5 keys to recovery from narcissistic parents. Children raised by narcissistic parents often experience negative consequences such as low self-esteem. Common characteristics of adults who grew up with narcissistic parents include stress and fear of conflict. Healing from the effects of narcissistic parenting includes self-soothing techniques. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013), narcissists are emotionally cold, lacking in empathy, and insensitive to the feelings and needs of others. What can you do if you’ve had a parent like this? If we grow up with a narcissistic parent, we often struggle with feelings of inadequacy and anxiety (Määttäi, Määttä, Uusiautti, & Äärelä, 2020). Research has shown that children of narcissistic parents can even suffer from complex trauma (Mahoney, Rockspoone, & Hull, 2016). Pi Venus Winslow, a survivor of narcissistic parenting, now works as a life coach to help others recover from such parenting. Narcissistic parenting, she told me in an interview, "trains us to be codependent and compliant. We can become people-pleasers with a desperate need to look good to maintain our image. We become acutely aware of other people's emotional states while being disconnected from our own." “We struggle with low self-worth, inadequacy, and anxiety,” she explains. We have a lot of fear—"fear of judgment, rejection, and conflict. We may fear people in power.” And we can neglect our own physical and emotional health because our narcissistic parents neglected our needs. “Believing that we're unlovable, unintelligent, we can develop a victim mentality,” she says. We get into relationships with other narcissists, she says, because the pattern feels “familiar to us.” Our narcissistic parents did not provide us with what Abraham Maslow (1971) identified as our basic needs for food, shelter, safety, security, and love. As Winslow says, all children need “to be cared for, to be seen, to be understood. We need love; we need connection; we need significance, certainty, and security. And we need a sense of belonging and purpose.” Winslow points out that “a lot of adult children of narcissistic parents really struggle with being emotionally stuck in old childlike ways of feeling.” We can become chronically stressed, hypervigilant, and easily triggered by anything that resembles an old pattern from the past. Flooded with fear, we feel like the helpless child we once were. As neuroscience research has shown, we react from our amygdala, the brain’s alarm center, which limits our options. The fight-flight-or-freeze response shuts down our higher brain centers and our ability to think rationally (LeDoux, 1996). The Road to Recovery Winslow points to five key steps in the process of recovery. 1. Soothing Ourselves. Our path of recovery begins by recognizing when we’ve been triggered and soothing ourselves so we can respond more effectively. Winslow recommends taking a deep breath, “and on the exhale, relax your body, relax your shoulders, relax your face. Relax your hands, relax your chest. Just try to relax your major muscle group. And just keep taking deep breaths.” This cuts the stress reaction, calming our minds and bodies. Her advice parallels Buddhist tradition, mindfulness-based stress reduction, and research at the HeartMath Institute, which shows how slow, heart-focused breathing can bring our emotions and bodies back into balance (Childre, Martin, & Beech, 1999; Dalai Lama, 2002; Kabat-Zinn, 1994). 2. Recognizing Our Patterns. Once we’ve soothed ourselves, Winslow says, we can begin recognizing our patterns, “the similarities between our childhood and the choices we're making in our adult lives.” To make better choices in the future, we can reflect on why we feel the way we do and why we’ve made our past decisions. Then, we can take steps in the direction we want to go in our lives. It’s a process of “catching ourselves in our old patterns, then shifting and changing them.” 3. Dealing With Grief and Unresolved Issues. The journey of recovery will bring up unresolved issues and painful feelings. “As children of narcissistic parents,” Winslow explains, “we were often taught not to feel our feelings.” Recovering from narcissistic abuse, “we're going to have grief and unresolved issues come up, which is a natural part of the healing process. So we're going to experience shock and pain, anger, sadness, and fear.” Instead of feeling ashamed of such feelings, repressing or denying them, we need to acknowledge our feelings, work through them, and eventually “get to a place of acceptance and peace.” We may need professional help to work through this process. 4. Setting Healthy Boundaries. When we become aware of our feelings, we can set healthy boundaries. This can be challenging since our narcissistic parents continually violate our boundaries, and setting boundaries brings up fear of offending someone we’re close to. Winslow refers to boundaries as “safety limits” and says that now, as adults, “we're responsible for making decisions to keep ourselves safe.” We can realize that a boundary has been crossed “when we feel anger or resentment. And then we can communicate that boundary to other people in a healthy and respectful way.” To develop our ability to set boundaries, she says, we can begin by “setting boundaries with ourselves,” for example, by eating more vegetables each day. Setting our own boundaries builds our trust and confidence in ourselves so we can then set boundaries with others. 5. Becoming Our Own Inner Parent. The ultimate goal of recovery, Winslow says, is to give ourselves respect, security, stability, love, and attention we needed growing up: “We can ask ourselves, ‘what can I do to support myself emotionally, to soothe my inner child to get my needs met?’” This approach resembles internal family systems therapy (Schwartz, 1995), which works with the different parts within us. We have an inner parent, our centered self, as well as other parts, like our six-year-old, frightened child part. Our centered self can soothe that child part, saying, “I sense what you're feeling. I'm an adult, and I'll take care of you.” Recovery from narcissistic parenting is an ongoing practice. Winslow sees it as training, “like martial arts or learning a new language or a musical instrument. With practice, you're literally rewiring your brain, so things that used to send you in a tailspin no longer have power over you.” It's a continuous process of growth and development “where we can embrace our authentic selves and live our lives intentionally, free from codependency and narcissistic abuse.” This post is for informational purposes and should not substitute for psychotherapy with a qualified professional. © 2024 Diane Dreher, All Rights Reserved. Diane Dreher, Ph.D., - Website - References Winslow, P.V. (2024, March 13). Personal communication. Pi Venus Winslow is a published author, public speaker, and transformational life coach for those recovering from a narcissistic upbringing. Her mission is to empower others to reclaim their authentic selves and live intentionally free from codependency and narcissistic abuse. All references to Pi Venus Winslow are from this interview. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). Washington, D. C.: American Psychiatric Publishing. Discussion of Narcissistic Personality Disorder on pages 669-671. Childre, D., Martin, H., & Beech, D. (1999). The HeartMath solution. New York, NY: HarperCollins. Dalai Lama. (2002). How to practise. J.Hopkins (Ed. & Trans). New York, NY: Simon & Schuster. Kabat-Zinn, J. (1994). Wherever you go, there you are. New York, NY: Hyperion. LeDoux, J. (1996). The Emotional Brain. New York, NY: Simon & Schuster. Määttäi, M., Määttä, K., Uusiautti, S., & Äärelä, T. (2020). She does not control me anymore but I can hear her voice sometimes: A phenomenographic research on the resilience perceptions of children who have survived from upbringing by a narcissistic parent. European Journal of Education Studies, 6 (12), 17-39. Mahoney, D., Rockspoone, L. & Hull, J. C. (2016). Narcissism, parenting, complex trauma: The emotional consequences created for children by narcissistic parents. The Practitioner Scholar, 5 (1), 45-59. Maslow, A. H. (1971). The farther reaches of human nature. New York, NY: Viking Books. Schwartz, R. C. (1995). Internal family systems therapy. New York, NY: The Guilford Press.

Personal Perspective: Panic attacks once disrupted my life. Now I treat them. Panic recovery allowed for a re-broadening of my world and an ability to step back into my life As panic began to become demystified for me, I slowly began to feel more control over it. I learned to let go of the avoidant and safety-seeking behaviors that I thought were protecting me. The account you are about to read is deeply personal and not easy to write. But one thing I have learned about panic (and most other challenges we face) is that there is power in commonality and in recognizing that others can understand what you are facing. So, if you are struggling with panic and panic attacks , I share my story with you in mind and I hope it will help you to feel less alone. When I was around 32, I began to experience debilitating panic attacks. They would strike seemingly without warning and throw me into a state of total chaos, disorientation, and dysregulation. My body would be overcome with frightening symptoms, including a heart that seemed to beat out of my chest, a feeling of unsteadiness and lightheadedness, blurred vision, and all manner of strange yet uncomfortable and alarming physical sensations. Mentally, I felt a sense of unreality, as though in these panicked moments, nothing was real. Emotionally, fear took hold, as my physical symptoms seemed to indicate something horribly, irreversibly wrong. When I panicked, nothing felt safe. As these episodes began to occur with greater frequency, I began to panic about being panicked. I would hope and pray that today would be a day without an attack. I began to avoid situations that might elicit panic and I started to see multiple doctors, visit urgent care centers and emergency rooms, and seek specialists in order to explain why my body was doing the things it was doing. To my dismay, none of them—cardiologists, neurologists, allergists and the like—could explain it. I did not know at the time that there was no medical problem; rather, my stress response was dysregulated: I was overwhelmed, out of touch with my life circumstances, and needed help outside of a medical setting. This brings me to my recovery. I see it as a recovery because, much like a chronic illness or a debilitating injury, panic interrupted my life, obstructed my ability to be present, and forced me to narrow my experience. Recovery allowed for a re-broadening of my world and an ability to step back into my life. I never thought a sentiment as seemingly simplistic as “you are not in danger” would open the door to life without panic. But it did. The wonderful and skilled therapist who told me this recognized that underlying everything I was experiencing symptomatically was a belief that I was in danger and that doom awaited. It was not batteries of medical tests or specialists or hospital visits that finally helped my panic subside—it was a cognitive leap of faith, an allowance that maybe, just maybe there was no disaster waiting to befall me. Of course, my recovery was not as simple as just hearing a few words. I would estimate that my therapist repeated this mantra at least 50 times during our time together. It was a message I needed to hear and keep hearing. If the automatic narrative I carried with me was “I am in danger,” then I needed to continue challenging it with an opposing message. My therapist stayed on message and his support never wavered. He also educated me, explaining the mammalian brain, the primitive fear responses, and the concept of fight, flight, or freeze. He showed that recovery begins with understanding what you are facing. As panic began to become demystified for me, I slowly began to feel more control over it. Once the cognitive groundwork had been laid, I was free to begin my behavioral recovery. No longer believing that I was in imminent danger, I started to do once again the activities I had shelved in the name of safety—little things like walking my dog without an overwhelming dread that something awful would happen began to accumulate and instill a further sense of safety. I started going out again, attending events, and, essentially, broadening my life. I was recovering by letting go of the avoidant and safety-seeking behaviors that I thought were protecting me. In reality, they were limiting my life and my experiences. Though I was beginning to do better and panic less, it was a zigzag path. One particularly anxious week, I tearfully told my therapist, “I just want to never be anxious again.” In his usual gentle and compassionate manner, he replied, “You have to be reasonable with yourself. And never being anxious is unreasonable.” He was, in essence, saying that the answer was not to never be panicky; it was to accept that I might feel that way at times, but to ultimately know and believe that it did not mean a catastrophe loomed. I felt lighter. The pressure was finally off: I did not need to never be anxious. I simply needed to know that when I was, I could still be safe and OK. Funny how sometimes the biggest realizations come in the smallest moments. My therapist also encouraged me to be more aware of my life circumstances, and ask myself questions like, “Am I tired? Am I overworked? Do I have a lot on my plate?” These types of self-checks started to help me recognize that panic often occurred when I was fatigued, stretched too thin, or stressed about work and other life situations. It’s another concept that seems simple enough but that we rarely follow in actual practice. How often we simply push through our lives barely paying attention to what our bodies and minds really need. It began to all make sense: Of course, my body would freak out if I was overwhelmed and exhausted. It was trying to tell me something, namely that I was doing too much. It wasn’t trying to tell me I was in danger; it was trying to tell me to take my foot off the pedal. As I began to pay more attention to the larger life circumstances, my body did not need to alert me to them as dramatically as it had in the past. I should add that there were other important elements to my recovery beyond my experience in therapy. I began taking a low dose of an SSRI medication to help me manage anxiety and panic and I worked hard to implement the strategies I learned in therapy into my daily life. These were the things that helped me; your own recovery may not take the same path. Two years later, I enrolled in a graduate program to become a clinical social worker and, ultimately, to become a psychotherapist. If you would have told me when I was at the mercy of panic that I would be able to earn a master’s degree, hold down two years of an internship, pass two licensing exams and do 3,000 hours of clinical supervision then go on to own and operate my own practice, I would never have believed you. But here I am. In my practice, I enjoy working with people who are struggling with anxiety and panic. Why? Because I get it. And I get it beyond a textbook, a graduate-level course, or a seminar. I get it on a human level. It was, above all, humanness that helped me recover from panic. Make no mistake: I still get anxious sometimes. I even still experience panic feelings once in a while. But they do not overwhelm me as they once did. They do not pull me out of my life. I can break down how I recovered from panic this way: I let go of the shame and stigma I had previously attached to therapy. I sought help at a time when I needed it. I became a student of panic and learned everything I could about it, which allowed to gain some control over it. I learned to challenge my longstanding beliefs, particularly the one that told me “you are in danger.” I began to pay more attention to my extenuating circumstances, such as my workload, my level of fatigue, and my stressors. This helped to keep myself from reaching a panic point. I became more reasonable with my expectations of myself. I became OK with being anxious sometimes and no longer expected myself to never feel panicky. If you are reading this because you are struggling to manage panic, please know the following: Panic is scary, but you are safe. Panic can be managed. Panic does not have to rule your life. There is hope and healing. My story is only one of countless stories of coming through the discomfort of panic and stepping once again fully and safely into your life. Phil Lane, MSW, LCSW, - Website -

Some men need to be better understood; some need to better understand themselves Some men who are referred for anger management may have a right to be angry. Many men who are always angry need to learn to better experience and name their feelings so that anger isn't a default emotion. A man in better touch with his feelings is in better touch with himself, and therefore stronger and more secure in the world. As a male therapist, I get oodles of referrals from men who are told they need “ anger management. ” Most often, the person who sends them is their wife. Most men accept this diagnosis and come in sheepishly, wanting me to fix them so they don’t get angry anymore and their wives won't be upset with them. By and large, these men fall into one of two categories: (a) men who are out of touch with their inner emotional worlds, and (b) men who are being judged according to a double standard and are therefore quite rightly angry about it. I’ll deal with the second category first, because at least in my practice it’s the less common version. I recently saw a man who was very concerned about his occasional outbursts at home. He works full time and supports his family, supplying nearly 100% of the money coming in. His wife is very busy with a start-up that is not yet successful. She is consumed by her start-up and is not available for much of the care of their children , so the husband is caring for them as well. Occasionally the stress overwhelms him. He is working as many hours as she and 90% of the housework and childcare fall on him. Why wouldn’t he get angry? If the roles were reversed, would we tell her she needs anger management? I think men pay a price for having deeper voices and greater physical strength. Their anger is generally more threatening than that of a woman, so when they get angry it’s easier to focus on the implied threat than to look past it and say: “Is there something here that needs to be paid attention to?” Often in these situations, it only requires outside validation to help the man control his anger. Once he knows he’s not off the wall with his upset, that he has every right to be angry, his anger lessens. And I think it’s important for all of us to recognize the circumstances behind the anger at least as much as the expression of the upset. Related to this is the fact that many women are unaware of how deeply aggressive their forms of speaking can be. Often, they are verbally the more fluent, and while they may not shout as loudly, their words cut at least as deeply. When the man reacts in anger, she may say, "See, I told you he's always angry!" The other category is, in my experience, the more common: Men don’t have enough awareness of their inner worlds in general, and of their feelings in particular. I liken emotions to keys on a piano: Can you play the whole range of 88, from the lowest to the highest, or do you only know a few found near middle C? For most men, especially those told they need anger management, the answer is usually that they can play just a few keys: happy, sad, hungry, horny, and angry. Anger thus becomes a default emotion, standing in for all kinds of other feelings. It’s not, therefore, that the man is so angry. It’s just that anger is what he knows how to express, how to name. There’s a fancy word I like to use in these situations: Alexithymia. It means a difficulty identifying and naming emotions. Most men who come for anger management are alexithymia. Helping them recognize and name different keys on their emotional register gives them greater connection to themselves, and therefore greater control of how they behave. Initially I tell men that learning to name their feelings with their partners will improve their sex lives, because it will help their partners feel more connected to them. But ultimately, the biggest benefit is the connection a man will have with himself. Josh Gressel, Ph.D., - Website -

How to stay motivated and live the fulfilling life you want to live. Values are a compelling force leading individuals toward their motivation and drive. A growth mindset and radical flexibility are linked to higher levels of motivation. Practicing self-compassion contributes to staying motivated even when faced with setbacks and adversity. Part 1 of this series, 12 Common Barriers That Get in the Way of Your Motivation, featured discussion about the psychology of motivation and being consciously aware of the barriers that can thwart your progress. Here we’ll broach practical strategies toward increasing motivation leading to a more fulfilling and satisfying life aligned with your values and being your best self. Practical Tips for Increasing Motivation 1. Be Acquainted with Your Values. One of the most important steps toward increasing motivation is to become thoroughly acquainted with your values. In acceptance and commitment therapy (ACT), values are what we believe to be important, how we execute our daily lives, what we stand for, what guides our priorities, and what gives life deeper meaning (Collis, 2011). It is when we do not live aligned with our values that discontentment and disempowerment occur. We lose connection with ourselves, with what’s meaningful to us, and don’t behave in a mindfully driven way. To learn how to identify your intrinsic values, see my book, ACE Your Life: Unleash Your Best Self and Live the Life You Want. ​​​​​ 2. Cultivate a Growth Mindset. A growth mindset, the belief that abilities can be developed through dedication and effort, is linked to higher levels of motivation. Carol Dweck provided examples of how to cultivate a growth mindset. Instead of saying, “That’s OK, maybe patience is not one of your strengths,” which reflects a fixed mindset, reframe it to reflect a growth mindset: “I’m not a patient person yet” (Dweck, 2006). Just add yet to the end of the sentence. Dweck spoke of the importance of using language that suggests what’s expected of us as humans, that we’re always learning, growing, and evolving. This helps to keep up motivation, momentum, and sustainability of behaviors . 3. Impose Radical Flexibility. Those who are resilient tap into their personal strengths, are perpetually curious, and are open to new experiences, ideas, and possibilities. They are willing to experience a full range of intense emotions and tend to be more proactive at doing things that make their lives more fulfilling despite their circumstances. Stagnation comes with rigidity, an attachment to outcomes, and paying attention unilaterally to results rather than the process. That includes flexibility with routines; for example, if you have a set routine, notice the process and try changing it up occasionally. Choose different degrees of challenge, times, or environments to keep tasks engaging. 4. Recognize That All Thoughts and Feelings Are Noticed, Welcomed, and Moved Through. All thoughts and feelings have utility and are necessary to remind us of what’s important to us. They represent what you have, not who you are. They show up because your mind is neurobiologically wired for safety and protection. This is positive and essential. Thoughts and feelings are not to be demonized, resisted against, or avoided, but rather noticed, welcomed, and moved through, which inevitably results in mindful value-driven behavior. For example, instead of engaging in automatic negative thoughts that inhibit your motivation and behavior, recognize that you’re having thoughts in the present moment. Observe them for what they are and the meaning they hold, merely thoughts trying to protect you from fear, hurt, discomfort, or gravitating toward the familiar; they don’t necessarily need to be acted upon. Be motivated to behave based on who you are and strive to be. 5. Build a Routine and Be Routinized. Routines can help people move forward even on days when motivation is lacking. When behaviors become habits, the brain requires less energy to engage in them. Establishing a consistent routine around a goal—such as exercising at the same time each day—can reduce the need for constant motivation and make goal-directed behavior more automatic (Clear, 2018). Approach your life with consistent structure and organization with the ability to pivot and be flexible when necessary. Also, always show up, even if you don’t feel like it. Your endorphins, dopamine, or other neurotransmitters will compel your motivation after you’ve taken the first step. 6. Use Positive Reinforcement. Rewarding yourself for completing tasks can increase motivation. Extrinsic rewards can be as simplistic as taking a short break or watching a movie after a productive day. These rewards reinforce positive behaviors and make it more likely that you’ll continue. It can be especially helpful for maintaining motivation for repetitive or challenging tasks (Deci et al., 1999). However, it’s essential to use rewards judiciously. Over time, shift your focus to the intrinsic rewards of a task—such as the sense of accomplishment or learning—so that motivation becomes more self-sustaining. 7. Leverage Positive Social Influence. Positive social influence is a powerful motivator. Surrounding yourself with motivated individuals, mentors, or supportive friends can reinforce your commitment and motivation (Reeve, 2009). Engaging in group activities, joining a club, or finding an accountability partner can help keep you motivated, encouraged, focused, and accountable. Engaging with people who share similar goals can increase motivation through mutual support and shared achievements. 8. Increase Autonomy in Tasks and Build Self-Efficacy. According to self-determination theory (SDT), autonomy, or the feeling of control over one’s actions, is crucial for intrinsic motivation (Deci & Ryan, 2000). Allowing for more flexibility and choice in your tasks can increase motivation. Self-efficacy is strengthened through repeated successes and constructive feedback. To increase self-efficacy smart small and begin with tasks that are achievable and gradually increase difficulty to build confidence. Constructive feedback can improve the belief in your abilities, especially when feedback emphasizes your effort and progress. 9. Set Specific and Achievable Goals. One of the most effective strategies for increasing motivation is to set SMART goals: specific, measurable, achievable, relevant, and time-bound. Research shows that clear and challenging goals lead to higher motivation levels than vague objectives (Locke & Latham, 2002). Personalize goals and break larger goals into smaller more manageable steps. For example, instead of setting a broad goal like “be healthier,” create a plan with specific actions, such as exercising for 20 minutes three times a week. Achieving smaller milestones along the way provides a sense of accomplishment and helps build momentum. Also, always keep in mind rest, recovery, mindfulness, and stress management for continual motivation and sustained progress. 10. Visualize Success. Visualization, or mentally rehearsing success, has been shown to increase self-efficacy by creating a positive mental picture of achievement. Research shows that visualization enhances mental rehearsal, preparing individuals for real-life challenges (Taylor & Pham, 1999). It is a technique used by athletes and successful professionals to boost motivation. By imagining the steps to achieve a goal and visualizing success, you can reinforce your commitment and increase motivation. 11. Practice Self-Compassion. Self-compassion or treating yourself thoughtfully and kindly during difficult times helps reduce fear of failure and increases resilience. Focusing on self-criticism after setbacks can lead to reduced motivation. Studies have shown that self-compassionate individuals are more likely to stay motivated even when facing setbacks and adversity because they are less harshly critical of themselves and are more likely to bounce back more readily (Neff, 2003). When encountering challenges or experiencing self-doubt, use self-compassionate language. Remind yourself that mistakes are part of learning, and that perseverance is key. Increasing motivation requires a combination of psychological insights, actionable strategies, and self-awareness. Through cultivating a mindset and environment conducive to sustained motivation, you can make it easier to pursue and achieve your goals, paving the way toward living the life you were meant to live and being the person, you are meant to be and strive to be. To help motivate and inspire you, listen to my Motivation and Inspiration Guided Meditation. Michelle P. Maidenberg, Ph.D., MPH, LCSW-R, CGP - Website - References Clear, J. (2018). Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones. Penguin. Collis, R. (2011). Getting Clear About Values. Deci, E. L., & Ryan, R. M. (2000). The "what" and "why" of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227-268. Deci, E. L., Koestner, R., & Ryan, R. M. (1999). A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychological Bulletin, 125(6), 627. Dweck, C. S. (2006). Mindset: The New Psychology of Success. Random House. Locke, E. A., & Latham, G. P. (2002). Building a practically useful theory of goal setting and task motivation. American Psychologist, 57(9), 705-717. Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85-101. Reeve, J. (2009). Understanding motivation and emotion. John Wiley & Sons. Taylor, S. E., & Pham, L. B. (1999). The effect of mental imagery on goal completion. Journal of Personality an d Social Psychology, 66(3), 510-523.

Practical strategies for parents and educators to foster confidence and calm. Recognize the signs of anxiety in children, such as school avoidance or stomachaches. Create a supportive and predictable environment in school. Collaborate with teachers and school staff in the process. If your child has anxiety , school can be a daily struggle. Your child or teen may resist getting out of bed, express physical complaints like stomachaches or headaches before bed or in the morning, or struggle to make friends. Some subjects may feel especially challenging, and the noise and activity of the school environment can be overwhelming. The reasons for school-related anxiety can vary, but one thing is clear: when a child is preoccupied with worry, it’s hard for them to focus on academics. Over time, this can lead to a cycle of frustration and fear, with each worry feeding into the next. An anxious child’s inner dialogue might sound something like this: “I can’t focus because I’m worrying about my mom’s safety, so now I missed the math lesson. I don’t know how to solve these problems, but I’m afraid to ask for help. My teacher will be upset with me. Now I have a homework sheet of 20 problems I don’t understand. And I have science and spelling homework, too. Samantha wouldn’t play with me today—did I do something wrong? What did the teacher just say? Was that the bell? Are we going to gym? I can’t do this!” How Can I Help My Anxious Child Succeed in School? Fortunately, there are support plans available that can help. These come in two forms: a 504 Accommodation Plan and an Individualized Education Plan (IEP). 504 Accommodation Plan A 504 Accommodation Plan provides support once a diagnosis is in place. Created by a team including parents, the principal, the school nurse, teachers, and a counselor, this plan offers accommodations that help your child manage their anxiety at school. It’s valid for a year and can be updated annually, though reviewing every three months is often beneficial as a child’s needs can fluctuate throughout the year. Common 504 accommodations for anxiety include: Daily check-ins: Inform the school team—principal, counselor, and teacher—about your child’s challenges so they can help make the morning routine smoother. Arrangements could include a designated staff member to meet your child at drop-off to ease separation and transition. Flexible attendance: If attending a full day is overwhelming, consider a gradual return—starting with a half-day and slowly adding classes as your child adjusts. Staggered entry: Allowing your child to arrive before or after the morning rush can reduce anxiety about crowded hallways. Regular check-ins: Establishing a trusted adult (like a guidance counselor) who meets with your child regularly or on an as-needed basis can provide comfort and support. Individualized Education Plan (IEP) An IEP provides specialized education and additional resources if a child’s anxiety significantly impacts their learning. This program can include in-class support or co-teaching for challenging subjects. It involves a case manager from the Child Study Team (CST) and may include testing by the CST or from a clinical psychologist. For children who have co-existing conditions such as ADHD or specific learning disabilities, the support can be even more comprehensive. Out-of-class resource programs might provide modified curriculum support tailored to their abilities. An IEP can include 504 accommodations along with additional options such as: Reduced workload and homework: Completing only selected problems (e.g., odds or evens) can make assignments feel more manageable. Avoidance of spotlight: Allow your child to volunteer instead of calling on him to avoid added pressure. Breaks as needed: Giving your child permission to take breaks when they feel overwhelmed can help them reset. Safe space: Designate a quiet space in the school where your child can go to decompress. Extended time: Allowing extra time on assignments, tests, and quizzes can ease performance pressure. Quiet testing environment: Permit your child to complete tests or assignments in a quieter setting if needed. The Real Impact of Anxiety on School Life Anxiety can profoundly impact a child’s school experience. For many, holding it together at school means they’re exhausted by the time they get home, leading to emotional outbursts that can be difficult for the family . As a parent, sharing your child’s struggles with teachers, counselors, and the principal can provide much-needed support and reduce your own burden. By involving the school in your child’s daily challenges, you can help them find relief during the school day rather than bearing the weight of their anxiety alone until they come home. Liz Nissim-Matheis, Ph.D., - Website -

Schizoaffective disorder and schizophrenia differ, including in remission rates. Schizoaffective disorder is often mistaken for schizophrenia. Schizophrenia and schizoaffective disorder are distinguished from each other by type of affect. Patients with schizoaffective disorder are more likely to experience remission than those with schizophrenia. Advocating for rights for people with schizophrenia is a tough lifestyle. In fact, there are only a handful of activists in the United States who have successfully executed writing a memoir, starting a YouTube channel, and gathering a following. What is less spoken about is that these activists often do not exactly have a schizophrenia diagnosis in the true sense. Many of us advocating for schizophrenia education have schizoaffective disorder instead. It is easy to conflate the two because both disorders display classic symptoms of psychosis: delusions, word salads, and hallucinations, to name a few. But the two differ primarily on one distinction: Schizoaffective disorder comes with the debilitating effect of extreme moods, and schizophrenia often results in a lack of affect, or mood . Schizoaffective disorder’s mood categorization is based on whether or not the patient is exhibiting either depression episodes or both mania and depression symptoms, resulting in either Schizoaffective Disorder Type I or Type II. A patient will get diagnosed with schizoaffective disorder rather than bipolar disorder with psychotic symptoms when the patient experiences psychotic symptoms outside of the manic and depressive episodes. Psychosis in bipolar is more of an effect of the moods, while psychotic symptoms in schizoaffective disorder are the primary debilitating factor. What the Research Says About Recovery So why does it seem like people with schizoaffective disorder are more public and seemingly better in prognosis than people with schizophrenia? Some studies have looked into this issue. In Italy in 2014, for example, researchers looked into remission and recovery rates in patients with schizophrenia and patients with schizoaffective disorder. Participants included 102 people: 46 diagnosed with schizophrenia and 66 with schizoaffective disorder. What they found was that schizoaffective disorder was more commonly diagnosed in females, while schizophrenia patients were more often male. The percentage of those in remission (which is when symptoms become less severe) was higher in those with schizoaffective disorder than those with schizophrenia. Patients with schizoaffective disorder had a statistically significant rate of 42.4 percent of patients in remission compared to 23.9 percent of individuals with schizophrenia. Recovery was also better for individuals with schizoaffective disorder than for individuals with schizophrenia. Those rates that were statistically significant were 22.7 percent of schizoaffective patients versus 6.5 percent of schizophrenia patients. A similar percentage of patients were placed on the same first-generation antipsychotics (33.3 percent of schizoaffective patients and 34.8 percent of schizoaffective patients), while 73.9 percent of schizophrenia patients and 78.8 percent of schizoaffective patients were put on second-generation antipsychotics (which are thought to be more effective with fewer side effects), which shows many were treated with the same methods. People with schizoaffective disorder were more often prescribed benzodiazepines (like Xanax and Klonopin) and mood stabilizers. The researchers were puzzled about why this was but speculated that schizoaffective patients have more mood components, which could somehow affect prognosis. Additionally, studies conducted in other countries—for instance, in Israel—reported unreliable diagnoses of schizoaffective disorder throughout time. People with schizoaffective disorder were more likely to be misdiagnosed and have their diagnosis changed compared to people who received the diagnosis of schizophrenia. Schizoaffective disorder remains a controversial diagnosis, and because it is commonly misattributed to patients it can be difficult to determine how truly distinct it is as a diagnosis when the patient can easily fit many criteria for other disorders. It is clear that patients who have schizophrenia differ in fundamental ways from those who have schizoaffective disorder. How those differences are explained is currently unknown, but statistical rates of recovery indicate that there are some reasons why people with schizoaffective disorder more frequently recover and experience remission. Sarah An Myers References Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016. Pinna, F., Sanna, L., Perra, V., Randaccio, R. P., Diana, E., Carpiniello, B., & Cagliari Recovery Study Group. (2014). Long-term outcome of schizoaffective disorder. Are there any differences with respect to schizophrenia? Rivista di psichiatria, 49(1), 41-49. Florentin, S., Reuveni, I., Rosca, P., Zwi-Ran, S. R., & Neumark, Y. (2023). Schizophrenia or schizoaffective disorder? A 50-year assessment of diagnostic stability based on a national case registry. Schizophrenia Research, 252, 110-117.

Children's sleep can be affected by what peers do and say. Children and adolescents may experience many kinds of discrimination. These experiences create emotional distress and can lead to disrupted sleep. Parents should be aware that distressing experiences can be a cause of their children's sleep problems. Despite the old saying about sticks and stones, others’ words really can be hurtful. It is an unfortunate aspect of growing up that many children and teens are frequently mean to one another. Ridicule, exclusion, discrimination, and bullying of others are pervasive and can be based on many characteristics, including attractiveness, body shape or size, gender, race and ethnicity , nationality, social class, clothing, religion, politics, language and speech, intelligence and academic ability, or physical ability (did I leave anything out?). These kinds of situations are not new, of course, but the availability of social media has amplified the opportunities and even afforded anonymity in some instances (e.g., the number of “likes”). Rejection by peers can have devastating effects, including emotional distress, anxiety , depression , eating disorders , and self-harm. Do these experiences also influence sleep? Sleep disruptions, including the inability to fall asleep or stay asleep, nightmares, and nocturnal enuresis, are common in children and adolescents , but the research on the relationship between distressing experiences and sleep is relatively sparse. So what has the research revealed? Dr. Tiffany Yip and colleagues have provided an excellent recent review of research in this area. Their focus is on racial/ethnic discrimination and sleep, with discrimination documented in most instances through daily diaries and sleep measured in various ways including self-report and objective measurement with wrist actigraphy. The evidence is clear: Experiencing discrimination and even witnessing others being discriminated against is associated with shorter sleep duration, more difficulty falling asleep, poorer sleep quality, and daytime sleepiness. These effects are even seen in longitudinal designs where sleep can be affected weeks or months later. Sleep is a modifiable behavior, and the authors describe numerous studies that have shown some effective interventions to help children and adolescents sleep better. Improvements in sleep hygiene (e.g., reducing caffeine intake and use of social media in the evenings), cognitive behavioral therapy, and education about sleep are among interventions that have had success. Unfortunately, the authors could find no intervention studies specifically aimed at those who experience discrimination, and they highlight the need for such studies. Interventions by psychological, medical, and educational professionals are beneficial but rarely available to those who might need them. But talking to children daily about their interactions with others at school or on social media is something any parent can do. While it is impossible to shield children from distressing experiences, processing them with a parent or an older sibling can be beneficial. Parents can also take note when their children are not sleeping well and recognize that discrimination can be a cause. Joseph A. Buckhalt, Ph.D., References Yip, T. et al. (2024). Developmental links between ethnic and racial discrimination and sleep. Child Development Perspectives. 24 April 2024.

Discover the keys to healthy giving. Are you "overly nice" and suffering as a result? What I mean by this is that empaths and many caring people often burn themselves out by over-giving and don’t know when to back off. They mean well. But what’s missing is balance and knowing when to give less and replenish themselves. I’ve known people who've sacrificed their last molecule trying to help someone who may not have even wanted their help. Or they've exhausted themselves by trying to fix others. To maximize how your giving can heal others and yourself, learn to remain discerning and balanced. Neuroscience has confirmed numerous ways that healthy giving enhances wellness. For instance, volunteering has been shown to lower stress levels, reduce depression , and lessen your aches and pains. Plus, MRI scans have demonstrated that donating to a worthy cause increases dopamine, the pleasure hormone. Contributing to a community also has been proven to enhance people’s ability to cope with addiction and bereavement. The desire to give flows naturally from having empathy. You care. You want to help. So you offer your time, your knowledge, and your energy. (For me, time is my most valuable gift.) Perhaps you listen to a coworker going through a tough divorce or you do a load of wash for an ailing neighbor. Maybe you simply smile at a stranger. It’s a myth that healthy giving is only unconditional or selfless. Healthy giving may also be conditional. Healthy giving comes from your heart but is also about setting boundaries in situations that warrant it and practicing self-care. One form of giving is showing someone appreciation, whether it’s for taking out the trash, filling in for them at work, or writing a moving novel. Appreciation helps people feel validated and flourish. It can lift you out of a miserable mood so you can think, “Maybe this situation isn’t so bad after all.” I teach my patients, and the UCLA psychiatric residents I supervise, how to give wisely—sometimes a life-or-death concern. It’s a lesson in balancing and conserving energy that many of us overly nice people need to learn. You too can learn to empathize without sacrificing your own well-being. Following are some positive traits of healthy giving: Empathize without feeling drained Practice random acts of kindness Set healthy boundaries, such as saying a positive “no” Prioritize self-care, rest, and alone time to replenish energy Feel nourished by giving Know your own limits Accept support Delegate responsibilities Allow others the dignity of their own path without interfering (Source: The Genius of Empathy) To feel more energized and balanced in your giving, experiment with incorporating these traits into your life. Learning to balance empathy with self-care is a beautiful ongoing healing process. I’m inspired by the 14th Dalai Lama’s prayer about helping others in the book Ethics for the New Millennium, in which he seeks to be “a guide for those who have lost their way” and “a bridge for those with rivers to cross.” In our own unique styles, we can do this too. Judith Orloff, M.D., - Website -

Your anxiety helps to keep your child safe. We are living in an era of escalating tensions, conflicts, and worries. Some call it a "stress epidemic." The Surgeon General has warned that parents are a lot more stressed than others, dangerously stressed in fact. So much is out of your control, but some important things are within your control. Love your child. Accept your anxiety. Be kind to yourself. Reach out for help. Help others. You've got this! Being a parent today means feeling stressed. In fact, the U.S. Surgeon General has issued a “ dangerous stress ” warning to American parents. Knowing that you’re in good company—that most other parents are also super stressed—might give you some comfort, but that’s not enough to help you manage those feelings. To begin with, it’s good to acknowledge that we’re living in a climate of escalating fear, where everyday advertisers, politicians, and experts give us new reasons to worry. And the message is megaphoned up a few notches for parents. On top of everything else, you’re being told that you should also worry about your child’s or adolescent’s behavior, their development, their mental health, your parenting, school shootings, drugs, social media predators, the environment. So much can go so wrong. And in case you’re not anxious enough already, here's one more thing to add to your stress bundle: Your anxiety may be contributing to your child experiencing mental health problems of their own. I am not advocating that you stop worrying altogether; a certain level of anxiety helps keep you safe. It’s important to pay attention to what’s going on for your child and in the world, so that you can do whatever needs doing to keep your family and community strong and healthy. You Can Do This. What I am advocating is that you connect to the love you feel for your child, and do your best to take good care of yourself. Simple, right? Maybe not, but when you’re feeling strong and calm, you’re in the best possible place to give your child what they need, thereby allaying your anxiety and theirs. 7 Suggestions for Muddling Through Love your child. No matter what else is going on in the world, in your family, and with your child, connect with the loving connection you feel for your child. They feel your love, and need that more than anything you can buy or do for them. This is priority Number One. Acknowledge your anxiety. Let it be okay to be anxious. Anxiety is not only normal and predictable in a chaotic world (and even more so if you’re a parent) but it’s also helpful in keeping yourself and your family and your community safe. Take good care of yourself. Nutrition, sleep, exercise, outdoor time, social time, quiet time—all those good things you try to make sure your child gets enough of are important for you too. You’re a better parent when you’re feeling strong and healthy and happy, so look for ways to make that happen. Ask for help. Parents today feel more alone and isolated than ever. If that describes you, it’s time to put some energy into cultivating your network of social support. Talk to friends, relatives, neighbors, or professionals about what’s troubling you, or just get together for a cup of coffee with someone. Help others. Look for others who might benefit from some help. That can be small-scale, like taking a dozen cookies to your neighbor who’s struggling with toddler twins, or it can be large-scale, like getting politically active because you see a need for change. The neurochemistry of giving to others is potent. When you help someone else, you strengthen your network of social support, and you feel better about yourself and your problems. You're also making the world a better place, and that's ultimately good for your anxiety and your child's future. Be kind. Be patient with yourself and with your child. Do your best to be kind to yourself, and to be present as often as possible to what’s good about this child in this moment. Love your child. At the end of the day, your solid dependable love is what matters most. When you’re showing up with love in your heart, it’s hard to be too anxious, especially if you’re also taking good enough care of yourself. Yes, it’s a time of heightened anxiety for everyone, for a lot of terrible reasons, and a time when parents more than others are feeling completely stressed out. But you won’t be much good to yourself or your child if you let yourself be overwhelmed by that. So, take a deep breath and think about how you can take good care of yourself today. Dona Matthews, Ph.D., - Website - References “Parental Mental Health & Well-Being,” from the Office of the Surgeon General, US Dept of Health and Human Services “The Surgeon General's Advisory on Parental Stress,” by Eugene Beresin “Infographic: Stress in Parents Compared to Other Adults,” American Psychological Association “The Anxious Generation We Should Be Talking About,” by Emily Edlyn “Stressed Parents—Voila, Stressed Kids,” by Janet Hibbs and Anthony Rostain “How to Feel Less Stressed as a Parent,” by Cara Goodwin “Parent Stress Is a Serious Public Health Concern,” by Cara Goodwin “Prepared to Care: The Case for Kindness and Self-Kindness,” by Tracy Dennis-Tiwary

No two people have the exact same depression. What explains these differences? Depression affects 280 million people, but it looks different in everyone. How we define depression plays a huge role. Age, sex, and cultural differences also play a role. Globally, over 280 million people have depression . But if you were to ask a random sample of 1,000 people to describe their depression, you would have a low chance of finding two people who have the exact same experience. Why is that? Defining Depression We first need to define depression to understand why it looks different in everyone. Depression, or a Major Depressive Episode, is a mental health diagnosis that is characterized by nine symptoms: (1) depressed mood ; (2) “anhedonia,” or markedly diminished interest or pleasure; (3) increase or decrease in either weight or appetite; (4) insomnia or hypersomnia; (5) psychomotor agitation or retardation; (6) fatigue or loss of energy; (7) feelings of worthlessness or inappropriate guilt; (8) diminished ability to think or concentrate, or indecisiveness; and (9) recurrent thoughts of death or recurrent suicidal ideation (American Psychiatric Association, 2022). A diagnosis requires that someone has at least five of these symptoms, one of which must be either depressed mood or anhedonia. These symptoms need to be persistent for at least two weeks and cause significant distress or impairment. Additionally, these symptoms should not be better explained by another factor, like a new medication. So, if we have these defined criteria, why does depression vary so much from person to person? 5 Reasons Why Depression Looks Different in Everyone 1. The criteria are not one-size-fits-all. The definition of depression, itself, invites differences from person to person. Research shows that it is rare that any two individuals will have the exact same combination of symptoms—as you can see in the criteria above, depression is defined by a combination of five out of nine symptoms. One study, led by Eiko Fried and Randolph Nesse (2015), analyzed over 3,000 patients and investigated how often patients share the same symptom experience. Their study revealed that how we define depression can result in over 1,030 unique symptom profiles! The most common symptom profile was only endorsed by 1.8% of the sample. Put simply, there are many, many ways to meet the criteria for depression. 2. Depression is defined by subjective experiences. Depression is a diagnosis that is rooted in subjective experiences like mood, emotions, thoughts, and behaviors. The word “subjective” does not mean someone’s experience is not real—if someone feels sad, then they feel sad. But as a psychologist, I cannot give someone a blood test to assess if they are “happy” or “sad,” nor can I use a brain scan to assess for suicidal thoughts. Even for the physical symptoms, like loss of energy, there is no reliable objective test to determine the severity of someone’s fatigue. To diagnose depression, clinicians must conduct interviews with patients to assess how they feel. And, as we all know, one person’s “sad” looks a lot different than another person’s “sad.” 3. Depression presents differently across age groups. How depression looks can vary across children , teenagers , and adults . Research shows that specific symptoms may show up more frequently in certain age groups. In one study by Rice and colleagues (2019), they analyzed how frequently depression symptoms were endorsed by adolescents and adults. Their study found that “vegetative symptoms”—like appetite and weight change, loss of energy, and insomnia—were more commonly seen in adolescent depression than adult depression. Meanwhile, adult depression was more likely to include symptoms of anhedonia and concentration problems. These findings can help people become more sensitive to noticing signs of depression based on age. 4. Sex differences exist between men and women. Large global studies have consistently found that women are more likely to be diagnosed with depression than men. Among adults in the United States, 10.3% of women—compared to 6.2% of men—met criteria for depression in 2021 (NIMH, 2023). The reasons for these sex differences are complex, driven by an interplay of social, psychological, and biological factors (Eid et al., 2019). It is also possible that how we define depression makes it easier for women to meet the criteria, and men may present with depression differently (Martin et al., 2013). In support of this idea, Cavanagh and colleagues (2017) conducted a large review of studies and found that men with depression were more likely to have difficulties with alcohol use, drug use, and risk-taking/poor impulse control behaviors. Meanwhile, women had a higher frequency and severity of traditional depression criteria, like depressed mood, appetite/weight changes, and sleep difficulties. Recognizing these differences can help both men and women get help for depression. 5. Cultural differences are real, but more research is needed to understand these differences. Cross-cultural research shows that the expression of positive and negative emotions can vary across countries and cultures. This is important to note because depression—a diagnosis characterized by mood and emotions—is mostly defined from a Westernized perspective. The criteria were not developed and tested in other countries, and thus our estimates of depression around the world may be somewhat biased. For example, a multinational analysis of 116 countries found that countries meaningfully varied in their expression and valuing of emotions (Tay et al., 2011). While the range of emotions if felt universally across cultures, some cultures are more likely to express joy than others, and the same rule of thumb applies for negative emotions (Cordaro et al., 2018). However, a new study by Panaite and Cohen (2024) found some consistency across countries in terms of how emotions were reported among adults with depression, compared to adults without depression. Their study highlighted the need for more cross-cultural research to understand the complexities of how depression is experienced across the world. The Takeaway There is no “one” look to depression. Depression does not have one mascot that represents everyone’s experience. However, by understanding why depression varies from person to person, we are better positioned to provide one-fits-one care and support from person to person. Andrew Devendorf, Ph.D., - Website - References American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Cordaro, D. T., Sun, R., Keltner, D., Kamble, S., Huddar, N., & McNeil, G. (2018). Universals and cultural variations in 22 emotional expressions across five cultures. Emotion, 18(1), 75. Eid, R. S., Gobinath, A. R., & Galea, L. A. (2019). Sex differences in depression: Insights from clinical and preclinical studies. Progress in Neurobiology, 176, 86-102. Fried, E. I., & Nesse, R. M. (2015). Depression is not a consistent syndrome: An investigation of unique symptom patterns in the STAR* D study. Journal of Affective Disorders, 172, 96-102. Haroz, E. E., Ritchey, M., Bass, J. K., Kohrt, B. A., Augustinavicius, J., Michalopoulos, L., ... & Bolton, P. (2017). How is depression experienced around the world? A systematic review of qualitative literature. Social Science & Medicine, 183, 151-162. National Institute of Mental Health (NIMH). (2023). Major Depression. Panaite, V., & Cohen, N. (2023). Does Major Depression Differentially Affect Daily Affect in Adults From Six Middle-Income Countries: China, Ghana, India, Mexico, Russian Federation, and South Africa?. Clinical Psychological Science, 21677026231194601. Rice, F., Riglin, L., Lomax, T., Souter, E., Potter, R., Smith, D. J., ... & Thapar, A. (2019). Adolescent and adult differences in major depression symptom profiles. Journal of Affective Disorders, 243, 175-181. Tay, L., Diener, E., Drasgow, F., & Vermunt, J. K. (2011). Multilevel mixed-measurement IRT analysis: An explication and application to self-reported emotions across the world. Organizational Research Methods, 14(1), 177-207.

Battling blurred lines in your personal and professional relationships Establishing healthy boundaries is how one can take control of unhealthy intrusions, demands, or expectations. Setting healthy boundaries is a great first step, but some people in one's life may challenge or ignore them. It is important to understand the dos and don’ts of maintaining healthy boundaries. We all struggle with some people in our lives ignoring our boundaries, and then we wonder how we can maintain our boundaries in the future and remain focused and connected to our healing and growth while living with hurt feelings. As human beings, we are social animals. We thrive through our social networks throughout our lives. Together, we learn and grow. We define who we are, what we want, how we treat others, and how we wish to be treated. At times, we find it necessary to create healthy boundaries between ourselves and the people in our lives. Healthy personal boundaries work in the same way as a well-constructed and maintained fence. While most of us are familiar with the phrase, “Good fences make good neighbors,” few are familiar with its origin in a 1914 poem by Robert Frost called “ Mending Wall. ” In this poem, the author examines the often-fraught interpersonal dynamics of two neighbors who learn a lot about boundaries through their evolving desire to engage and challenge one another while attempting to respect one another’s property. When we set out to establish healthy boundaries with the people in our lives, what we are essentially doing is correcting unhealthy patterns of over-dependency in relationships and other problematic habits we have identified that no longer serve us and focusing on our self-care and well-being. While we don’t intend to upset friends or family members by appearing aloof or uncaring or wish to be perceived as unprofessional or irresponsible by colleagues and supervisors when we suffer from stress, burnout, and feelings of overwhelm due to a lack of boundaries, we often encounter resistance to our new rules. The purpose of new rules When we create healthy boundaries for ourselves, we are essentially rewriting our rules of engagement. These new rules define our boundaries and protect us from unhealthy and unwelcome intrusions, demands, and expectations. They also enable us to build mutually respectful relationships and manage our finite resources of time and energy. Defining and defending your boundaries Setting healthy boundaries takes a great deal of self-reflection and effort. Then, once our boundaries are set, we need to communicate them to the people in our lives. Though it might be reasonable to assume that once we have set and communicated our boundaries to the people in our lives, all will be well, the reality is that what follows can be a time of great challenge and effort. Especially when we have set boundaries to address the long-term negative impacts of people-pleasing and prioritizing the needs of our friends, family members, and workplaces over our self-care, life tasks, and responsibilities, our new rules are unlikely to go unchallenged. There are, of course, times when it is reasonable to ignore our boundaries and say yes to a colleague or supervisor facing a looming deadline, a friend in crisis, or a family member who needs our help. Managing resistance to change When you establish healthy boundaries that change long-standing dynamics with friends, family members, and colleagues, there are likely to be some people who struggle to understand or accept the changes. There may also be people in your life who challenge your new rules for myriad reasons. Some may not take your efforts seriously. Others—especially those who stand to lose some or all of the benefits of your time, attention, and energy—may find adjusting to your boundaries inconvenient and troublesome. You may find that those who have benefited from your former lack of boundaries often try to challenge your boundaries by engaging in manipulative tactics that seek to appeal to your compassion, concern, and sense of responsibility, and blur the lines you have drawn about your time and energy. The Dos And Don’ts of Maintaining Healthy Boundaries Your healthy boundaries are yours and yours alone. It is up to you to stand your ground and stay committed to defending your boundaries against the people in your life who struggle to accept your new rules of engagement. Don’t personalize the actions, reactions, and choices of other people: Some people in your life may struggle to understand your new rules. Their reactions reflect their struggles rather than your efforts to make changes for your betterment and well-being. Don’t give in to guilt: Guilt is a red flag emotion. When you feel guilty for standing your ground, it is a sign that someone wants something from you that you are not comfortable giving. Do stay aligned and committed to your highest and best: Remember why you established healthy boundaries, and how much these boundaries have helped you reduce stress, create healthier relationships, and manage your time and energy. Pay attention to who challenges your boundaries: Chances are that the people who challenge or ignore your boundaries played a huge part in your decision to create boundaries in the first place. Be prepared for push-back. Have compassion for yourself and others while you adjust to your new rules. Change takes time. Stay connected to your feelings and be patient with those in your life who challenge and resist your new boundaries. This article is brought to you by Psychology Today - Website - Monica Vermani, C. Psych., - Website -

Strategies to heal and cultivate healthier connections after childhood trauma. Lack of attachment or feeling unsafe can make it hard for trauma survivors to build healthy adult connections. Trauma can impact survivors' ability to trust, express emotions, set boundaries, and regulate emotions. Survivors heal and build healthy relationships through self-awareness, boundaries, compassion, and support. Do you often wonder if your partner will be there for you when you need them the most? During conflicts, do you tend to withdraw, push your partner away, or react with an emotional outburst? Do you also have difficulty expressing or asserting your needs in relationships? If you've experienced childhood abuse —whether physical, sexual, or emotional—you may be facing relational challenges. Childhood trauma can have a lasting effect on your ability to form healthy, secure attachment s in adulthood. The quality of our early relationships, particularly with primary caregivers, plays a significant role in how we connect with others as adults, especially in intimate relationships (Silva et al., 2024). Why Childhood Trauma Makes Emotional Connections Challenging In my clinical practice, trauma survivors frequently express dissatisfaction in their relationships. These challenges often stem from core beliefs such as " No one can be trusted, " " I can't express my feelings safely ," or " I am unworthy of love. " These beliefs, common among trauma survivors, can significantly impact the ability to trust others and create difficulties in forming and maintaining healthy connections (Ferrajäo & Elklit, 2020). Secure attachments in childhood help us build trust, feel safe, and regulate emotion—key factors for healthy relationships in adulthood. Conversely, a childhood marked by abuse can result in insecure attachments, leaving lasting emotional scars that carry into adulthood (Bowlby, 1973). If this resonates with your childhood experience, you may struggle with trust, self-confidence, and emotion regulation, which can impact your communication , conflict resolution, and connection with partners (Heller & LaPierre, 2012). How Trauma Impacts Relationships 1. Challenges With Trust and Emotional Intimacy. It’s natural to struggle with trust and vulnerability after experiencing abuse and broken trust in childhood. For trauma survivors, vulnerability can feel unsafe, and expressing emotions might have previously resulted in rejection or harm. As a result, you may have developed coping mechanisms, such as emotional withdrawal or repression. While these mechanisms protect you, they can also create emotional distance in your relationships, leading to misunderstandings and disengagement. If you find yourself doubting whether your partner will be there for you when needed, you may react with jealousy, withdraw, or even try to sabotage the relationship during conflicts. While this is a defense mechanism against further hurt, it prevents deeper connections from forming. 2. Fear of Abandonment or Rejection. Feeling unsupported in childhood and internalizing the belief that you are unworthy of love can create a fear of abandonment by your partner, leading to persistent anxiety. If this resonates with you, reflect on whether you tend to cling to your partner, overanalyze situations for signs of rejection, rely too heavily on them for emotional support, or push them away at the slightest hint of abandonment. These actions can unintentionally create the very situation you fear. 3. Struggles With Boundaries. Childhood abuse often involves blurred or violated boundaries, making it difficult to establish healthy boundaries in adulthood. This might show up in intimate relationships as challenges asserting your needs, respecting your partner's boundaries, or maintaining your sense of self. These struggles lead to resentment, burnout, or emotional exhaustion. 4. Difficulty Regulating Emotions. As children, we learn to regulate emotions through our caregivers' example. However, childhood trauma can leave us without healthy emotional coping skills. Reflect on how you respond to stress or conflict in relationships—do you have intense outbursts, withdraw, or shut down? These signs of emotional dysregulation can create a toxic cycle in relationships, leaving partners feeling overwhelmed, confused, or hurt. As conflicts escalate, this can lead to further disconnection and misunderstanding. 4 Strategies for Healing and Building Healthy Relationships While the effects of childhood trauma on adult relationships can be significant, they are not permanent. Healing is possible. Here are some strategies that can help: 1. Self-Awareness. One of the first steps in healing from childhood trauma is building self-awareness. Recognizing trauma-based patterns and understanding the roots of your fears and insecurities can help you break unhelpful behaviors in relationships. Self-reflection exercises, journaling, and mindfulness practices can all be helpful tools for fostering greater awareness. 2. Communication and Establishing Healthy Boundaries: Effective communication is essential for building trust and intimacy. For those who struggle with vulnerability, taking small steps toward openness can gradually deepen emotional closeness. Approach the conversation with calmness and clarity about your needs. Practicing assertiveness and self-respect is key to breaking the cycle of trauma-related people-pleasing. Set clear, reasonable consequences for when your boundaries are crossed. For example, if your partner tends to ignore you when you speak, use “I feel” statements to express your needs and emotions without blaming them. You might say, “I feel hurt when I’m ignored. If that happens again, I’ll need to speak to a friend who will listen.” 3. Compassion: Healing from trauma is not linear, and it takes time. It’s important to approach both yourself and your partner with compassion. Recognize that trauma affects how we respond to conflicts, which can foster empathy and understanding in your relationship. If you feel you reacted poorly during a conflict, offer yourself the same compassion you would give a friend. Remind yourself of the kind of things you would say to them in that situation. 4. Seeking Support: Establishing a support system is essential for healing. Surround yourself with supportive friends, family, or a therapist who can provide the compassion and nurturing you need. Therapy can be a safe place to reframe unhelpful beliefs about yourself and others, develop helpful coping strategies, and improve communication skills. If you are not ready to work with a therapist, consider support groups or books that can help you process lingering trauma. Copyright by Stacey R Pinatelli, Psy.D. Excerpted in part from my book Hope and Healing for Survivors. Stacey R Pinatelli Psy.D. - Website - References Bowbly. J. (1973). Attachment and Loss. New York: Basic Books. Ferrajão, P. C., & Elklit, A. (2020). World assumptions and posttraumatic stress in a treatment-seeking sample of survivors of childhood sexual abuse: A longitudinal study. Psychology of Violence, 10(5), 501–508. Heller, L., & LaPierre, A. (2012). Healing developmental trauma: how early trauma affects self-regulation, self-image, and the capacity for relationship. North Atlantic Books. Silva, A., Ferreira, S., Silva Pinto, É., Rocha, S. A., & Barbosa-Rocha, N. (2023). The Relationship Between Childhood Abuse and Adult Attachment Styles: The Mediator Role of Sensory Over-Responsivity. Journal of Aggression, Maltreatment & Trauma, 33(2), 236–254.