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 -

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.