Practical self-help ideas to lower stress in social situations. Sometimes what people label as "social anxiety" is actually a reasonable way of being. Most social anxiety comes from unrealistic expectations of ourselves or those of people with whom we're interacting. Different tactics are needed depending on whether that social anxiety is based on reasonable or unreasonable expectations. Everyone gets nervous in some social situations — perhaps a first date, an important meeting, or giving a presentation. But when the fear extends to avoiding or being too quiet with other people, and it’s lasted for months or longer, it’s often termed “social anxiety disorder” or “social phobia disorder.” But “social anxiety” is like a headache: The cure depends on the cause. Perhaps it’s not a disorder but a reasonable way to be. It’s possible that what some people label as “ social anxiety disorder ” is a sensible approach to interaction. For example, a reasonable basis for accepting yourself as quiet rather than pathologized as socially phobic is to realize that wise people may choose to remain silent when they perceive the risk-reward ratio to be poor: that their idea needs more work, would sidetrack the discussion, or be better expressed later, perhaps in writing or in a subsequent meeting. Another sensible rationale for remaining quiet is if you believe it’s wiser or kinder to listen and learn than to speak and regurgitate: By listening attentively, you’ve given the other person the opportunity to express and further develop their thoughts—talking can clarify. When I’ve worried that I haven’t provided a client with enough input, I’ve sometimes gotten a reassuring thank-you for having listened carefully. But if you perceive your anxiety about social situations to be unhealthy, it usually derives from the fear that you’ll fail to meet either realistic expectations or unrealistic ones. Here are approaches to each. When you’re unlikely to meet realistic expectations Sometimes, despite your best efforts, you may not achieve what you’d hoped to, but these strategies can help you improve for the future. Be better prepared for example, if you’re scared about an upcoming meeting, would it help to make an extra effort in preparing for it, whether by reading, writing, or talking with someone? If you’re nervous about a first date, prepare a couple of conversation starters such as, “What do you enjoy doing for fun?” or “Do you want to tell me about your family?” Be prepared to answer those questions yourself. Accept your right to be flawed realize that you have a right to speak your truth even if imperfect or not well-received. When expectations are unreasonable More often, social anxiety is caused by unreasonable expectations. One or more of these may help: Self-reflection by thinking or journaling. You might explain to yourself why your anxiety is undue. For example, “Whatever the flaws in what I say, they’re unlikely to be deal-killers.” If you’d like to look for other roots of your social anxiety, list significant recent or past interactions with your parents, siblings, friends, romantic partners, boss, coworkers, and clerics. For each, ask yourself if any are causing your current social anxiety. Perhaps there are lessons to be learned from that review. Progressive exposure. Below, derived from a Mayo Clinic list, are some social activities that are less challenging than, for example, going to a party. List them in ascending order from least to most scary to you. Then try the first one and progress to others when you feel ready. At home, eat with someone you trust. Make eye contact and small talk, even just, “How was your day?” Try the above in a restaurant. Say hello to someone who’s not too scary: for example, a friendly coworker or perhaps the person next to you in line at the supermarket. Give a compliment, such as, “Your scarf is pretty.” Ask a store clerk where some product is located. Ask a friend to get together. When you do, have something to say at the ready: for example, what you did today, are looking forward to, or are thinking about. General stress reducers Remind yourself that you’ll survive. Just before you’re about to begin a scary interaction, remind yourself that you can survive even saying something stupid, perhaps cutting your losses with something like, “Excuse me, I misspoke.” Take a special breath. Then, and again later, if you start to feel stressed , take one special breath: breathe in slowly, hold for a moment, and then breath out even more slowly. See a cognitive-behavioral therapist? If the above hasn’t sufficiently helped, consider having some sessions with a cognitive-behavioral therapist . They tend to be effective in helping phobic people. You can find a therapist near you on Psychology Today’s Therapist Directory. The takeaway. Social anxiety usually comes down to a fear of not meeting expectations, your own or those of the people with whom you’ll be interacting. That’s why even socially anxious people tend to be less fearful when interacting with children, developmentally disabled people, or pets. But the good news is that social phobia, indeed all phobias, are among the most ameliorable of emotional problems. Marty Nemko, Ph.D. - Website - Books

7 effective treatment approaches for clients with health-related fear. A variety of popular therapeutic modalities can be helpful for clients with illness anxiety. Clinicians need to understand the most effective therapeutic approaches for helping illness anxious clients. Illness anxiety , while sometimes overwhelming and frightening, can be coped with. Some popular commonly used therapeutic modalities may be effective in assisting clients who are struggling with intrusive and obsessive thoughts about their physical health status. Following are 7 therapeutic interventions and how they can be implemented to help these clients. Cognitive Behavioral Therapy (CBT) CBT is perhaps the first-line treatment of anxiety disorders, including Illness Anxiety Disorder (IAD.) Because it teaches clients to question and challenge their anxiety-driven conclusions, it allows for building evidence to discredit the anxious thought. In simple practice, it may look like this: Event: Client experiences chest pain. Automatic Thought: “I am having a heart attack, and I need to call 9-1-1.” Challenge to Automatic Thought: “I am not experiencing any other physical symptoms. I am also prone to heartburn, and I ate something spicy at lunch.” New, adaptive thought: “I am most likely not experiencing a heart attack and this physical discomfort I feel is likely unrelated to a heart attack. It is more likely that I am experiencing indigestion. At this moment, I probably do not need emergency services.” This type of “thought stopping” and challenging, cornerstones of CBT, can help a client slow the rush and flood of thoughts that occur following an unexpected and uncomfortable physical symptom. Rational Emotive Behavioral Therapy (REBT) An offshoot of CBT, REBT focuses on the “unconditional acceptance” of ourselves, our lives, and our situations through a rational, rather than an emotional , lens. REBT teaches clients to “dispute” irrational thoughts in the service of arriving at a more sensible, logical view of a situation. Because anxious cognitive patterns often lack logic, REBT is helpful in restoring and promoting a healthier, alternative way of looking at a situation. Dialectical Behavioral Therapy (DBT) DBT helps patients find a cognitive “middle ground” between the emotion-driven mind and the logic-oriented mind. Because anxiety is most often emotion-based, it tends to ignore logic and rational thinking. This single-mindedness can result in unhealthy behavioral responses . Learning and implementing DBT skills can assist clients in tolerating feelings of discomfort rather than having to react emotionally to them. In the case of IAD, if a client learns to slow their cognition following an uncomfortable feeling, they have a greater opportunity to utilize logic to arrive at an appropriate behavioral response. For the IAD patient, this may mean the difference between seeking unnecessary emergency care and having a more reasonable response, such as scheduling a doctor’s visit in the near future. DBT teaches clients to work and respond from their “Wise Mind,” the healthy overlap of the emotional mind and the rational mind.2 Somatic Therapy The word somatic, from the Latin for “of or pertaining to the body,” refers to anything body-related. Somatic therapy is an umbrella concept which includes a number of body-based interventions such as meditation, yoga, physical exercise, dance or movement therapy, breathing exercises, and massage. Somatic therapy highlights the importance of the brain-body connection and should be considered as an option to help those struggling with IAD. Generally, somatic therapy skills can be taught to a client by a therapist or counselor. Mindfulness-Based Cognitive Therapy (MBCT) It is a Buddhist belief that anxiety “lives in the future,” and the importance of mindfulness and presence in the moment cannot be overstated in the treatment of IAD. Mindfulness teaches clients to replace “what if” with “what is.” In the case example given above, “what if” sounds like “My chest feels tight and that means I’m going to have a heart attack,” whereas “what is” sounds like “My chest feels tight right now in this moment.” The “what is” thought is simply an acknowledgment of what is happening, without an attached assumption or conclusion. Through acknowledgment of our feeling in the moment, we are able to “be with” our feelings rather than respond emotionally or behaviorally to them. Narrative Therapy (NT) Narrative therapy teaches us to view our lives as a story but cautions us against focusing on only one part of the story. Often, we become singularly focused on the “problem story,” the part of the larger narrative influenced by our challenges and problems. NT urges us to take a broader, more inclusive view of our life story, noticing and honoring both the problematic and challenging parts as well as the more comfortable and victorious sections. Through this approach, we begin to see our personal narratives as nuanced rather than one-dimensional. For an anxious person, anxiety loosens its grip and becomes only a portion of the story, not all of it. Imaginal Exposure Therapy Visualizing and imagining the situations that frighten us can be helpful in beginning to feel safe again and can promote a gradual return to activities and situations that have caused anxiety or avoidance. For example, a therapist may guide a care-avoidant client through an imagined scenario in which they have a medical visit at a doctor’s office. Because the visualization is done within the safe confines of the therapy office, the exercise may begin to rebuild safety and comfort within the anxious client’s mind regarding the situation, promoting an eventual return to the actual situation. Once the client can visualize safely returning to a previously feared situation, they often can return to the situation in real life. Phil Lane, MSW, LCSW - Website - References Ellis, A., & Ellis, D. (2019). Rational emotive behavioral therapy. American Psychological Association. Lane, Phil. (2024). Understanding and Coping with Illness Anxiety. Routledge. White, M., & Epston, D. (1990). Narrative means to therapeutic ends. W.W. Norton & Company, Ltd.

Performance anxiety can keep kids from activities they enjoy. Here's how to cope. Performance anxiety can lead to symptoms that compromise high performance. Children who believe that they are no better than their last win maintain a deficiency in their self-concept. Children motivated by unconditional love—not fear—will more typically achieve high levels of performance. Some children focus on performance to compensate for an impoverished self-concept. Performance anxiety presents as unusually strong worry or fear around activities that involve accomplishment. It can be experienced in any number of areas that range from public speaking to athletic performance, academics to sexuality, test-taking to interviewing. The causes of performance anxiety are varied, but the process is the same. The threat of failure or lowered performance can lead to symptoms that can compromise high performance. Athletic performance anxiety is a subset of generalized performance anxiety. Ironically, performance anxiety can actually increase the risk of injury among athletes. What are the signs of performance anxiety in children? The symptoms of performance anxiety include physical symptoms such as increased heart rate, elevated blood pressure, fast or shallow breathing, dry mouth, sweating, and pale or flushed skin. These symptoms can be accompanied by ruminations centered around the fear of failure and/or negative outcomes associated with failure. “I’ll never get into college with these grades.” “No one will like me if I mess up the speech." “If I perform a dance at the talent show, the whole school will laugh at me.” Behavior patterns can vary widely, particularly in children. Some children may become obsessed with practicing, studying, or repetition, while other children can become task-avoidant, delay homework or competitions, or display an “I don't care” attitude. How can parents figure out what's going on? Parents need to observe their children’s behavior and attitudes carefully. Asking these questions can also help. Does my child seem overly worried or anxious about performance issues? Does my child demonstrate excessive concern about performance such as staying up all night to study, being unable to sleep from worry around an exam or competitive event, or refusing to see friends in order to prepare or study? Has my child begun to avoid performance activities? Paradoxically, does my child act like they don't care about performance? It is important for parents to talk to their children and ask them about their feelings around performance. Does the child feel satisfied or dissatisfied? Does the activity interfere with their child’s happiness or pleasure in life? Does it keep them from engaging in activities that they enjoy? Do they feel anxious or worried about performance? How do they feel about themselves if they don't make the grade they're hoping for or fail to compete at the level they desire? What are some things that parents can do to help their children cope with performance anxiety? Help children realize that failure is survivable. Performing poorly from time to time is simply a part of life and does not have catastrophic consequences. Sharing stories about Uncle Edward who performed poorly in business but persisted and later was successful when he developed a new company is important. Build a positive self-concept, generally, by loving your child unconditionally. Children need to know that self-esteem is not dependent on performance but is an ongoing steady state. Accepting that the unexpected rain on the day of the bicycle race, which interfered with course conditions and his finish, is just another example of learning to accept and live with adversity and imperfection. Teach that success is not a comparative process. Parents should encourage children to reach for their “personal best” and help them develop their own steps in their chosen direction. In this way, it is important to avoid focusing on Betty who made a perfect score on the spelling test. More important is Edward’s solid improvement from 80 to 85 percent on his spelling words week over week. Reinforce children for effort. “You are working hard at your French and making progress. I bet you'll be able to speak to the waiter in the French restaurant in no time,” versus “Suzie is a real French whiz, I hear.” Encourage children to take charge where they can control things. They can train for a certain number of hours per day, or they can take classes from a classically trained musician. The focus here is on those opportunities, not the outcome. Celebrate the joy of the game and encourage your child to do the same. Both model and reinforce the benefit of fulfillment and happiness in the process of mastery. Be available with equal measures of affection for both the wins and losses over the course of your child’s efforts. Help children understand that life is a long time, and that their love of biking or swimming or basketball will persist. People bike at eighty, swim at sixty and seventy, and teach their children and grandchildren how to play the sports they love. Athletics is not just about performance. In the end, it is more about fulfillment and enjoyment as both a competitor and a fan. What are some things that kids can do to cope with performance anxiety? Prepare in advance. Practicing, training, and rehearsing skills build confidence over time and are certainly required in order to perform well. Engage in daily exercise as an anti-stress activity. Develop pre-performance strategies to build confidence. For example, athletes may do cross-training in order to help their skill base, practice speeches at home before the actual presentation, or rehearse and memorize information in order to improve recall. Visualize the task or event with successful outcomes. Use self-calming such as meditation or mindfulness. There are a number of online tools to help both children and adults with these skills. Learn breathing exercises and practice other pre-performance rituals. Talk with a therapist. There are a number of treatment strategies available, including cognitive behavioral therapy , therapy that helps children learn specific tools to manage anxiety and performance, or more general counseling that helps people to feel more powerful and in control. What are some helpful things that parents need to know about raising child athletes? Parents must realize that their job is not to put more pressure on their child but rather remove pressure from them. This is done primarily through unconditional love that remains constant over time: “I love you no matter what the outcome is.” “I will help you in any way I can as you try to reach your goal.” “Your value never changes in my eyes, and my affection for you never diminishes.” Children who grow up believing that they are no better than their last win maintain a deficiency in their self-concept that can last a lifetime. Consider the following more foundational goals: My child has… confidence in their ability to work hard, respect for their skills and abilities, developed knowledge of themselves and others, experienced fond memories of being a part of a team or group, shared meaningful experiences with their mothers and fathers, felt celebrated and supported through victory and defeat, known love as constant, and had fun along the way. Children motivated by love—not fear—will more typically achieve high levels of performance and reach personal fulfillment in their areas of interest and achievement. Portions of this post also appear on the Scary Mommy Blog and drmaryannlittle.com. Mary Ann Little, Ph.D., - Website -

These solutions can alleviate anxiety rooted in toxic childhood stress. Anxiety disorders are often rooted in unresolved adverse childhood experiences . A combination of effective treatment strategies offers hope for resolving them. Anxiety , including panic attacks , is now the most common psychiatric condition in the U.S., affecting nearly one in five adults, and prevalence rates are increasing worldwide. Often, anxiety seems to have a life of its own: it seems excessive and unreasonable; you don’t know where it’s coming from; and willpower doesn’t stop it. For many, adverse childhood experiences (ACEs) provide a clue. This article addresses solutions for this common problem. 1. Address the root cause. Recall that attachment disruptions and other ACEs wire the brain to be on high alert. Unsettled, disturbing memories from childhood lodge in the non-verbal right brain , with its strong connections to the emotional and survival regions of the brain, often beneath conscious awareness. These memories continue to fuel anxiety until they are processed and settled. Fortunately, many strategies developed in recent years can soothe and settle these memories. Some are self-managed, and some are guided by specially trained trauma therapists (see, for example, Schiraldi 2021). In addition, the following skills can help. 2. Sit with the fear . Often, we tense up and try to fight our worries, which increases stress arousal. Or we might try to flee our worries. But avoiding our fears (for example, through addictions, procrastination , etc.) merely provides temporary relief. Mindfully sitting with your fears is a third, more effective option. Start by being aware of the breath. Breathe abdominally, low and slow, so that only your belly rises and falls as you breathe. (Stress-induced rapid, shallow breathing in the upper chest region often triggers anxiety and panic symptoms, so this is an important first step.) Then without judging, create a space to allow the anxiety to be. With curious interest and acceptance, notice where in your body you experience the anxiety. Soften around that area. Then breathe compassion (or lovingkindness) into that area. Paradoxically, this approach can lessen anxiety without trying to do so. 3. Confide your fears. Research has shown that simply writing the facts, feelings, and thoughts related to your fears for 15-30 minutes on each of four days dramatically reduces symptoms and improves health and sleep. You can write about old hurts, or you can write about present worries. Write in a neutral place, like a table in a corner. Write only for yourself. If it gets overwhelming ease up. During the day, postpone your worries, knowing you can address them during your writing period. 4. Flow with panic attacks. Should panic attacks occur, bracing and fighting them prolongs them. Panic attacks are simply stress responses “on steroids.” They typically run their course in 10-20 minutes, especially if you don’t fight them. Soften your body. Relax into, and flow with, the fear. Imagine that you are a reed bending with the wind. 5. Feed the gut microbiome . People with anxiety tend to have an imbalance of microbes in the gut, which activates the brain’s fear center, increasing anxiety. The balance of good to bad microbes can be optimized with a Mediterranean-style diet , which emphasizes fiber-rich plant foods (vegetables, fruits, nuts, whole grains, seeds, beans) and healthy fats (from sources like fish and olive oil), while minimizing red meats and processed foods. (This type of eating also helps to reduce the brain inflammation and oxidative stress that is often seen in anxiety.) 6. Hydrate. Even mild dehydration can cause anxiety symptoms. Drink plenty of water throughout the day. 7. Consider taking a full-spectrum vitamin and mineral supplement. Studies have found that supplements (one study looked at Centrum Silver, for example) can reduce anxiety and improve brain function. Turmeric is another supplement that can reduce anxiety. 8. Monitor your thyroid. An overactive thyroid gland can make you feel anxious, like you are on caffeine, resulting in racing thoughts, sleep disruption, and other anxiety symptoms. Many people with this common problem are unaware of it or are not properly treated. Discuss this with your doctor. 9. Avoid caffeinated energy drinks. Army research found that the regular consumption of energy drinks actually increased symptoms of anxiety, post- traumatic stress, fatigue, and disrupted sleep (Tobin et al., 2018). 10. Use tranquilizers cautiously. Benzodiazepines, such as Xanax, Valium, Klonopin, and Ativan, are widely prescribed for anxiety. A new survey (Ritvo et al., 2023) revealed that long-term consequences occur during and after the use of benzodiazepines in the majority of people using them. These consequences include anxiety, sleep problems, trouble focusing, and disruptions in personal and work life. Benzodiazepine use teaches no coping skills and discontinuation can be very difficult. Coping skills for anxiety can be just as effective, generally have no unpleasant side effects, and might enable you to minimize or avoid benzodiazepine use. 11. Move your body. We’ve known for many years that exercise improves anxiety, depression , low self-esteem , and troubled sleep. Among its many benefits, exercise expends excessive stress energy and produces master molecules that help the brain forge new, calmer neural pathways—making exercise particularly beneficial for survivors of ACEs. Even a ten-minute walk can help. Walking in the woods or near water can be especially calming. And don’t overlook tai chi, yoga, or qi gong. 12. Improve self-esteem. At the University of Maryland, we found that low self-esteem and anxiety are highly correlated, and that self-esteem can be improved by applying sound principles and skills (Schiraldi, 2016). 13. Sleep well. Regular, adequate, quality sleep is known to help regulate anxiety, promote positive memory storage, and reduce the intensity of negative memories. Most adults require 7-9 hours of sleep to feel and function at their best. Try going to bed and getting up at the same times every day to strengthen sleep cycles. Dim lights 1-3 hours before retiring (especially blue lights), and block noise and light from entering the room. 14. Take action when possible. You might try making a list of all the things you worry about. You might see that there are a handful of things, not an infinite number. Rank them from most to least concerning. Then go down the list, one at a time, and see what you can do to solve or improve them. Accept what you can and can’t do. “If you worry, you can’t do your best. If you are doing your best, why worry?” Conclusion Excessive anxiety is common but need not be a lifelong sentence. Rather than increasing anxiety by fighting or fleeing it, try as best you can to kindly and patiently accept your fears, soothe and settle them, and then move on. Often, small changes in the way you approach your fears can reap large benefits. Glenn R. Schiraldi, Ph.D., - Website - Books - References: Schiraldi, G. R. (2021). The Adverse Childhood Experiences Recovery Workbook . Oakland, CA: New Harbinger. Schiraldi, G. R. (2016). The Self-Esteem Workbook . Oakland, CA: New Harbinger. Tobin, R. L., A. L. Adrian, C. W. Hoge, and A. B. Adler. (2018). “Energy Drink Use in U.S. Service Members After Deployment: Associations with Mental Health Problems, Aggression, and Fatigue.” Military Medicine 183: e364–e370. Ritvo, A. D., Foster, D. E., Huff, C., Finlayson, A. J. R., Silvernail, B., and Martin, P. R. (2023). Long-term Consequences of Benzodiazepine-induced Neurological Dysfunction: A Survey. PLoS ONE 18 (6): e0285584.

Recognizing that anxious beliefs are inherited can help us to challenge them. Not all beliefs and behavioral responses belong to us. Challenging those that don't can help reduce anxiety. Neural flexibility shows us that thought and behavioral patterns can be changed over time. It is helpful to question beliefs and behavioral responses that do not align with our true selves. When we conceptualize anxiety , we tend to see it as an omnipresent, immutable entity which we can neither change nor challenge. But the reality is that many of our anxious behaviors have been learned, so it stands to reason that anything which can be learned can be “unlearned.” Consider this example: a young boy’s mother is persistently anxious, worried about everything and anything, and her running monologue is one of dread, concern, and impeding catastrophe. Her behavior is reflective of her conceptualization of life as a danger-filled proposition: she is avoidant, isolative, and tends to shelter herself from her perceived certainty of a negative outcome. When her son asks if they can go to the amusement park, she responds that it is too busy, the rides are too dangerous, and there are too many strangers. In essence, she messages that the entire experience is unsafe. Reflective of this belief, her behavioral response is to avoid the amusement park, telling her son they are better off staying at home. The mind of a young child is malleable and impressionable: her son, in turn, learns that busy places are dangerous, strangers signal danger, and fun activities are, actually, risky. He is susceptible to inheriting his mother’s behavioral response of avoidance, and this can create a maladaptive pattern of behavior throughout his life. Of course, all circumstances and situations are unique. It is certainly not a guarantee that the child, as an adult, will manifest all of his mother’s anxiety-driven behaviors. In fact, neural flexibility shows us that thought and behavioral patterns can be changed over time. As the child matures, he very well may form his own beliefs that may be vastly different from those of his mother. So, how do we do this? First, we must identify that some beliefs which we carry with us actually do not belong to us; we have inherited them and, perhaps, not realized that they can be challenged and that they are ripe for reassessment. Through normal stages of development, children and adolescents begin to challenge the beliefs of their parents and form their own ways of viewing the world. The boy in this example may realize that he, unlike his mother, enjoys amusement parks and, in fact, feels completely safe on the rides and among the throngs of other visitors. His behavioral response, then, forms in a very different way that his mother’s. Where she ran from this particular stimulus, he goes toward it. This simplistic example illustrates the way that we inherit and learn beliefs and behaviors and, more importantly, the way that we begin to unlearn these same beliefs. In implementing this concept of unlearning into your own life, start by choosing and anxious belief and asking yourself, “whose belief is this?” Next, investigate the behavior attached to the belief and ask yourself, “whose response is this?” You have now cleared the path to asking yourself, “what is my belief?” For the boy in this example, the belief that crowded places are dangerous did not belong to him: it was his mother’s, as was the behavioral response of avoidance. His belief was that places like amusement parks are fun and safe. While we can respect that others’ beliefs and behaviors are formed from experiences, we can also allow ourselves to question and reject beliefs and behavioral responses that do not align with how we live in the world. Phil Lane, MSW, LCSW, - Website -

Metaphors can help some young adults who experience psychosis. Optimal health care occurs when clinicians provide therapy compatible with their patients’ belief system. Metaphors can be used to help deal with hallucinations. As hallucinations can present in many ways, clinicians must utilize a creative and flexible approach. Velo-cardio-facial syndrome (VCFS), also known as DiGeorge syndrome or 22q11.21 deletion syndrome, has a prevalence in the United States of approximately 1:2,000. Patients affected by this syndrome have an elevated risk for psychosis in late adolescence, which ends up affecting 30 to 40 percent of young adults with VCFS. This post describes hypnotic metaphors that have helped treat psychosis in this patient population. In addition to psychosis, psychiatric disorders are present in most individuals with VCFS (Fabbro et al., 2012) and include anxiety , mood disorders including depression , ADHD of the inattentive type, learning disabilities primarily involving non-verbal skills, oppositional defiant disorder, specific and social phobias, and obsessive-compulsive disorder . Individuals diagnosed with VCFS commonly experience cognitive deficits, with an average full-scale IQ of 73.3, and face limitations in communicative abilities in about 70 percent of cases. They also have numerous associated medical disorders, as described by Shprintzen (2008). Over the past decade, I have worked with 10 adults with VCFS (age range 18 to 39), including four adults who dealt with psychosis. Their hallucinations had been only partially controlled with the use of medications. To aid in their treatment, I taught them how to use hypnosis that included the use of metaphors to help them handle their difficulties in dealing with their hallucinations, including distinguishing them from reality. In approaching these patients, it is worth keeping in mind that optimal health care occurs when clinicians provide therapy compatible with their patients’ belief system. Thus, I believe this also is true when patients report hallucinations or delusions. In such cases, I have found it useful to consider the patients' beliefs as real, and to help them cope by providing suggestions that fit within their belief system, rather than telling them that their beliefs are false. Red Pill/Blue Pill A 20-year-old with VCFS developed frequent episodes of paranoia, during which he felt his parents were replaced by evildoers, heard voices telling him things he did not want to hear, and became frantic when he felt unsafe. He was a fan of the movie The Matrix, in which people are given the option to take a red pill or blue pill. The red pill allows them to awaken from the simulation in which they are living, while the blue pill would make them forget their awareness of the reality outside of the simulation. I suggested that this patient be given an option to take a red Skittle (candy) or a blue Skittle while he was in a paranoid state. On some occasions, he chose to take the red Skittle, and his delusions then resolved. Another technique that helped this patient temporarily was the suggestion that he put the voices on a radio and then turn the radio off. Discarding Voices A 23-year-old with VCFS complained of recurrent voices that were telling her to do bad things. She did not want to disclose the content of these intrusive thoughts. Over several weeks I gave her many suggestions regarding how to reduce the impact of her loud internal voices, which she reported helped her cope with them for up to several days or a few weeks. The suggestions included throwing the voices into the ocean, locking them up, turning down their volume, or telling them to pipe down. On one occasion, her voices agreed to speak telepathically so that they would not be so loud. I suggested that she tell the voices she would spend time with them in the evening, as long as they were quiet during the day. On another occasion, I suggested she invite positive voices and teach them to sing to drown out the negative ones. I gave her an amethyst stone (and suggested that as an alternative she could use Chinese Baoding balls) that she could hold to help control the voices. Finally, I provided her with a reassuring recording I made for her in which I told her she could control her voices by telling them to speak silently. She said that listening to the recording helped. This patient also developed hallucinations regarding seeing spiders. I suggested she use the Baoding balls to run over the spiders, imagine spraying them with anti-spider spray, or offer to give the spiders haircuts, since they hate haircuts. These suggestions helped reduce but not eliminate the spiders. Talking With Imaginary Beings A 34-year-old patient with VCFS who lived with her parents spent much of her days talking on the telephone to imaginary friends. She told her mother that one of these friends had died. She was not receptive to being told by her family that her friends were imaginary. On some occasions, she said that she had heard knocking on her door in the middle of the night. After working with me for several weeks, this patient asked me questions about how to deal with fallen angels and demons. She said she had never encountered such beings but was interested in the subject. I told her that in my experience with other patients, finding out what the beings desired and addressing their concerns has helped the beings depart. I thought the discussion about out-of-this-world beings involving other patients represented progress, as it allowed this patient to explore the theme of interactions with imaginary beings in a face-saving way. Subsequently, although she no longer reported talking to imaginary beings, she began reporting that she had developed dark nightmares. We discussed the possibility of her learning to control her nightmares by telling herself that she wanted to be protected in her nightmares by a superhero, which she said helped. She then told me that in one of her recurrent nightmares, she was disturbed by the loud sound of a magnetic resonance imaging (MRI) machine. I suggested that she could drown out the sound by playing music in her dreams. Subsequently, her nightmares about the MRI machine resolved. The Takeaway As hallucinations and delusions can present in many ways, a clinician must utilize a creative and flexible approach with offered suggestions. It is unclear whether the experiences with VCFS patients that I report in this post are generalizable to treating patients with psychoses that arise because of other reasons. Ran D. Anbar, M.D., FAAP, - Website - References Fabbro A, Rizzi E, Schneider M, Debbane M, Eliez S. (2012). Depression and anxiety disorders in children and adolescents with velo-cardio-facial syndrome (VCFS). Eur Child Adolesc Psychiatry. 21(7):379-385. Shprintzen RJ. (2008), Velo-cardio-facial syndrome: 30 Years of study. Dev Disabil Res Revs. 14: 3-10.

Learning about these effects can help you be less critical of yourself. In previous posts, I’ve written about the effects of child sexual abuse (CSA) on survivors. This post outlines some lesser-known consequences of CSA that you may not be aware of. In addition, according to new studies, people who have been subject to CSA are more likely to experience physical and mental health effects than previously thought. Globally, understanding the impact of CSA on health has historically been understudied compared to other risk factors on one’s health . For example, new research shows that the previously stated connection between an increased risk of alcohol use and an increased risk of self-harm are actually larger in magnitude and more extensive than previously suggested. Adult victims of CSA are four or five times more likely to have abused alcohol or illicit drugs. New research also found that survivors of CSA are twice as likely to smoke and be physically inactive. Physical Consequences Historically, researchers have considered the impacts of CSA to be confined to mental health issues and substance misuse. However, recent studies found that the physical health consequences of abuse are also substantial. Most noteworthy, patients with a record of childhood mistreatment (all types of childhood abuse and violence) were 42% more likely to develop asthma. It was also found that across studies, adults who experienced CSA were more likely to report health problems such as: Poorer overall health Pain/fibromyalgia Gastrointestinal symptoms Obesity and other eating disorders Chronic and diffuse pain, especially abdominal or pelvic pain Lower pain threshold Social Consequences Researchers have also documented many negative social consequences of CSA, including: Relationship disruption (break-up/divorce) Dissatisfaction with their relationships Sexual unfaithfulness/promiscuity Increased sexual dysfunction Some of this information has been known for quite some time but what has not been known are the socioeconomic consequences of CSA such as the fact that survivors of CSA were found to: Be three times more likely to be out of work due to sickness and disability Be 14% more likely to be unemployed Be less likely to go to, or graduate from college Effects on Women Specifically Depression , anxiety and anger are the most commonly reported emotional responses to CSA. However, the following gynecologic problems are all common among female survivors: chronic pelvic pain dyspareunia (difficult or painful intercourse) vaginismus (painful spasmodic contractions of the vagina) nonspecific vaginitis (inflammation of the vagina) and gastrointestinal disorders Female survivors are also less likely to have regular Pap smears and may seek little or no prenatal care Sexual Effects on Women Disturbances of desire, arousal and orgasm may result from the association between sexual activity, violation and pain. Female survivors are more likely to: Have had 50 or more intercourse partners Have had a sexually transmitted infection Engaged in risk-taking behaviors that put them at risk of contracting human immunodeficiency virus (HIV) In addition, early adolescent or unintended pregnancy and prostitution are associated with CSA. Consequences for Men Although the following effects of CSA can be common for both sexes, male victims seem to suffer more from them than female victims: Male survivors often become frightened of emotional connection and isolate themselves as adults. Sexually abused males often have difficulty distinguishing between sex, love, nurturance, affection, and abuse. They may often experience friendly interpersonal approaches as seductive and manipulative. On the other hand, they may not notice when they are being exploited. Believing sexual closeness is the way to feel loved but experiencing love as abuse, some male victims solve their dilemma by engaging in frequent, indiscriminate, and compulsive sexual encounters. Sex is pursued incessantly, but with little chance for intimacy. Instead they are left feeling empty and lonely. Although relatively few sexually abused boys become abusers, many men fear they’ll become abusive or worry that they if they disclose their history, others will consider them predators. For this reason and many others, such as fearing that the abuse made them gay or that others will think they are gay because they were abused, most male victims do not disclose the abuse and thus do not get the treatment, nor the support and compassion they need. For many, acknowledging victimization means admitting they are weak. Sexual Effects for Everyone In addition to there being new research, there are some consequences that have been known for quite some time among professional therapists but not necessarily to the general public. I wrote about these consequences in my latest book: Freedom at Last: Healing the Shame of Childhood Sexual Abuse. These include: Feeling disgust toward various parts of the body, such as the vagina or penis. Not wanting to be touched on parts of the body that were involved with the sexual abuse. For example, if the abuser touched your breasts you may not want to have your breasts touched. Not wanting to engage in sexual activities that remind you of the sexual abuse. For example, if the abuser penetrated you may have a strong aversion to being penetrated but you may be okay with other sexual activities that the abuser did not engage in, such as oral sex. Hopefully this information has helped you understand a loved one or yourself better and has encouraged you to seek help if needed. To find a therapist, please visit the Psychology Today Therapy Directory. Beverly Engel - Website - References Adult Manifestations of Childhood Sexual Abuse, Committee on Health Care for Underserved Women, Number 498, August 2011, The American College of Obstetricians and Gynecologists. Engel, Beverly. (2023). Freedom at Last: Healing the Shame of Childhood Sexual Abuse. Guilford, Conn. Prometheus Books. Hailes, Helen and Yu, Ronggin. “Long-term outcomes of childhood sexual abuse: an umbrella review. Lancet Psychiatry, 2019 Oct 1: 6(10): 830-839 Health impacts of abuse more extensive than previously thought, research says (2023, December 11). The effects of childhood sexual abuse on health and well-being (2024, February 8)

Sixty percent of second marriages end in divorce. The divorce rate among couples aged 50 and over has doubled since 1990. There is an increase in the number of people putting off marriage or taking marriage off the table completely. A second marriage is likely to inherit the same disagreements that arose during a first marriage. If marriage is a lot, then ending a marriage is a lot more than a lot. Divorce is grieving the loss of someone you thought you would be with forever while planning for a better future for yourself for tomorrow. Here are five interesting facts about divorce to keep in mind. 1. Your likelihood of divorce is 50 percent higher if you or your partner smokes. A 1998 study by Doherty & Doherty found that adults who smoke are 53 percent more likely to have experienced divorce than those who do not smoke. In 2009, the Melbourne Institute of Applied Economic and Social Research determined that the risk of divorce among married partners where only one of them was a smoker increased the likelihood of divorce by 75 to 90 percent higher than those where both couples smoke. Several theories have been offered to explain the smoking-divorce connection, including the idea that smoking itself may lead to disagreements about whether or not your partner should be smoking, Health concerns about the partner who smokes may also negatively impact the relationship, and smoking puts additional financial strain on the couple as a whole. 2. Fifty percent of marriages still end in divorce. Over the past 150 years, divorce rates have steadily continued to climb until the 1990s. Around that time, the divorce rate began to dip below 38 percent from 2000 to 2010 and 30 percent from 2011 to 2021. In addition, the rate of marriage has declined. In 1995, the marriage rate was roughly 45 per 1,000 women, but by 2020—just 25 years later—the marriage rate had fallen to 31 per 1,000 women. Some level of a reduced divorce rate makes sense since we also have fewer people marrying. There has also been a notable increase in the number of people living together before marriage. This means people could potentially be putting off marriage for a few years or taking the idea off of the table completely. Despite all of this fluctuation in who is doing what when, 50 percent of all marriages in the U.S. have still ended in divorce for the better part of the last 150 years. 3. Sixty percent of second marriages will end in divorce. If you're looking to enter a new marriage to escape the baggage from your previous marriage, I have some pretty bad news for you...it's unlikely at best. Divorce is often thought of as the monster hiding under the bed. It's scary and frightening, and you never know what might happen—until it does. And then...a big nothing burger? Look, divorce is extremely difficult. But after some time passes, it becomes pretty clear that the Big Bad you feared and the relief of surviving the worst thing you imagined has replaced your lingering fear. A significant amount of evidence points to the idea that your second marriage is quite likely to inherit the same disagreements that arose during your first marriage as well as some special arguments all its own. Unfair? Sure. Many people report unresolved issues from the first marriage often resurge in the second marriage. Yeah...it turns out the trust issues you had with your first husband weren't all about him but were, in fact, largely about you. We also have the possible added level of difficulty that comes from having to blend two families by marriage. The grand total of the second marriage equation? Well, it's nowhere as easy as Mike and Carole Brady made it out to be. 4. Couples under the age of 20 have the highest divorce rates. Young love doesn't appear to be the strongest, most stable love. Forty-eight percent of people who get married before age 18 are likely to divorce within 10 years of marriage. Sixty percent of those married between ages 20-25 will end in divorce. Why? The only people who accept their youth are those struggling to hold on to it. The majority of us are quick to try to impress people by our wit and wisdom, both of which have limited depth and breadth at the ripe old age of 25. Younger couples may lack the maturity and life experiences necessary to put in the hard work of a long-term marriage. 5. The divorce rate among couples aged 50 and over has doubled since 1990. This increase in divorce among older adults is often referred as a "gray divorce" and is largely thought to be a result of increased life expectancy. After all, when we envisioned spending the rest of our life with someone, did we have any idea how long forever would last? Did we ever envision a life with just our partner, an empty nest, and no distractions to be found? Society has also contributed to the increase in divorces later in life thanks to more women working outside the home and gaining financial independence. There has also been a changing view of divorce thanks to television and media that normalizes the idea of older adults ending unhappy marriages. Conclusion There is no right or wrong way to handle an unhappy marriage. There is only the decision to listen to your heart and your head, no matter how old you are or how many times you have been betrothed. Lindsay Weisner, Psy.D., - Website -

A new review concludes that many gender-related treatments lack strong evidence. The treatment of gender distress is highly politicized, but scientific evidence is lacking. A new review concludes that hormone treatment may not reduce the risk of suicide in gender dysphoric youth. The review also finds no clear evidence that social transition in childhood has any effects on mental health. Blocking puberty may not induce changes in gender dysphoria or body satisfaction. "Gender incongruence" is the term used to describe a marked and persistent incongruence between an individual’s experienced gender and their assigned gender or biological sex. "Gender dysphoria," which commonly arises after the onset of puberty, happens when gender incongruence is associated with clinically significant distress or functional impairment. Many of those who experience gender dysphoria will end up identifying as transgender (or trans, for short), an umbrella term for people whose gender identity is different from the gender they were assigned at birth. How should children and adolescents who experience gender incongruence and gender dysphoria be treated? Persistent emotional distress—gender-related or otherwise—is, to an important degree, a health (and healthcare) matter. Yet gender distress has in recent years become politicized, and the lives and health of gender-troubled children and adolescents have become fodder for the political and ideological culture wars. As American politics and ideology often go, this complex and nuanced issue has thus been shoved into a tired, dichotomous formula. For the progressives, the issue is one of minority rights. Gender dysphoric children and adolescents should thus be supported in their struggle to live as they wish, free of prejudice and discrimination. Early intervention to align the children’s body and appearance with their preferred gender must be encouraged. Those who question this view are typically accused of transphobia. For conservatives, gender dysphoria is at best a passing individual fancy or troubling societal trend to be mocked and at worst a disease to be cured. Those who want to honor and affirm children’s gender struggles are seen as hopelessly "woke" social justice warriors pushing a radical agenda. As culture wars go, this one, too, has been generating much heat in recent years, but very little light. Thus, the clinical healthcare services provided to children and adolescents who struggle with gender dysphoria have not been based on a solid foundation of high-quality research evidence. A move forward from this abysmal state may have just happened, in the form of The Independent Review of Gender Identity Services for Children and Young People, commissioned by NHS England in 2019, with the goal of making evidence-based recommendations on the questions relating to the provision of these services. The final report of what is known as the Cass report (for Hilary Cass, the pediatrician who chaired the review team) just dropped in April 2024. It is consequential. For one, the report is a good example of how such tasks should be approached and executed: a thorough, detailed, evenhanded, and levelheaded examination that puts child welfare front and center and follows the available empirical evidence wherever it leads, while acknowledging—but not succumbing to—the various ideological, political, and societal forces at play. The review examined the existing formal research as well as receiving input from “people with relevant lived experience,” organizations working with LGBTQ+ children and young people, and medical and mental health professionals who provide care and support to children and young people struggling with gender identity . Writes Cass: “The aim of this Review is to make recommendations that ensure that children and young people who are questioning their gender identity or experiencing gender dysphoria receive a high standard of care. Care that meets their needs, is safe, holistic, and effective. “ The findings of the review are quite eye-opening. Cass first attempts to explain the dramatic recent increase in the number of gender dysphoric cases, as well as the recent shift in the gender dysphoric population from male to female majority. She argues that the increased social acceptance of trans phenomena is not a sufficient explanation. “The exponential change in referrals over a particularly short five-year timeframe is very much faster than would be expected for normal evolution of acceptance of a minority group. This also does not adequately explain the switch from birth-registered males to birth-registered females, which is unlike trans presentations in any prior historical period.” Cass notes that these gender dysphoria trends are immersed in the broader context of increased rates of mental health problems in children and adolescents (particularly females) in the last decade, and a corresponding increase in the number of young people “presenting with other bodily manifestations of distress; for example, eating disorders, tics and body dysmorphic disorder.” Gender identity and expression are determined by a difficult-to-disentangle mix of biological, neurological, psychological, and societal factors. Ostensible gender identity problems may thus be symptomatic of other, underlying and unresolved issues, Cass argues. Gender dysphoria, in other words, is not always about gender, just as germ phobia is not always about germs. Cass then discusses the role and impact of social transitioning, defined here as “social changes to live as a different gender such as altering hair or clothing, name change, and/or use of different pronouns.” She notes that such transitioning is not a one-size-fits-all phenomenon. “There is a spectrum from young people who make relatively limited gender non-conforming changes in appearance to those who may have fully socially transitioned from an early age and may be living in stealth.” She notes that a key difference between children and adolescents is that “parental attitudes and beliefs will have an impact on whether the child socially transitions. For adolescents, exploration is a normal process, and rigid binary gender stereotypes can be unhelpful.” The debate over the benefits and harms of social transitioning is a flashpoint in the culture wars. Cass, however, found “no clear evidence that social transition in childhood has any positive or negative mental health outcomes, and relatively weak evidence for any effect in adolescence. However, those who had socially transitioned at an earlier age and/or prior to being seen in clinic were more likely to proceed to a medical pathway.” “Although it is not possible to know from these studies whether earlier social transition was causative in this outcome, lessons from studies of children with differences in sexual development (DSD) show that a complex interplay between prenatal androgen levels, external genitalia, sex of rearing and sociocultural environment all play a part in eventual gender identity… Therefore, sex of rearing seems to have some influence on eventual gender outcome, and it is possible that social transition in childhood may change the trajectory of gender identity development for children with early gender incongruence.” She concludes: “Avoiding premature decisions and considering partial rather than full transitioning can be a way of ensuring flexibility and keeping options open until the developmental trajectory becomes clearer.” Cass then turns to inquire about the evidence regarding medical transitioning (a part of transition in which a transgender person undergoes medical treatments so that their physical and sex characteristics better match their gender identity). She first addresses the common use of puberty blockers with gender dysphoric children. “The original rationale for the use of puberty blockers,” Cass notes, “was that this would buy ‘time to think’ by delaying the onset of puberty and also improve the ability to ‘pass’ in later life. Subsequently, it was suggested that they may also improve body image and psychological well-being.” The evidence, however, shows that blocking induces “no changes in gender dysphoria or body satisfaction,” she writes. Evidence as to the effects of puberty suppression on psychological or psychosocial wellbeing, cognitive development, cardio-metabolic risk, and fertility is found to be “insufficient” and “inconsistent.” Moreover, the fact that a vast majority of young people who are started on puberty blockers proceed to masculinizing/feminizing hormones suggests that puberty blockers do not in fact “buy time to think” and may rather “change the trajectory of psychosexual and gender identity development.” Cass thus proposes that “because puberty blockers only have clearly defined benefits in quite narrow circumstances, and because of the potential risks to neurocognitive development, psychosexual development, and longer-term bone health, they should only be offered under a research protocol.” The evidence about hormone treatment is examined next. “It has been suggested that hormone treatment reduces the elevated risk of death by suicide in this population,” Cass notes, “but the evidence found did not support this conclusion.” Cass notes the lack of high-quality outcome research—short- and long-term—of hormone interventions in adolescents with gender dysphoria or incongruence. Thus, she writes, “No conclusions can be drawn about the effect on gender dysphoria, body satisfaction, psychosocial health, cognitive development, or fertility. Uncertainty remains about the outcomes for height/growth, cardiometabolic, and bone health. There is suggestive evidence from mainly pre-post studies that hormone treatment may improve psychological health, although robust research with long-term follow-up is needed.” Cass notes that while a diagnosis of gender dysphoria is often considered a prerequisite for hormone treatment, such diagnosis “is not reliably predictive of whether that young person will have longstanding gender incongruence in the future, or whether medical intervention will be the best option for them.” Therefore, Cass recommends “an extremely cautious clinical approach and a strong clinical rationale for providing hormones before the age of 18. This would keep options open during this important developmental window, allowing time for management of any co-occurring conditions, building of resilience, and fertility preservation, if required.” Cass notes the overall dearth of quality long-term outcome data on both medical and non-medical interventions, which means that “young people and their families have to make decisions without an adequate picture of the potential impacts and outcomes.” In sum, youngsters' gender concerns should not be mocked or denied. Gender curiosity and exploration are common, particularly in adolescence, and should not be unduly pathologized. At the same time, young children should not be hustled onto a path toward gender transition. However well-intentioned, the Cass review suggests that current official guidelines, such as those of The American Academy of Pediatrics, are not rooted in solid evidence. Likewise, the popular, medicalized approach known as “gender-affirming care," which is based on the notion that children’s early declarations of identity must be accepted at face value and their transition aggressively assisted, may not be justified by the evidence. Gender dysphoria may be transitory; it may at times be a symptom of underlying stress unrelated to gender identity. Changing one’s gender affiliation and appearance are often insufficient to resolve the underlying psychological dysfunction and alleviate distress. Yet for some youngsters, transition is a solution. “Being gender-questioning or having a trans identity means different things to different people. Among those being referred to children and young people’s gender services, some may benefit from medical intervention and some may not. The clinical approach must reflect this.” Finally, the healthcare we provide to youngsters who are struggling with gender distress should be a means to an end of helping them, rather than a means of winning a battle in the culture wars. Focusing on gender needs to be supplanted by a focus on the person. The care we provide youngsters who struggle with gender distress needs to be based in empirical facts, not merely good intentions or ideological and political theories. Noam Shpancer, Ph.D.,

Forgiveness, social connections, and our evolved psychology. Forgiveness is often a more difficult process than we might expect it to be. From an evolutionary perspective, forgiving others without holding them accountable would be problematic. When appropriate, however, genuine forgiveness has all kinds of benefits for the forgiver and others. Last I checked nobody's perfect. And social life often comes with some levels of conflict. A co-worker might hold it against you that you got a promotion, and they didn't—and their reaction to this situation might take the form of resentment and conflict. Your spouse might have gutted your checking account buying expensive jewelry without even thinking of consulting you. And that could lead to problems. Your sister may have failed to say thank you for helping her throw a surprise birthday party for her husband. Your best friend might insult your spouse in public after having a few too much egg nog at a holiday party. You might have a family member who cursed you out for no apparent reason in front of your spouse and children. One of your friends may have backed into your car in your driveway upon leaving one night and ended up totally denying it (even though you saw it happen clearly on the Ring camera). And so forth. An unfortunate facet of the human condition bears on the inherent imperfections that we all carry. When people transgress against us, we often don't take it well (see Geher et al., 2019). We often see transgressions, especially those that are directed at us and that are relatively severe, as hard to forgive. One of the main issues in navigating the sometimes-treacherous waters of the human social world pertains to these questions: When is something forgivable? And when has some act passed the boundaries of forgiveness? Forgiveness in Evolutionary Context From an evolutionary perspective, forgiving people too quickly and easily can be problematic. We evolved as a species in which reciprocal altruism, or the tendency to help others who have helped us in the past (see Trivers, 1971), is extremely foundational. In such a world, maintaining strong and positive connections is key. Having a broad network of people whom you can count on to help you (as opposed to cross you or exploit you) is key to a happy and successful life (see my and Nicole Wedberg's (2022) book, Positive Evolutionary Psychology). As my co-authors and I argue in an article on the evolutionary psychology of forgiveness (De Jesus et al., 2021), forgiving others' transgressions against you without holding them accountable could ultimately hurt us by making us seem like doormats; such unconditional forgiveness would not have been selected by nature. From an evolutionary perspective, genuine and deep (emotional) forgiveness really needs several stars to alight. The transgressor needs to see their role in the situation and take ownership. Feelings of guilt need to enter the picture. Genuine apologies, often including a public element, need to be made. And the victim of the transgression needs to be open to the possibility of forgiveness (which is, as you know if you are old enough to be reading this, not always the case). This all said, forgiveness is one of these critical emotional processes in the human experience that, when appropriate, comes with benefits of various kinds. Below are three benefits of forgiveness based in work in the behavioral sciences. 3 Benefits to Forgiveness Keeping social connections (see Geher & Wedberg, 2022). Humans evolved to live in small-scale societies surrounded by kin and familiar others. Losing social connections in such a world would clearly be both hurtful and, potentially, dangerous. While our social worlds have expanded since the pre-agrarian days, our minds have not evolved much past these times. For this reason, estrangements between people are still deeply painful (see Geher et al., 2019). Keeping social connections strong and healthy has always been a critical part of the human experience. Genuine forgiveness often helps with this process. Establishing or maintaining a positive social reputation (see Geher et al., 2019). People who develop reputations as benevolent and forgiving tend to be admired and appreciated by others. Cultivating a reputation as someone who is forgiving is good for one's reputation. And a positive reputation is a huge key to success in the all-too-often treacherous waters of human social life. Forgiving others has mutual benefits in this way. Emotional benefits (see Kim et al., 2022). In an emotional context, genuinely forgiving others has emotional benefits for the forgiver. Forgiving is ultimately associated with psychological health , reduced anger , and increased hope. It is not hard to see how this constellation of emotions can help us sleep better at night. Forgiveness, when appropriate, is an emotionally healthy experience. Bottom Line People mess up. We are all imperfect in varying ways and to varying degrees. And part of life includes getting hurt by others; this is an unfortunate fact of the broader human experience. While humans did not evolve to forgive transgressions at the drop of a hat (see De Jesus et al., 2021), we did evolve with forgiveness as a tool to (a) help keep us connected to others, (b) help us cultivate positive reputations, and (c) increase the emotional well-being of ourselves and of others. This time of year, as daylight continues to wane, if you're like me, you think about people in your world. And you might think about forgiving certain others with whom you've had some level of problems. While forgiveness may not always be appropriate or even possible, all things equal, based on the behavioral-science data and ideas presented here, it seems that the benefits of forgiveness may ultimately outweigh the costs of holding grudges. Glenn Geher, Ph.D., - Website - References De’Jesús, A. R., Cristo, M., Ruel, M., Kruchowy, D., Geher, G., Nolan, K., Santos, A., Wojszynski, C., Alijaj, N., DeBonis, A., Elyukin, N., Huppert, S., Maurer, E., Spackman, B. C., Villegas, A., Widrick, K., & Zezula, V. (2021). Betrayal, Outrage, Guilt, and Forgiveness: The Four Horsemen of the Human Social-Emotional Experience. The Journal of the Evolutionary Studies Consortium, 9(1), 1-13. Geher, G. & Wedberg, N. (2022). Positive Evolutionary Psychology: Darwin’s Guide to Living a Richer Life. New York: Oxford University Press. (SOFT COPY) Geher, G., Rolon, V., Holler, R., Baroni, A., Gleason, M., Nitza, E., Sullivan, G., Thomson, G., & Di Santo, J. M. (2019). You’re dead to me! The evolutionary psychology of social estrangements and social transgressions. Current Psychology. doi: 10.1007/s12144-019-00381-z Geher, G., Di Santo, J., & Planke, J. (2019). Social reputation. In T. Shackelford (Ed.), Encyclopedia of Evolutionary Science. New York: Springer. Kim JJ, Payne ES, Tracy EL. Indirect Effects of Forgiveness on Psychological Health Through Anger and Hope: A Parallel Mediation Analysis. J Relig Health. 2022 Oct;61(5):3729-3746. doi: 10.1007/s10943-022-01518-4. Epub 2022 Feb 21. PMID: 35190955; PMCID: PMC10120569. Trivers, R. L. (1971). The evolution of reciprocal altruism. Quarterly Review of Biology, 46, 35–57.

The effects of persistent parental lashing out, gaslighting, and betrayal. Oversharing can be associated with parental emotional abuse. In adult survivors of childhood emotional abuse, oversharing can be driven by fear or need for validation. Sharing in relationships for these reasons can create vulnerability and suboptimal functioning. Adult survivors of childhood parental trauma often engage in oversharing. This contrasts the under sharing that is often seen with survivors of other types of traumas. Specific types of childhood trauma teach and condition children to overshare by punishing these children for not sharing. As adults, these individuals routinely overshare, which results in a compromise of their interpersonal effectiveness. Survivors of most traumas, especially those who suffer from significant symptoms of post-traumatic stress disorder (PTSD) , do not like to talk about their traumatic memories because doing so retraumatizes them. As they recount events in which they were victimized by a crime, had a near-death experience, etc., they relive it and experience high levels of anxiety and intrusive recollections. These individuals very often avoid talking about their thoughts and feelings in general, as a way of avoiding being triggered by reminders of their traumatic event or events. Adult survivors of childhood trauma from exposure to frequent emotional abuse from a parent suffer a special type of trauma. Some parents who are compromised by symptoms of a personality disorder, such as borderline (BPD) or narcissistic personality disorder (NPD), lash out at their children when they are emotionally dysregulated. This sometimes takes the form of a direct verbal attack on the child’s developing character. Other times it takes the form of gaslighting, lying, and betrayal. Parents with symptoms of these disorders also struggle with interpersonal boundaries. As a result, they are uncomfortable with other people having private thoughts or feelings. This manifests as a persistent demand that their child share their experience whenever the parent inquires. The following dialogue between Shey and her mother is a common example. Mom: What were you just thinking about? Shey: Nothing in particular. Mom: I saw you make a face. Shey: It had nothing to do with you. Mom: You can’t wait to get out of here. You hate me. Shey: That is not what I was thinking. Mom: I’m your mother. I know what you are thinking and feeling. Shey: I was actually thinking about a scarf I saw at the store but it is too expensive. Mom: You are so ungrateful. I wish I never had children. In this sample dialogue, Shey’s mother “forces” Shey to disclose her inner thoughts and feelings by accusing her of the worst possibility. When Shey finally does disclose, her mother punishes her for resisting. Many children of parents with significant symptoms of personality disorders are exposed to this sort of treatment frequently throughout their childhood. Many of them develop the habit of telling others what they are thinking and feeling before they are confronted. Adult children of parents with insufficient or absent boundaries often continue to habitually overshare their inner thoughts and feelings with others. Over-Justification One common form of oversharing is over-justification. People who grew up under circumstances similar to Shey's often disclose to others their reasons for making decisions without being asked to. Here is a sample dialogue that Shey might have gotten into with her friend that illustrates this tendency. Dee: Shey, can you watch my cat this weekend? Shey: I am sorry, but I have a dentist appointment on Friday and I am hosting a colleague on Saturday. Dee: The cat doesn’t require much care. You can just come by my place in the morning and after dinner to feed her and change the litter. Shey: I told you, I have plans all weekend. Dee: Are you having serious dental problems? Shey: No, I am going for a routine cleaning and exam, but I have to get groceries after. This dialogue demonstrates one example of how oversharing can compromise social functioning. When asked about cat-sitting, Shey should have responded, “I am sorry, but I am not available this weekend.” By oversharing, Shey created an opportunity for Dee to scrutinize and challenge her reasons for not agreeing to cat-sitting. Oversharing for the Purpose of Denormalization Because of the natural egocentrism associated with the developing brain, children tend to believe that whatever occurs in their homes and their lives is what everyone experiences. They normalize their experience. As children get older and are exposed to other family structures, they begin to realize that most of their friends and peers are not emotionally abused by their parents. This makes them try to reconcile why their extended family, such as grandparents, aunts, uncles, etc., allow them to be treated harshly. Families of abusive parents either intervene or enable. As adults, these survivors of childhood emotional abuse often continue the effort to share their traumatic experiences of childhood with others in an effort to experience someone who sees their experience as not being normal. They are validated by other people being surprised, shocked, or aghast at their recollections, even though it often retraumatizes them to recount. Survivors of war trauma, violent crime, etc. do not need this validation, as these sorts of traumas are acknowledged instantly by everyone. Sharing one’s thoughts, feelings, and experiences with others is healthy when done for the purpose of bonding with another person. Sharing to avoid punishment or to validate abuse is not healthy. It is retraumatizing to the individual and it weakens them when their boundaries are challenged. When the habit of oversharing is the result of repeated childhood parental trauma, healing of the traumatic wound is necessary to neutralize the habit. The oversharing in these individuals is driven by fear of being punished if they fail to do so. They were expected to do so without being asked. Healing this wound involves reprocessing the traumatic aspect of this symptom. This requires an understanding that while you were forced to overshare as children to avoid punishment, as an adult you will not allow anyone to punish you for enjoying your privacy. It will also guide you towards validating your own experiences rather than retraumatizing yourself by seeking validation from others. Daniel S. Lobel, Ph.D.,

Personal Perspective: Setting rules helps one cope with chronic pain and illness. Painful emotions inevitably arise at times. Remind yourself that “no feeling is final.” Never take another person’s side against yourself. Learn which self-care measures you can always count on for help. I became chronically ill in 2001 when I didn’t recover from what appeared to be a routine viral infection. In the age of COVID-19, my doctor says we should think of me as a “long hauler” from that virus. At first, I didn’t set any guidelines. I was in denial that I might have to change my entire lifestyle. I couldn’t believe that the pain and illness might be chronic. I thought, “You get sick and then you get better.” And, so, I returned to work part-time after six months, even though I was too sick to do so. During that period, I was either in bed or lying on a couch in my office or sitting in a chair to teach. My husband would drive from his workplace in another town, take me to the law school to teach my class, and then pick me up afterward. It's highly possible that this failure to admit to myself that I was too sick to work is one reason I’m still so sick today. Going back to my job put a stop to any healing that might have been taking place from that initial virus. Even after I stopped working, I didn’t set guidelines After I stopped working, I fell into a dark place of guilt and self-blame. I thought, “What’s wrong with me that I can’t get better? it must be some mental defect.” Yes, I really thought that. My husband and I always went to my daughter-in-law’s parents’ house for Thanksgiving. The first Thanksgiving I was sick, I insisted we go, even though they live 550 miles away. Looking forward to it, we rented a hotel room nearby. The trip was a disaster. I spent the whole time on my hosts’ bed. That may have been my lowest point. Their bedroom had a big window that enabled me to look through the backyard and into the family room. I can still see my family there, along with some visitors I’d come to love. I watched through those windows and wept. How I changed With a lot of help, I gradually changed. My background in Buddhism was helpful. It had taught me that life could be tough and the only path to peace was to work on gracefully accepting my life, however it was unfolding. I was also helped by other people who were chronically ill. I’d met them online. Our stories were strikingly similar, even though we often had different diagnoses. I realized that what happened to me was a normal part of the life cycle. One of the conditions of being alive is that I might get injured or sick and have to change the way I was living. There was no reason to blame myself or feel guilty. At times, I still struggle to stick to the guidelines I’ve finally set, but if I blow it, I simply acknowledge it, pick up the pieces, and start again. Here are those guidelines: 1. Remember, “No feeling is final.” I can’t take credit for this quotation. It’s from the poet Rilke. His reflection on impermanence has been incredibly helpful to me. For example, if hear about a trip I wish I could take, and that painful emotion envy arises, I take it as a signal to be extra kind to myself while I wait for the emotion to pass. And it always does. 2. Never take another person’s side against yourself . I consider this nonnegotiable. It could be a friend or a relative challenging you about how much pain you’re really in—physically or mentally. Trust your own judgment. You are the expert on you, so never take sides against yourself. 3. Don’t do things that exacerbate your symptoms. I recognize that sometimes you can’t control this. In addition, you might make the choice to do something that you know will exacerbate your symptoms, but it’s really special. I went to the wedding of close friends a few years ago. Even though I left before the reception, I “paid” for it with a flare in my symptoms, but it was worth the price to me. That said, most of the time you can choose not to exacerbate your symptoms by relying on your experience of how much you can handle. This means you need to become an expert on what you can and cannot comfortably do, 4. Special occasions aside (that wedding), always be ready to say “no.” Learning to say “no” is required to keep you at what I call your “baseline.” It means that you must refuse to agree to do something out of obligation or guilt if, in your judgment, you know it will exacerbate your symptoms. For example, it’s Thanksgiving and you know you can comfortably bake one pie to help with the food. But your cousin asks you to bake three pies (or even two). Just say no, no matter how negatively he or she reacts. To do otherwise violates my second guideline of never taking sides against yourself. Since living day-to-day with chronic pain and illness, I’ve discovered the power and relief of saying “no” as in, “No, I can’t spend more than an hour visiting”; “No, I can’t stay for the reception.” If people can’t handle it, it’s about them, not you. 5. Come up with self-care measures you can always count on to make you feel a bit better. It could be a nap every afternoon. It could be a warm bath. It could be a favorite TV show. I recommend that you make a list. That way you’ll always have those self-care measures at hand. 6. Remind yourself that, despite your health problems, you don’t have a monopoly on suffering. No matter what their health status, everyone faces difficult challenges: a friend who’s in constant conflict with her partner; a supervisor who’s unbearable. So, one guideline I follow is: “I’m not the only person with problems in this life.” I hope this has been helpful. My best to everyone. Toni Bernhard, J.D., - Website -