How they can guide you with a trauma-informed approach. Post-Traumatic Stress Disorder (PTSD) is a severe mental health condition that affects millions of people worldwide. It can arise after experiencing or witnessing a traumatic event, causing individuals to struggle with intrusive thoughts, emotional distress, and avoidance behaviors. Seeking professional help from a qualified PTSD therapist is essential for effective treatment and healing. Understanding PTSD and Its Impact Before delving into the qualities of a competent PTSD therapist, it is crucial to understand the impact of this condition. According to the National Center for PTSD, about 6 percent of the U.S. population will experience PTSD at some point in their lives. Trauma whether resulting from combat, sexual assault, natural disasters, or other traumatic events, can significantly disrupt an individual's life, relationships, and overall well-being. Gender plays a significant role in PTSD prevalence, with women being more susceptible to developing the condition compared to men. About 8 percent of women and 4 percent of men will experience PTSD at some point in their lives. This disparity is attributed, in part, to the types of traumatic events more commonly experienced by women, such as sexual assault, which can leave lasting psychological impacts. Furthermore, veterans face a higher risk of developing PTSD compared to civilians. Among veterans, those who have been deployed to war zones are at even greater risk of experiencing PTSD. The exposure to combat-related trauma intensifies the likelihood of developing this mental health condition. The Power of Trauma-Focused Treatment Trauma-focused treatment has shown promising results in helping individuals with PTSD. This evidence-based therapy focuses on addressing the specific issues related to trauma, using various therapeutic techniques to help clients process their traumatic experiences and develop coping skills. According to many studies conducted between 1995 to 2013, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has been found to be highly effective in reducing PTSD symptoms in children and adolescents. What is Trauma-Focused Cognitive Behavioral Therapy? Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based therapeutic approach designed to help individuals, particularly children and adolescents, who have experienced trauma and are struggling with the psychological effects of traumatic experiences. TF-CBT combines elements of Cognitive Behavioral Therapy (CBT) with trauma-focused interventions to address the unique needs of trauma survivors. The main goals of trauma-focused cognitive behavioral therapy are to: Address Trauma-Related Symptoms: TF-CBT aims to reduce and manage the distressing symptoms associated with trauma, such as intrusive thoughts, nightmares, flashbacks, and emotional numbing. Promote Emotional Regulation: The therapy helps individuals learn effective strategies to cope with overwhelming emotions and regain a sense of emotional control. Enhance Safety and Coping Skills: Clients are taught healthy coping skills to manage stress and anxiety while enhancing their sense of safety and empowerment. Foster Cognitive Restructuring: TF-CBT works to challenge and reframe negative beliefs and thoughts related to the traumatic event, promoting more adaptive and constructive thinking patterns. Address Trauma-Related Grief: The therapy provides a safe space to process feelings of grief and loss associated with traumatic experiences. Improve Interpersonal Functioning: TF-CBT aims to improve communication and problem-solving skills, enhancing the individual's ability to form healthy relationships and connections. The TF-CBT process typically involves the following components: Psychoeducation : Therapists educate clients and their families about trauma and its impact on mental health to enhance understanding and reduce stigma. Relaxation Techniques: Clients learn relaxation and grounding techniques to manage anxiety and stress. Exposure and Desensitization: Gradual exposure to trauma-related memories or triggers is used to help individuals process and cope with their traumatic experiences. Narrative Development: Clients are encouraged to share their trauma narrative in a safe and supportive environment, promoting understanding and acceptance of their experiences. Safety Skills: Therapists help clients develop safety plans and strategies to manage potential triggers and crisis situations. Qualities to Look for in a PTSD Therapist Specialization in PTSD Treatment: Look for therapists who have specialized training and experience in treating PTSD and trauma-related disorders. Such therapists are well-versed in evidence-based interventions and understand the complexities of trauma recovery. Empathy and Compassion: PTSD therapy requires a high level of empathy and compassion. A therapist who creates a safe and non-judgmental space allows clients to feel heard and supported, fostering a strong therapeutic alliance. Trauma-Informed Approach: Seek therapists who adopt a trauma-informed approach in their practice. This approach ensures that the therapist recognizes the potential impact of trauma on a person's life and provides care that is sensitive to their unique needs. You can read more about this in the section below. Collaborative and Client-Centered : A competent PTSD therapist will involve the client in their treatment plan, collaborating on achievable goals and personalized strategies to aid in their healing journey. Up-to-Date Knowledge: PTSD treatment methods are continually evolving as research progresses. Look for therapists who stay current with the latest developments in trauma-focused therapy. What is a Trauma-Informed Approach? A Trauma-informed approach is a way of understanding and responding to individuals who have experienced trauma in a manner that is sensitive, compassionate, and supportive. This approach acknowledges the widespread impact of trauma on mental health and recognizes that trauma can affect individuals in various ways, leading to potential long-term consequences in their lives. The key principles of a Trauma-informed approach include: Safety: Ensuring physical and emotional safety is a top priority when working with individuals who have experienced trauma. Creating a safe and supportive environment helps foster trust and healing. Trustworthiness and Transparency: Being reliable and transparent in all interactions builds trust between the individual and service providers. Trust is essential for clients to feel comfortable sharing their experiences and seeking help. Choice and Empowerment: Allowing individuals to have a sense of control and autonomy in their treatment and recovery process is empowering. Giving choices and respecting their decisions promotes healing and self-esteem . Collaboration and Mutuality: A trauma-informed approach emphasizes collaboration between service providers and clients. It recognizes the client as an active participant in their healing journey and promotes a sense of mutuality. Cultural Sensitivity: Understanding and appreciating the cultural backgrounds of individuals are essential in providing effective and respectful care. Being sensitive to cultural differences prevents traumatization and fosters inclusivity. Understanding Trauma's Impact: Service providers strive to understand the potential impact of trauma on individuals' lives, behaviors, and coping mechanisms. This understanding helps in developing appropriate interventions. Avoiding Re-traumatization: Ensuring that environments, interactions, and interventions do not inadvertently re-traumatize individuals is a core principle. Avoiding triggers and maintaining a trauma-sensitive approach are vital. Conclusion When dealing with PTSD, choosing the right therapist is paramount to the recovery process. Seek professionals with specialized training in PTSD treatment, empathy, and a client-centered approach. Remember, healing is possible, and you deserve a life filled with happiness and well-being. Rubin Khoddam, Ph.D.

Cutting-edge techniques can improve PTSD symptoms. The amygdala detects threats and helps us deal with danger. Patterns of brain activity called theta rhythms are important for fear memories. Theta rhythms in PTSD patients are linked to symptom severity. Changing amygdala theta rhythms significantly reduces PTSD symptoms. Fear is an adaptive emotion that helps us cope with threatening situations. Deep within the temporal lobe of the brain is the amygdala, the most studied brain area involved in fear. The amygdala uses all kinds of information from outside and inside the body to help us interpret and react to danger. The Amygdala and Fear Upon detecting a threat, the amygdala causes reactions that prepare us to deal with danger. For example, if you hear a sudden noise behind you when walking alone at night, you might experience a racing heart, changes in breathing, and tension in your muscles. These amygdala-dependent reactions enhance the body's readiness to respond to the threat. The amygdala is also important for making fearful memories. When an individual encounters a threatening situation, the amygdala forms a memory of that event, tying together all the parts of the environment, such as sounds, smells, and visual features. These fearful memories help us adapt and make faster decisions in the future. However, in some people who have experienced trauma , the amygdala is hyperactive, which is believed to cause maladaptive behavior that is distressing. An example of this is the symptoms associated with post-traumatic stress disorder (PTSD). Amygdala Activity Rhythms Associated With Threats Distinct types of brain rhythms are associated with various cognitive functions, including fear memory. In the amygdala, a type of rhythm called theta is thought to help the amygdala process information and form memories. Most of what we understand about amygdala theta rhythms comes from animal studies because measuring it requires placing electrodes into the brain. Theta has been recorded in the amygdala of patients with epilepsy undergoing neurosurgery; however, whether theta might be different in PTSD patients is poorly understood. Finding out how theta functions in people suffering from PTSD could be critical for developing new treatments. Recording Theta in the Human Amygdala In a remarkable study, Gill et al. recorded amygdala rhythmic activity as part of voluntary clinical trials for PTSD. Patients were implanted with electrodes into the amygdala, and brain activity was recorded for more than one year. Activity in the amygdala was recorded while patients looked at unpleasant images and listened to audio recordings of their own trauma-related memories. Patients also self-reported their symptoms using a questionnaire, and the researchers were able to link amygdala theta activity changes to times when PSTD symptoms were at their worst. Neuromodulation of Amygdala Theta for Treatment of PTSD The authors then applied an innovative technique known as closed-loop stimulation to change amygdala function in the hope of reducing PTSD symptoms. In closed-loop stimulation, the surgical device was used to stimulate electrically the amygdala when theta was detected. Remarkably, using this treatment strategy for one year led to significantly reduced severity of PTSD symptoms as well as reduced amygdala theta activity during aversive stimuli. Future Directions Admittedly, this is an invasive approach that requires neurosurgery and careful monitoring of patient health. Other clinical trials in PTSD patients are underway that are using non-invasive neurofeedback with functional MRI to downregulate amygdala function during trauma recollection. While this neurofeedback technique is showing promise for giving patients control over amygdala activity, it has yet to reduce symptoms significantly when compared to control subjects. Nonetheless, further work using these types of approaches is called for and necessary to help the millions of individuals suffering from PTSD. Jonathan Fadok, Ph.D., - Website - References Gill, J.L., Schneiders, J.A., Stangl, M. et al. A pilot study of closed-loop neuromodulation for treatment-resistant post-traumatic stress disorder. Nat Commun 14, 2997 (2023). Zhao, Z., Duek, O., Seidemann, R. et al. Amygdala downregulation training using fMRI neurofeedback in post-traumatic stress disorder: a randomized, double-blind trial. Transl Psychiatry 13, 177 (2023).

Personal Perspective: Are we doing more harm than good? There is a widely held belief that a preparatory phase is needed before PTSD treatment. There is no research comparing phase-based treatment directly with trauma-focused treatment. There is evidence that treatment works better when not delayed by a coping skills phase. The popularity of phase-based therapy for PTSD may be a training issue. Although there is no controlled research supporting the idea that patients need to be prepared to start evidenced-based treatments (EBTs) like cognitive processing therapy (CPT) or prolonged exposure (PE), there is a widespread belief among therapists that a preparatory phase may be beneficial or even necessary. Phase-oriented approaches consist of at least two parts, one phase in which some type of stabilization is provided, particularly with skills to increase emotional regulation or coping skills, followed by a trauma -focused treatment. A meta-analysis of phase-based programs found considerable improvements over time, but most studies examined did not have control conditions or used only waitlists/supportive counseling and not direct comparisons to EBTs only. Therapists' beliefs in the readiness of patients may affect whether they are offered treatment at all. One VA study of readiness for a residential program was based on mental health directors and providers based on subjective judgments of stability, readiness to change, and skills to manage distress. However, they admitted difficulties predicting who is actually ready for treatment or for which kind of treatment. A study of community therapists’ attitudes toward learning CPT found that many therapists thought that phase-based treatments were necessary. Although beliefs changed with case consultation, those who maintained their preexisting beliefs were less likely to complete training. On the other hand, there is abundant evidence that EBTs like CPT or PE, without any introductory phase, are effective in reducing PTSD symptoms, even among those with comorbidities such as depression , dissociation , suicidal ideation, substance abuse , and personality disorders . Adding a preliminary stage to treatment may, in fact, delay treatment or result in treatment dropout. Some examples follow: De Jongh et al. (2016), along with 20 other authors, reviewed treatment guidelines for Complex PTSD (CPTSD). The focus was on the need for a stabilization phase before trauma-focused treatment. After a complete review of the available treatment research, they determined that in studies with stabilization only, the dropout rate was about 50 percent and did not differ in PTSD or affect regulation compared to waitlist conditions. There was no research comparing phase-based treatment directly to trauma-focused treatment only. The available research on trauma-focused therapy with CPTSD or child sexual abuse without a stabilization phase showed significant improvements and no adverse effects. De Jongh concluded that treatment guidelines for CPTSD that recommend a stabilization phase may risk patients being denied or delayed from effective evidence-based treatments. In a study of adolescents in Germany with a child sexual abuse history, Rosner et al. (2019) conducted a phase-based treatment including commitment and emotion management followed by cognitive processing therapy (CPT). The CPT was conducted intensively over four weeks. Although there was a slight improvement in symptoms during the first phase, there were large reductions in symptoms following CPT. This included significant effects on PTSD, depression, borderline symptoms , behavior problems , and dissociation by the three-month follow-up. Dedert et al. (2021) focused on the widespread use of phase-based approaches for veterans using actual VA clinic data from 778 veterans who sought treatment for PTSD. Clinic directors have reported adopting preparatory groups to increase readiness for evidence-based treatments (EBTs), typically CPT or prolonged exposure (PE), to improve coping skills and reduce no-shows. These preparatory groups included psychoeducation about PTSD symptoms and relaxation skills, increasing positive behaviors to reduce PTSD symptoms, along with cognitive restructuring and anger management. What Dedert et al. found was contrary to those expectations. Standard procedures for clinicians were to describe treatment options, recommending CPT or PE as first-line treatments with the most evidence (and later in the study period, EMDR), but suggested that any patients who had reservations about treatment be first enrolled in a ten-week preparatory treatment. A total of 391 veterans initiated preparatory treatment. Only 24 percent subsequently initiated one of the EBTs. A total of 530 veterans initiated an EBT without a preparatory group. Preparatory groups resulted in small changes in symptoms of PTSD and depression. When an EBT followed the preparatory group, there were also small decreases in symptoms. However, when EBT was started first, the treatment resulted in moderate to large decreases in PTSD and depression symptoms. Dedert's findings indicated that the preparatory groups did not increase participation in an EBT and that direct entry into an EBT worked better than treatment following the preparatory group. One question to ask, given the lack of evidence that a preparatory phase is either necessary or sufficient, is why phase-based treatments are so popular. One possibility is a lack of knowledge about these findings. Another is that therapists have their own fears about doing EBTs. In an article on therapists' "stuck points" (inaccurate beliefs) prior to training in CPT, the second most common (of 37 items) was “Clients need preparatory treatment before they are ready to deal with their trauma.” Higher levels of therapist stuck points and less reduction in stuck points during training resulted in a lower likelihood of completing training requirements and less use of CPT 12 months later. Perhaps more focus should be on training therapists so that patients are not denied treatments that work. Patricia A. Resick, Ph.D., ABPP, References Dedert, E. A. et al. (2021). Clinical Effectiveness study of a treatment to prepare for trauma-focused-based psychotherapies at a Veterans Affairs specialty posttraumatic stress disorder clinic. Psychological Services, 18, 651-662. De Jongh, A., et al. (2016). A critical analysis of the current treatment guidelines for complex PTSD in adults. Depression and Anxiety, 33, 356-369. LoSavio, S. T. et al. (2019). Therapist stuck points during training in cognitive processing therapy: Changes over time and associations with training outcomes. Professional Psychology: Research and Practice, 50, 255–263.

Finding gratitude for your grit, gifts, and ability to overcome. Complex PTSD, or relational trauma, can be tied to generational legacies of abuse, neglect, or abandonment. Without awareness, someone could believe that these kinds of generational burdens are their failings alone to remedy. Starting a "gratitude-for-myself" practice can remind someone of the grit, gifts, and changes they've created in this generation. Through this practice, someone can find some grace for themselves and for what they have "done differently." In healing from relational trauma or complex PTSD —a type of PTSD thought to arise as a result of extended or repeated trauma—we often forget or dismiss what it is we’ve been up against. And for some of us, it’s what we’ve been up against our entire lives. Generations of negative family patterns and relational woundings are our legacies. Sometimes we forget—or never were really aware—of our generations and generations of “burden loading”: burdens handed down to us, carried, compounded, and left unmitigated through our family lines—burdens like abuse , neglect, abandonment, or loss. These are wounds created through our families, communities, societies, and/or cultural and historical norms. When we forget that we carry these generational burdens, at our core we may believe all of the compounded shame, inadequacy, and powerlessness we feel is because of how we, alone, have “failed” to make our life different. Our individualistic society reinforces this notion. On a personal level, our sense of those perceived failings may include feeling horrified when we slip and sound or act “just like my mother/father.” Or they show up when we have a hard time taking a compliment or acknowledging our gifts because we’re loaded with secret shame. And often, we compare ourselves to others—or worse, we compare ourselves to an ideal self that will always elude us. So, we believe that to feel safe and sane and able to survive, we must go on a mission to get those “failings” under control. We get into perfectionism, consumerism, workaholism, or addictions—which makes perfect sense, because the non-conscious belief goes something like, “If I’m just smart enough, fast enough, rich enough, or numbed out enough, I will never have to feel 'that' again. No more of that vulnerability, that loneliness, that not belonging. I will get that handled!” We tend to rev up, and then double down on, our familiar strategies for control. When we’re in this revved-up space, I argue that it's good to consider pausing—and maybe pausing a beat longer to consider starting a gratitude practice. Here, I would offer a little different type of gratitude practice. It’s a gratitude-for-myself practice. You may start this practice by getting curious about how you might: Begin to find gratitude for what you have summoned in yourself to overcome, survive, and thrive. Get really specific. Look at the whole of your life. Write it down. What have you had to manage? What have you had to overcome? What have you done that’s been growth-producing, took courage, required a risk, or demanded perseverance? Acknowledge and honor what you now see written in front of you. Add to it. Share it with a trusted other. Seriously celebrate it. Allow yourself grace for your mistakes and shortcomings. Expect less of yourself. Slow down, just for a day. Strain less and see how things can maybe still work out. Identify ways—against all odds—you’ve broken patterns from previous generations. Ask what is your shame to bear, and what belongs elsewhere. What is truly your responsibility now? How have you successfully answered for it? Really appreciate that you are just one person trying to make a difference in a chain of unaddressed pain. With your children, acknowledge how you’ve worked to “do it differently” with them, to break the generational transmission. Consider what you’ve done in your larger family or community to bring healing. By even being willing to be aware, you’re doing your part for those who follow. One of my clients said at the end of a session, her eyes open in surprise, “I didn’t realize how much I’ve been handling all my life. I’m not depressed; I’m legitimately sad and tired, and I’m sort of proud of what I’ve done in spite of all of it.” In spite of a life full of loss and trauma, she found this understated appreciation for the grit and gifts and sea changes she has had to summon to create a life for herself. That self-gratitude is part of where healing compassion starts, both for oneself and for others. Go get it. Jennifer Lock Oman, LISW, BCD, - Website -

Identify the source of your challenges to get the right solutions. Generally, if one family member has ADHD , they’re not the only one. Some people with ADHD find their symptoms, such as forgetfulness or messiness, affect their relationships with other people. The ability to regulate emotions when they become intense is a skill that many people with ADHD struggle with. Unless you’ve been stranded on an island for the past decade, you’ve probably heard and read a lot about the phenomenon of adults getting diagnosed with ADHD . Many people age 18 and over feel like they have significant problems focusing, getting things done, procrastinating, and generally being efficient in their jobs and their personal lives. Many of these individuals have been successful academically; they may have even been honors graduates and high achievers. Their experiences look typical on the surface, but they say their life is a mess. Not to mention, social media has thousands of blogs, testimonials, and other resources about adult ADHD. There’s even a YouTube channel called “How to ADHD.” This post gives you questions you can ask yourself to help decide if you might have ADHD and benefit from a formal evaluation from a psychologist. 1. Do your symptoms disrupt your ability to function at work or at school? People often think they might have ADHD if the problems they have functioning are quite disruptive. Their struggles prevent them from being efficient, which means things take much longer than they should to complete. Many people hate their jobs because they feel like their responsibilities highlight the weaknesses they have in being efficient and organized. Or they get incredibly bored with their work, so they can’t always put their best foot forward. They may question their career choices or majors in college because they don’t feel motivated to complete tasks on time. 2. Do you struggle in personal relationships? Some people find their ADHD symptoms affect their relationships with other people. They may be forgetful, which annoys their friends or partner, they’re messy and disorganized, they talk too much or too loudly, or they constantly interrupt people. The quality of their relationships is therefore compromised by their challenges. Note: If similar problems are disruptive to your professional or personal life, it’s definitely time to seek support from someone with expertise in assessing and treating ADHD. 3. Do you experience intense emotions? The ability to regulate emotions when they become intense is a skill that many people with ADHD struggle with. They talk about losing control of their emotions, becoming reactive quickly, and being unable to calm down after getting really upset or excited. There are other mental health conditions for which this is also potentially an issue, but it’s much more common among people with ADHD than has been talked about in the research until recently. 4. Do other people in your family struggle with, or have they been diagnosed with, ADHD? You may not know if other people in your family have been diagnosed, so it’s worth having a conversation with a parent or sibling to find out more. There is a genetic component to ADHD, so it can run in families. Generally, if one family member has it, they’re not the only one. 5. Are you struggling with other conditions or circumstances that might mimic the ADHD experience? It is true that you could be one of those people who have compensated and functioned well, despite having ADHD that was overlooked when you were younger. It happens, and I do evaluations routinely with clients who meet the criteria, according to the DSM-5. But you may not know that there are other mental health conditions that affect focus, which can result in many of the other problems that we attribute to ADHD. Individuals with a history of trauma , for example, may exhibit some of the same cognitive symptoms, such as inattention, trouble making decisions, difficulty with organization, and trouble finishing things they start. These symptoms are also present in many people with depression and related mood disorders and anxiety. Additionally, individuals with chronic medical conditions, like thyroid disease and anemia, can also experience cognitive symptoms similar to those of ADHD. Sometimes people struggle with focus and disorganization if they’re overcommitted. Our society encourages us to be busy, to be involved in a lot of things, and to fill our days, but it’s possible to be too busy, and when this happens, it’s hard to focus on what is right in front of us. We have high expectations for ourselves and struggling to meet them may create an experience that feels like ADHD. Understanding the underlying source of your challenges is important because interventions, including medication, may change, depending on the reason for them. Getting to the bottom of why you struggle with these challenges needs to be investigated if they are becoming disruptive to the life you want to have. Talk to a mental health professional about your concerns, so that you can get the right answers. Carla Shuman, PhD - Website

Do You Struggle With ADHD and Shame? Seven strategies for overcoming shame and embracing life with adult ADHD. Introduction Living with adult ADHD can be challenging, and one often overlooked aspect of the condition is the experience of shame. Shame can create a constant internal battle and hinder individuals from reaching their full potential. However, understanding the nature of shame and implementing effective strategies can help you overcome it and lead a fulfilling life. In this post, I explore seven strategies for overcoming shame and embracing life with adult ADHD. By implementing these strategies, individuals with adult ADHD can break free from shame’s grip and thrive. 1. Self-Education One of the first steps in overcoming shame associated with adult ADHD is to understand the condition comprehensively. Educating yourself about ADHD’s symptoms, causes, and treatment options can help dispel misconceptions and reduce self-blame. Knowledge empowers individuals to recognize that ADHD is a neurobiological condition and that their struggles are not a result of personal shortcomings. According to Barkley (2010), “ADHD is a neurodevelopmental disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.” Understanding the neurobiological basis of ADHD can help individuals reframe their experiences and reduce self-judgment. 2. Self-Compassion Practicing self-compassion is crucial in overcoming shame. Individuals with adult ADHD often internalize societal stigmas and develop negative self-perceptions. Engaging in self-compassionate thoughts and actions involves treating oneself with kindness, understanding, and forgiveness. It is important to remember that ADHD is not a character flaw but a unique way of experiencing the world. Neff (2003) defined self-compassion as “being kind and understanding toward oneself in pain or failure, rather than harshly self-critical.” By cultivating self-compassion, individuals with adult ADHD can counteract shame and develop a more positive self-image. 3. Seeking Support Seeking support from understanding individuals, such as friends, family, or support groups, can be immensely helpful in overcoming shame. Sharing experiences, challenges, and triumphs with others who have similar struggles can foster a sense of belonging and reduce feelings of isolation. Support groups can provide a safe space for open discussions and exchange of coping strategies. Research by Matza et al. (2005) highlighted the importance of social support in managing ADHD. They found that individuals with higher social support levels reported better health-related quality of life. By connecting with others who understand their experiences, individuals with adult ADHD can find a sense of validation and support to overcome shame. 4. Reframing Negative Self-Perceptions Shame often arises from negative self-perceptions associated with ADHD-related difficulties. Individuals can reduce shame and improve self-esteem by reframing these negative thoughts into more realistic and compassionate perspectives. Recognizing personal strengths, achievements, and resilience can help shift the focus from perceived inadequacies to growth and progress. Lam and Dvorak (2019) stated, “Reappraising shame-inducing situations can lead to reductions in feelings of shame and increases in self-compassion.” By challenging negative self-perceptions and adopting a more compassionate outlook, individuals with adult ADHD can cultivate a sense of self-worth and decrease shame. 5. Practicing Self-Care Engaging in self-care activities is essential for individuals with adult ADHD to improve overall well-being and reduce shame. Regular exercise, adequate sleep, healthy nutrition, and stress-reduction techniques like mindfulness and meditation can contribute to better emotional and cognitive regulation. Prioritizing self-care allows individuals to manage ADHD symptoms better and enhances self-confidence. Dvorsky and Faraone (2014) found that excessive smartphone use, which often interferes with self-care practices, is associated with cognitive deficits similar to ADHD. Individuals can improve their overall well-being and reduce excessive smartphone use by focusing on self-care activities and reducing ADHD-related challenges. 6. Setting Realistic Goals Setting realistic goals is crucial for adults with ADHD to manage expectations and minimize shame. Breaking down larger tasks into smaller, manageable steps helps to avoid overwhelm and increase productivity. Celebrating each accomplishment, no matter how small, fosters a sense of achievement and boosts self-esteem. Hwang et al. (2019) emphasized the role of goal setting in academic functioning for individuals with ADHD. They found that goal setting mediates the relationship between ADHD symptoms and academic performance. By setting realistic goals and acknowledging progress, individuals with adult ADHD can overcome shame and experience a sense of accomplishment. 7. Embracing Personal Strengths Instead of focusing solely on weaknesses, adults with ADHD should acknowledge and celebrate their unique strengths. ADHD often brings creativity, hyperfocus, and the ability to think outside the box. By embracing these strengths, individuals can cultivate a sense of pride and self-acceptance, reducing shame and unlocking their full potential. White and Shah (2011) explored the relationship between ADHD and creativity in adults. They found that individuals with ADHD exhibited uninhibited imaginations and higher creativity levels than the control group. By recognizing and embracing their creative abilities, individuals with adult ADHD can build self-confidence and challenge shame-based beliefs. Conclusion Overcoming shame associated with adult ADHD is a journey that requires self-education, self-compassion, support, reframing negative self-perceptions, self-care, setting realistic goals, and embracing personal strengths. By implementing these strategies, individuals with adult ADHD can break free from shame’s grip and thrive. Scott Shapiro, MD - website Barkley, R. A. (2010). Taking charge of ADHD: The complete, authoritative guide for parents (3rd ed.). The Guilford Press. Dvorsky, M. R., & Faraone, S. V. (2014). Comparing the cognitive deficits associated with ADHD and excessive smartphone use. Journal of Attention Disorders, 18(2), 162-169. Lam, C. S., & Dvorak, R. D. (2019). Understanding the relationship between ADHD and shame: The roles of emotion dysregulation, perseveration, and self-compassion. Journal of Attention Disorders, 23(6), 603-613. Matza, L. S., Rentz, A. M., Secnik, K., Swensen, A. R., Revicki, D. A., & Michelson, D. (2005). The impact of ADHD on health-related quality of life in pediatric and adult patients. Quality of Life Research, 14(1), 137-149. Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85-101. White, H. A., & Shah, P. (2011). ADHD traits are associated with creative achievement in adults. Journal of Personality and Individual Differences, 51(7), 799-803.

Whatever treatments you decide, understanding you have ADHD makes a difference. Most adults with ADHD have never been diagnosed and are therefore going through life untreated. Many people with ADHD struggle with inattentive symptoms, such as distractibility, forgetfulness, disorganization, and poor time management. ADHD can be a risk factor for marital dissatisfaction , poor health, reduced lifetime earnings, traffic accidents, and substance abuse. Ari Tuckman, PsyD, CST, is the author of four books on adult attention-deficit/hyperactivity disorder (ADHD), most recently ADHD After Dark: Better Sex Life, Better Relationship. He is a psychologist and sex therapist in private practice in West Chester, PA, a former board member of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) National, and co-chair of the CHADD conference committee. MB: Thanks for taking the time, Ari. I’m curious, before we start talking about treatment, what are your thoughts on where we are with adult ADHD today? How common is it, and how often is it recognized and diagnosed? AT: The irony about ADHD in adults is that we know a lot about it—the problem is in getting that information out to clinicians and the general public. We're doing a pretty good job of identifying ADHD in kids, but most adults with ADHD have never been diagnosed and are therefore going through life untreated (which doesn’t just mean medication, of course). Most kids with ADHD retain at least some of those struggles into adulthood, but we stop looking for it when someone graduates. Probably about 4 percent of adults have ADHD, which is not a small minority. MB: What does adult ADHD typically look like? A lot of the recent research talks about the health implications of under-managed ADHD, and time management is core to adult ADHD, too. Are there adults, from your point of view, who are struggling with health or chronic stress who could unknowingly have ADHD? AT: Some people think of ADHD as mostly the hyperactive boy type, but many people with ADHD struggle mostly with inattentive symptoms, such as distractibility, forgetfulness, disorganization, procrastination, and poor time management. Also, hyperactive kids tend to settle down as they become adults, so it's less visibly obvious. For many people, it’s the inattentive and impulsive symptoms that continue to be a struggle, which can lead to additional stress as they try to keep up on all their responsibilities. This can also affect how they take care of their physical health, from forgetting to schedule follow-up appointments or tests to sticking with a generally healthy lifestyle of sleep, diet, and exercise. But if their ADHD isn't addressed, then it will always be harder for them to be more consistent about these good habits. Therefore, people who chronically struggle with inconsistency may want to consider the possibility of ADHD—it's certainly not the only cause of poor follow-through, but it is a common one. MB: Understanding what’s going on with ADHD can make a huge difference, in my experience, separate from any treatment choices. What impact have you seen as people begin to understand what executive function means in day-to-day life, and how it relates to living with ADHD? It’s often a way to let go of a lot of self-blame and judgment, for example, when working with families. AT: Just the act of getting diagnosed can be a real game-changer in how someone sees themself and understands their past struggles. I say that it's like reading the last chapter of a mystery novel, where everything comes together and all of a sudden their life makes much more sense—such as, "no wonder I kept shooting myself in the foot like that, despite knowing better." Understanding those struggles as a neurologically based information-processing weakness can feel less moralistic than all of the other prior explanations they had used or been told. Also, understanding how ADHD impacts how you navigate through your days, why it makes some tasks harder but doesn't affect other tasks, enables you to approach demands in ways that are more likely to be effective. There's no need to re-invent the wheel if other smart people have figured out good ADHD strategies before you. MB: What role does the research say medication can play in adult ADHD? Is it any different from pediatric ADHD? AT: The medication we use today for ADHD is the same medication that has been used for decades, so we know a lot about the benefits and side effects. Medication isn't magic, but the stimulants can be very effective for many people with ADHD, regardless of age, and tend to have manageable side effects. I say that stimulant medication closes the gap between intentions and actions and helps people with ADHD to be more consistent, planful, and efficient in what they do. We know that untreated ADHD can be a significant risk factor for marital dissatisfaction, poor health, reduced lifetime earnings, traffic accidents, substance abuse, etc.—pretty much all the outcomes that most of us want to minimize. I can understand that some people don't like the idea of taking medication, but we also need to consider what are the risks that come from not taking medication. Trying harder and using good systems and strategies is always going to be a requirement for a happy and effective life, but untreated ADHD makes it much harder to use those good habits in an enduring way. A little bit of the right medication can bring it all together so those good intentions work out more consistently. MB: So how can people work with the rest of ADHD, all of the organizational and time-management stress, and the health implications? AT: Most people need good systems and strategies to live well and stay on top of obligations. People with ADHD perhaps need it a little more. Good systems work much more reliably than just trying harder. This could mean strategies like really committing to using a calendar system with reminders, creating a less distracting work environment, reducing clutter, and checking in regularly with your romantic partner/coworkers on who is doing what. Perfection is not at all necessary—even just using these systems a little more often will probably lead to an improvement you can feel. Also, regardless of what you did yesterday, put in the effort to make today a good day and to use those strategies again. MB: What’s something practical people can try out, starting today? AT: Get enough sleep! Everyone does better with a good night's sleep, but it can be a challenge to come by, especially if you have ADHD. But make it a priority. Resist distracting activities that you get stuck in that keep you up too late. Maybe even set an alarm to tell you to go to bed. And don't believe yourself when you say that you can stay up "just a little bit later" since often that becomes a lot later. Even if you aren't perfect about it, doing somewhat better on sleep is another one of those differences that you will feel. Mark Bertin MD - website - books

Approaching ADHD with knowledge and empathy. Tommy sat at his desk, and he opened his laptop. The essay instructions were on the screen, and he dutifully began to read. However, after just a few minutes, his attention drifted, lured away by the intricate spider web that adorned the entry door. Tommy became frustrated as he realized that he couldn't recall a single word he'd just read. He made an effort to refocus, but his mind proved elusive, slipping away once more. This scenario was all too familiar to Tommy. Every time he attempted to tackle his homework; it seemed like an uphill battle. His friends effortlessly breezed through assignments, while Tommy found himself wrestling with his wandering thoughts, constantly veering off course . At the age of 13, Tommy received a diagnosis that shed light on his struggles: Attention Deficit and Hyperactivity Disorder (ADHD) . It was a revelation that carried both relief and sadness. Finally, he understood that his inability to concentrate wasn't a character flaw, and he wasn't simply "lazy," as his parents and teachers had sometimes accused him of being. But while the diagnosis provided clarity, it didn't provide a magical solution. Tommy's mind remained a restless wanderer, continually venturing down rabbit holes of distraction. Despite knowing the root cause of his difficulties, the challenge of managing his focus persisted, leaving him to grapple with his own mind, one essay at a time. Research into the neural mechanisms underlying ADHD has unveiled an intriguing perspective. It suggests that ADHD is not primarily characterized by abnormalities within specific regions of the brain but is instead a disorder rooted in disruptions of functional connectivity. A pivotal player in this connectivity conundrum is the default mode network (DMN). This network springs to life when individuals are in a state of rest and not actively engaged in cognitive tasks, like, for instance, tackling homework. Conversely, when we turn our attention to cognitive tasks, specialized task-related networks kick into gear to help us complete the task at hand. In those without ADHD, there exists a delicate balance between the DMN and these task-related networks. When one network becomes more active, the other tends to quiet down, creating a seamless transition between resting and cognitive engagement. However, for individuals with ADHD, the DMN doesn't obediently retreat during cognitive tasks. Instead, it persists, stubbornly maintaining its activity. This unusual behavior within the DMN is associated with the intrusion of unrelated thoughts or daydreams during these tasks. It's as if there's an ongoing tug-of-war in the brain between the DMN and the cognitive demands of the moment. This neurological battle offers an illuminating explanation for why those with ADHD often experience a constant, magnetic pull away from their current task, easily succumbing to distractions. It's not a mere lack of willpower; it's a neurological dance between two competing networks that makes focusing on a single task almost impossible. Unlike typically developing children , who often outgrow these difficulties as they mature, individuals with ADHD commonly continue to wrestle with these challenges throughout their lives. This enduring struggle can result in learning impediments and difficulties in social interaction. In recent years, there has been a noticeable increase in the diagnosis of ADHD in the United States. Approximately 9.4% of children aged 4-17 are affected, with boys more commonly diagnosed than girls. Moreover, around 4.4% of adults in the US are believed to have ADHD, although this number may be underestimated. One area where the impact of ADHD becomes evident is decision-making. Decision-making is closely intertwined with cognitive abilities, as it involves assessing various options and choosing the most favorable one. Individuals with ADHD often exhibit differences in their decision-making styles compared to neurotypical individuals, especially in decisions involving risk and the consideration of future consequences. This inclination toward risk-taking often persists into adolescence and adulthood, leading to behaviors such as delinquency and substance abuse. Raising a child with ADHD like Tommy can be a daunting journey for parents. Understanding what their child is experiencing, including difficulties in focusing, daydreaming, procrastination, non-compliance with instructions, and restlessness, can be perplexing. It's essential for parents to recognize that these behaviors are not intentional; children with ADHD require their parents' patience and understanding. Living with ADHD can be an extremely frustrating experience. Individuals often recognize that their actions are suboptimal, yet they feel powerless and incapable of altering them. Additionally, they grapple with the challenge of being misunderstood, as it's difficult to convey their experiences to those who don't share the condition. By approaching ADHD with empathy and knowledge, we can make a meaningful difference in the lives of those affected by this condition, helping them navigate their unique paths to success and well-being. Isabelle Brocas, Ph.D. - Website I. Brocas, "Decision-making and ADHD", LABEL reports April 2020 I. Brocas, "The Neuroscience of ADHD: Technical Report", LABEL reports, April 2020

12 ways to help your 11- to 14-year-old with ADHD build resilience and strength Early adolescence is a time of change in every dimension of a person's life, including intense brain-building. From age 11 to 14, neural plasticity is greater than at any time other than early childhood. Early adolescence is a time of great vulnerability as well as opportunity, a heightened danger for ADHD kids. Here are 12 ways parents can support their ADHD kids in thriving, building coping skills and resiliency. A young person can be forgiven for feeling out of control when everything—their body, brain, hormones, interests, perspectives, identity, and relationships—are all changing. The people around them are changing, too, in their expectations and interactions. This period is more fraught, more challenging, and more dangerous for kids with special needs like ADHD . Early Adolescence: Intense Brain-Building Laurence Steinberg, a psychologist specializing in adolescence, describes the period from 11 to 14 as the “age of opportunity,” a time when so much can go so wrong, but also a time of great possibility, a time when a young person can find and develop strengths that will help them thrive into adulthood. It’s a time of intense brain-building, with all of the vulnerabilities and possibilities that that suggests. Steinberg writes about early adolescence as a time when brain plasticity is heightened, second only to early childhood in opportunities for developing good (or bad) habits, and a critically important time for strengthening skills, resilience, and emotion regulation. The Age of Vulnerability Early adolescence is a time for your child to consolidate their ability to monitor and regulate their emotions and behavior . As true as that is for all kids, it’s absolutely essential—and terribly difficult—if your child has ADHD. Given their distractibility, need for stimulation, and problems with impulse control, they’re more likely to be interested in drugs and alcohol and befriend older kids engaged in high-risk activities. Because kids with ADHD usually need more structure and scaffolding than others, their academic frustrations can increase as they move into higher grades where the expectations are higher but the support is lower. As kids with ADHD move into early adolescence, they can feel increasingly ignored or rejected by other kids, acting impulsively or in ways that others find intrusive or emotionally excessive. At an age when friendships matter enormously, this can result in social isolation, a retreat into the virtual world, or spending time with troubled kids because they’re the only ones who accept them. Parenting Challenges Intensify As your child moves into early adolescence, they can appear to need you less. They can actively reject your requests and demands or your invitations to spend time together. But don’t fall into the trap of taking it personally, and don’t be fooled by it. They need you just as much as ever, but what they need is different than what they needed when they were younger. What can you do to help your child find opportunities in the challenges? 1. Take good care of yourself. Practice breathing techniques and other habits that support your mindfulness and good health . You’ll be better at managing your own stress, and you’ll provide your child with a better model of coping with life’s challenges. 2. Be present . Do your best to be openly available for relaxed conversation whenever you’re in the presence of your child. Whenever possible, set aside your phone and pay attention to their mental state. Be warm, welcoming, and positive. Don’t judge or criticize. Your being patiently available at the right moment can make the difference between a good decision and a dangerous one. 3. Take your child’s friendship concerns seriously. Their worries might seem trivial or fleeting, but being liked and accepted by their peers is one of the most urgently important dimensions of your child’s life right now and one of the areas most likely to trouble them. Support them in figuring out how to solve the problems of the day. 4. Encourage and facilitate healthy social activities. Sports, choirs, clubs, and other extracurricular activities can provide social opportunities in a structured environment. This is true for all kids, but it is especially important for an early adolescent with ADHD. It can help with social connection, the need for structure, and emotion regulation. 5. Include your child in a network of social support. Having a strong network of social support can prevent the social isolation and loneliness that can be dangerous at this stage. Your child will benefit enormously from feeling part of a rich network of warm and caring people—adult friends, relatives, and neighbors—and so will you. 6. Actively support your child’s coping skills. Depending on how impetuous or volatile your child is, they might benefit from having a tutor or counselor to help them develop and strengthen their coping skills. Strong emotion regulation skills can make a difference in the trajectory of their life going forward and will become critically important when they start to drive. 7. Talk with your child about risky behavior. Talk openly with them—thoughtfully and respectfully—about the serious problems associated with substance abuse, sexual activity, vandalism, and other risky behavior. Let them know you have rules and expectations but that you’re open to talking if they run into issues. 8. Minimize the rules. Make rules only when necessary for your child’s protection or your sanity. You don’t want to spend valuable time and parenting capital enforcing the rules you make. 9. Welcome power issues and conflict. You’re a good parent if you find yourself arguing frequently with your teenager, as long as there’s also love, warmth, and good humor in your relationship. A hot debate is a great way for your teenager to discover what you care about and why it’s worth caring about. 10. Be open to non-academic learning opportunities. School can feel irrelevant to an early adolescent. Education does matter—and it’s important your child knows you believe that—but figuring out who they are and feeling good about that is a lot more important at this stage. Everything else builds on this going forward. 11. Work on balance. Encourage good habits of sleep, nutrition, outdoor time, social interactions, and pleasurable activities, along with all the responsibilities of home and school. Keep technology use to a minimum. 12. Stay connected to your child’s best self. Your early adolescent is changing quickly and will try on a series of different identities, some of which you won’t like very much and some of which they might not like very much, either. By believing in what’s best in them and seeing past the clothes and attitudes of the current phase, you can help them make good decisions in the long run. Dona Matthews, Ph.D., - Website - Book - References Age of Opportunity: Lessons from the New Science of Adolescence by Laurence Steinberg

In the amygdala, the cerebellum, and elsewhere. There are few things more infuriating to mental health professionals than hearing "ADHD is not real." Yes, even today, there are still critics, cynics, criticizers, and non-believers vying for the opportunity to disprove the diagnosis. Do I personally believe that the DSM-5 does a great job of outlining the criteria for the diagnosis? Not by a long shot. Do we need more research to help rule out other disorders that overlap with ADHD symptoms? 100 percent. Does the disorder perhaps even need a different name entirely? Absolutely. (ADHD individuals tend to have no issue focusing on the activities and experiences that they enjoy, hence hyperfocus—which the DSM does not even acknowledge—which I argue is grounds for a new name in and of itself.) ADHD is not a disorder of attention deficit; instead, it is a disorder of regulating attention and emotions due to structural and functional differences in the brain and neural networks. I suspect that the doubt and suspicion of the disorder stem from the belief that ADHD is categorized by a single deficit (again, I blame the name) rather than categorized dimensionally. ADHD is not a disorder of ability but performance due to neuroanatomical differences. Regardless, it's time that ADHD be recognized for what it is: a neurodevelopmental disorder, not a myth, nor a result of poor parenting. Below I will outline structures of the brain that are different in volume and shape and how those differences are thought to be linked to behaviors associated with ADHD. The ADHD brain is structurally and functionally distinct, and hopefully, the evidence below will keep the naysayers quiet... for now. How the ADHD Brain is Different A 2017 MRI imaging study found that overall brain volume and brain volume in six of the seven brain structures listed below were smaller in people with an ADHD diagnosis. Multiple studies have validated significant brain developmental delay and 3-5 percent smaller whole brain volume in individuals with ADHD compared to neurotypical brains. Please note that "smaller" does not equate to "less intelligent." We do not need to perpetuate stigma and misinformation further. Bigger does not translate to "better" in this case. As Craig Surman, the Professional Advisory Board Co-Chair for the organization Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) said in an interview about the results of the study, "It may be that these regions are used less in people with ADHD. Or that they are smaller because they are organized differently, or because the supporting tissue is different." Caudate nucleus . The caudate is associated with goal-directed behavior and motivation. As such, smaller volume and asymmetry of the brain structure that help make up part of the basal ganglia could be associated with difficulty getting started on tasks, planning movement, and sustaining momentum toward accomplishing goals, which are defining impairments related to ADHD. Putamen . The putamen is associated with learning and motor control, including speech articulation. The lack of volume may be responsible for symptoms of ADHD related to deficits in tasks related to fine motor skills such as handwriting, coordination, and or clumsiness. In his interview, Surman stated, "the caudate and the putamen work together and act as the gateway for motor activity. Disorders of these regions can result in hyperactivity of the motor system, a common symptom of ADHD." It may also be responsible for the frequent co-occurrence of apraxia and ADHD. Apraxia is a motor speech disorder that results in difficulty speaking. Nucleus accumbens . Smaller nucleus accumbens may be associated with motivated behavior, reward information, and emotional problems in ADHD via its function in reward processing. Variations in the nucleus accumbens could give us insight into one of ADHD's most impairing features: lack of motivation. Individuals with ADHD are often unnecessarily and unfairly portrayed and stigmatized as "lazy," "unmotivated," and even "indifferent," when in reality, their brains are structurally different. Amygdala . The amygdala, one of the oldest parts of the brain, was also found to be smaller in study participants with ADHD. The amygdala is often associated with experiencing emotions, specifically fear and aggression, including detecting threats and activating appropriate fear-related behaviors. Emotional dysregulation, another deficit in executive functioning central to ADHD, is characterized by emotional lability or quick and exaggerated changes in mood, which could be caused by variations in the amygdala resulting in the lack of emotional regulation. Cerebellum . The cerebellum is associated with the coordination of motor movements balance control, gait, posture, muscle tone, and voluntary muscle activity. Damage to this area in humans results in a loss in the ability to control fine movements, maintain posture, and motor learning. A 2017 study found that children with ADHD had significantly smaller cerebellar volumes. This structural difference could help account for the fine motor delays often seen in ADHD, i.e., using a pencil or grasping a spoon. It could also be responsible for dyspraxia, a developmental coordination disorder, which can co-occur with ADHD. Prefrontal cortex . The prefrontal cortex (PFC) is related to self-awareness, decision-making, judgment, insight, empathy, and the ability to self-regulate emotion and behavior. Studies have found that ADHD is associated with weaker function in the PFC, thinner PFC, and different structure of the prefrontal cortex. This may help us account for the ADHD shortfalls in advantageous decision-making, planning for the future, time management, procrastination, poor social skills, difficulty in maintaining relationships, externalization behaviors such as disruptive, aggressive, and defiant behaviors, lack of impulse control, and disorganization. Hippocampus . The hippocampus in individuals with ADHD is larger, not smaller. This brain structure is associated with long-term memory and working memory. Working memory is the ability to hold on to information in your memory while performing other tasks, a skill often used when following instructions, concentrating, or memory that's needed in the present moment—for example, listing to directions while remembering an address, remembering the steps of a math problem while doing a math problem. A study conducted in 2006 found that children and adolescents with ADHD had larger hippocampal volumes than neurotypical children. Researchers concluded that the increase in hippocampal volume might be the brain's attempt to compensate for disruptions in time perception, the tendency to avoid waiting, and sensation-seeking behaviors associated with ADHD. Kailey Spina Horan, Ph.D., LMHC - website

Strategies for clinicians to support the mental health of LGBTQ+ parents. Parents today are facing a spike in parental and work demands as well as parental stress. LGBTQ+ parents may face additional stressors stemming from discrimination and social stigma. Clinicians can help address the distinctive stressors of LGBTQ+ parents via inclusive practices. The U.S. Surgeon General’s 2024 Advisory on the Mental Health and Well-Being of Parents highlights the notable stress that parents are currently facing. For example, 41% of parents say that most days they are so stressed they cannot function and 48% of parents have reported that most days, their stress is completely overwhelming. While this data was not broken down by demographic groups, the Surgeon General’s report did note that “LGBTQ-parent families may face challenges such as discrimination and societal stigma that could exacerbate their stress and mental health challenges.” The distinctive stressors that LGBTQ+ parents face is an issue of growing concern as 18% (2.57 million) of LGBTQ adults are parenting children and approximately 5 million children are being raised by an LGBTQ parent in the USA (Williams Institute). To effectively address the sociostructurally stressors and related mental health challenges faced by LGBTQ+ parents, clinicians and psychologists should prioritize the creation of an inclusive and affirming clinical environment. This includes utilizing gender-affirming language, respecting individuals’ pronouns, and ensuring that intake procedures and assessments are sensitive to diverse family structures. Research has consistently shown that the therapeutic alliance is critical in determining treatment outcomes, and LGBTQ+ parents, in particular, may have prior experiences with healthcare discrimination. By cultivating a practice that acknowledges and affirms these unique familial configurations, clinicians can significantly enhance rapport and therapeutic engagement. In addition to individual-level interventions, psychologists should advocate for broader systemic and community-based changes. Psychoeducation on the intersectional stressors experienced by LGBTQ+ parents, such as discrimination, heteronormativity, and parenting stress, can enhance mental health literacy and improve coping mechanisms. The minority stress model (Meyer, 2003) provides a valuable framework for understanding how external stressors related to societal stigma exacerbate mental health challenges. Clinicians are encouraged to collaborate with local LGBTQ+ organizations or advocacy groups to provide clients with access to a broad array of community-based resources, enhancing the supportive networks available to these families. Clinicians should also be sensitive to the LGBTQ+ need for family of choice networks due to discrimination from birth families and/or religious communities. Research has shown that many LGBTQ+ parents turn to these chosen families—comprised of close friends, partners, and supportive individuals outside their biological kin—to fulfill emotional and social needs that their birth families may not meet due to prejudice or exclusion. Clinicians should actively validate and incorporate these chosen family dynamics into therapeutic interventions, as they play a crucial role in providing emotional support, resilience, and stability for LGBTQ+ parents. Chana Etengoff, Ph.D., - Website - References Etengoff, C., & Daiute, C. (2015). Online coming-out communications between gay men and their religious family allies: A family of choice and origin perspective. Journal of GLBT Family Studies, 11(3), 278-304. Horne, S. G., Johnson, T., Yel, N., Maroney, M. R., & McGinley, M. (2022). Unequal rights between LGBTQ parents living in the US: The association of minority stress to relationship satisfaction and parental stress. Couple and Family Psychology: Research and Practice, 11(2), 141. Murthy, V. (2024). Parents Under Pressure: The US Surgeon General's Advisory on the Mental Health & Well-Being of Parents. Wilson, B. D., & Bouton, L. J. (2024). LGBTQ Parenting in the US.

Learn to spot think thinking associated with maladaptive worry. Worry can be helpful and adaptive or unhelpful and maladaptive. Unhelpful worry repetitively asks “what if…?”, wants guarantees, and says “this time is different.” Unhelpful worry overestimates danger and underestimates your resilience. Unhelpful worry keeps reacting to past experiences or past lessons that are no longer relevant. The first post in this blog series, “3 Ways to Tell if Worry Is Helpful”, explained why people worry and covered the “3 A’s of adaptive worry”. This post discusses five ways to spot maladaptive, unhelpful worry. Worrying can be helpful and adaptive – or unhelpful and maladaptive. Worrying more than you need is stressful. It’s hard on you and often on the people around you. How can you tell when a worry is excessive? What are hallmarks of maladaptive worrying? Here are five signs of maladaptive worrying. 1. Unhelpful worry keeps saying “What if…?!!” Maladaptive worry proposes a series of horrifying “What if’s". Vivid, scary pictures of bad things that “might” happen come to mind, even if they are inaccurate or unlikely. Getting reassurance helps temporarily but worry returns again and again. If one worry is resolved, another takes its place. 2. Unhelpful worry wants total safety and certainty. Maladaptive worry makes unrealistic, impossible demands. It wants guaranteed safety. Unhelpful worry says if something frightening is possible, it is likely and you should worry. It confuses lack of absolute certainty with proof of danger. In reality, life has never offered guaranteed safety. Life offers risks and opportunities . 3. Unhelpful worry overestimates danger and underestimates your ability to cope and survive. Maladaptive worry tells you, “Danger is likely, and you won’t be able to cope!” It overestimates how serious the possible dangers are. Even when worries come true, they are often not as bad as the worry predicted. Unhelpful worry tells you to worry about dangers that do not exist or are so unlikely that worrying makes no sense. I call these “meteor” worries. For example, it is possible that a meteor may crash through the roof as I type these words, but I don’t worry about the possibility because it is so very unlikely. Unhelpful worry also underestimates your ability to cope. As humans, we are a resilient, coping species. Find reasons to trust yourself. Remember the difficulties you have surmounted and the challenges you have met. Think about your accomplishments, strengths, resources, and problem-solving skills. 4. Unhelpful worry wants you to believe that “This time is different!” Maladaptive worry has a terrible track record. Most of what it predicts never happens, but it wants you to ignore that. It tells you each new worry is accurate, realistic, and likely. It always finds something to worry about, shifting from one thing to the next until it finds something that makes you anxious. Once you feel anxious, it is natural to think you are facing a threat. As discussed in the first blog of the series, your brain’s alarm system (your amygdala or “reacting brain”) can misfire and send false alarms. Just because you are afraid does not mean you are threatened. Test your worry against the “three A’s of adaptive worry.” 5. Unhelpful worry can be triggered from past experience. You may be more likely to worry if past experiences made you believe you are vulnerable or unable to cope, others cannot be trusted, and/or the world is a dangerous place. The primitive "reacting brain" remembers and worries because of your past – even when there is no danger in your present. You may remember Jonathan from the first blog in this series. Jonathan constantly worried that his car was going to have a serious problem even though no problems occurred, and his skilled mechanic repeatedly checked and reassured him. Jonathan’s sense of impending danger and his trouble trusting stemmed from lessons he learned growing up with an alcoholic father. Jonathan never knew when his father would be drunk and angry, so he was always anxiously on guard. This hypervigilance was helpful in childhood but it continued into adulthood, keeping Jonathan unnecessarily worried and tense. Jonathan grew up hearing his fathers say over and over, “You can’t trust anyone. They’re all incompetent idiots. They take your money and screw you over.” These lessons made it difficult to trust which contributed to his maladaptive worry. Summary Worry can serve a useful purpose – or create unneeded stress. Worry can be adaptive – or maladaptive. Maladaptive worry is not accurate or consistent with the facts, it urges you to take actions that are not appropriate, and it stays around or keeps coming back. Be skeptical if your worry says any of the following or prompts you to think along these lines: “What if…?” Focus on what could go wrong. “Are you sure?” You need guaranteed safety and total certainty. “Danger is likely; you can’t cope.” The likelihood of danger is overestimated; your strength and resilience are underestimated. “This time is different!” This time worrying is justified. Disregard the fact that past worries were wrong. “Keep reacting to lessons from the past” Unhelpful reactions from the past continue even when your life has changed. Elizabeth McMahon, Ph.D. - website - book References: For more information about coping with anxiety, worry, or panic, read the "Overcoming Anxiety and Panic interactive guide." McMahon, E. (2019). Overcoming Anxiety and Panic interactive guide. San Francisco, CA: Hands-on-Guide.