways in which PTSD can interfere with daily functioning: School and work: PTSD symptoms, such as difficulty concentrating, memory problems, and intrusive thoughts, can make it challenging to focus on tasks at school or work. This can result in decreased productivity, poor performance, and potential difficulties in maintaining employment or pursuing educational goals. Relationships: PTSD can strain relationships with family, friends, and romantic partners. People with PTSD may experience irritability, anger , emotional numbness, or a sense of detachment, which can make it difficult to connect with others. The avoidance behaviors that often accompany PTSD can also lead to social isolation and strained interpersonal interactions. Everyday activities : Engaging in daily activities, such as going to the grocery store, attending social events, or participating in hobbies, can become overwhelming for individuals with PTSD. Hyperarousal symptoms, like hypervigilance or an exaggerated startle response, can make them feel constantly on edge and anxious, even in non-threatening situations. This may lead to avoidance of certain places, people, or activities, further impacting their quality of life. Emotional well-being : Living with PTSD often involves experiencing high levels of stress, anxiety , and emotional distress. Individuals with PTSD may struggle with managing their emotions, leading to frequent mood swings, feelings of sadness or hopelessness, or an inability to experience positive emotions. These emotional challenges can further contribute to difficulties in daily life and overall well-being. Chronic stress associated with PTSD can have adverse effects on physical health. It can weaken the immune system, disrupt sleep patterns, increase the risk of developing cardiovascular conditions, and exacerbate other pre-existing health issues. The good news is treatment is effective and accessible. PTSD Treatment Options—It's Never too Late Early Intervention is best, but effective treatments are available for PTSD, even if you have been experiencing symptoms for an extended period. With the right support and therapies, it is possible to alleviate the symptoms of PTSD and regain control over your life. Remember that you are not alone, and many resources and support systems exist to help individuals with PTSD. Over the years, advancements have been made in understanding and treating PTSD, leading to improved therapeutic approaches. It's essential to remember that everyone responds differently to treatments, and what works for one person may not work for another. If a previous treatment did not provide the desired results, it's certainly worth considering trying again or exploring alternative treatment options. According to the National Center for PTSD, trauma-focused therapy gives a person the a good chance of recovery. Other therapies and certain medications can also be effective. Trauma-focused psychotherapies: Treatment that focuses on the memory of the trauma and its meaning. Thinking about a traumatic memory may initially evoke feelings of fear or discomfort. However, when done under the guidance of a trained professional , this specific form of therapy can be highly beneficial for individuals with PTSD. This type of therapy includes cognitive processing therapy (CPT), prolonged exposure therapy (PE) and eye movement desensitization and reprocessing (EMDR). By addressing and gradually confronting the traumatic memories, thoughts, and emotions associated with the trauma, individuals can begin to heal and experience relief from PTSD symptoms. Research has shown that trauma-focused therapies can lead to significant improvements in PTSD symptoms as measured by the Clinician-Administered PTSD Scale (CAPS). CAPS is considered one of the gold standard assessments for measuring the severity of PTSD. The long-term outcomes of these treatments are encouraging. A study examined individuals who had received PE or CPT and followed up with them five to ten years later. The results showed continued improvement in CAPS scores. Approximately 80 percent of the study participants no longer met the diagnostic criteria for PTSD. It is important to note that individual responses to treatment may vary, and these results are based on research studies. However, they do provide hope for individuals seeking effective treatment for PTSD and highlight the potential for significant and lasting results. Medications: Certain medications, such as selective serotonin reuptake inhibitors (SSRIs), can be prescribed to help manage PTSD symptoms. They may be used in conjunction with psychotherapy or as a standalone treatment. Other therapies and interventions : In addition to trauma-focused psychotherapies and medications, alternative or complementary approaches, such as mindfulness-based therapies, acupuncture, yoga, support groups, and art therapy may also be beneficial for some individuals in managing their PTSD symptoms. These interventions can provide additional avenues for healing and self-expression, and they can be used as adjuncts to traditional therapies. In Summary If you or someone you know is struggling with PTSD, I encourage you to reach out to a mental health professional who can provide appropriate guidance and support throughout the healing journey. Working with a trained professional can provide essential support during this process. Therapists who specialize in trauma understand the complexities of PTSD can conduct a comprehensive evaluation, consider your individual circumstances, and recommend the most appropriate treatment approach for your specific needs. It may involve a combination of therapies or a tailored treatment plan. Remember, recovery from PTSD is a process, and it can take time. It's important to have patience and be open to trying different treatments until you find what works best for you. With the right support and treatment, it is possible to find relief from PTSD symptoms and regain a sense of well-being. Diane Roberts Stoler, EdD - Website - Book References: Foa, E.B., Keane, T.M., Friedman, M.J., & Cohen, J.A. (Eds.). (2009). Effective treatments for PTSD, Second Edition. New York, NY: Guilford; DeAngelis, T. (2017, November 1). PTSD guideline ready for use. Monitor on Psychology, 48(10). https://www.apa.org/monitor/2017/11/ptsd-guideline; Resick, Patricia A: Nishith, Pallavi: Weaver, Terri L: Astin, Millie C.: Feuer, Catherine A. Journal of Consulting and Clinical Psychology, Vol 70(4), Aug 2002, 867-879. doi: 10.1037/0022-006X.70.4.867