To effectively improve your happiness, have a valid way to verify your progress. No one can effectively improve on anything without a way to measure and verify progress. To succeed as a happiness seeker, you should know how happy you are, and how much happier you want to become. The Edo Questionnaire is our new tool for measuring happiness, both objectively and subjectively. Imagine enrolling in a physical fitness class and, like all the other students, you have promptly begun the daily exercises as instructed by the coach. However, you have no idea how much you currently weigh in pounds or kilograms—prompting the reasonable question: What is your target body weight? Knowing how much you currently weigh and having a preferred target weight in mind is necessary for your determination, resilience, and perseverance to evolve and matter—as you seek physical fitness. Similarly, imagine that you are pursuing happiness—striving day and night to become happier but have no idea how happy you currently are. A very reasonable question is: When and how will you know you are “happier” and, “happier than what” would that be? Just like in the pursuit of physical fitness, common sense strongly suggests that before starting any new endeavor, you should self-assess to know where you currently are and where you’d like to be. Thus, pre-testing and re-testing for happiness is a must since no one can effectively improve on anything without a way to measure, quantify, and verify progress. The Edo Questionnaire, our tool for measuring happiness—aka the PISA Scale—is now available for happiness seekers, happiness advocates, coaches, researchers, human resource directors, and wellness officers to use (Obayuwana, 2024). The Edo Questionnaire The Edo Questionnaire (or PISA Scale) is a 12-item self-assessment tool for measuring happiness. It can differentiate and identify happy, unhappy, very happy, languishing, or flourishing individuals in any given cohort. It is a perfect tool for rating happiness for whatever purpose or reason—when and wherever accurate measurement of happiness is desired. It is particularly suitable for testing and re-testing when monitoring progress or confirming improvements. It is short and precise, easy to administer and score, with no issues whatsoever about social desirability bias. Its unit of measure is PHI (or Personal Happiness Index)—which ranges from 0.125 on the languishing end of the scale to 8.0 on the flourishing end of the scale. The questionnaire has good internal consistency with an alpha value of 0.88. The content validity ratio is 0.85—with five SMEs used in calculating the CVR. Test-retest reliability is 0.95 Why Know Your PHI? PHI is a true measure of your well-being—objectively determined and subjectively verifiable. It is much like weighing yourself, determining your height, or taking your own blood pressure, and temperature—objectively performed by yourself, using the right tool. For all adults, whether a peasant or a millionaire, rural or urban, and regardless of age, gender, language, culture , geography, annual income, or national GDP, the PHI is a valid way to tell objectively when you are “happier” and also, how much “happier than what”. The following case report is very illustrative. The Case Report of AJ AJ was a forty-three-year-old female who was the assistant principal of a middle school. She attended one of my presentations and subsequently privately requested one-on-one happiness coaching services from me. During stage two of our one-on-one happiness coaching sessions, her PHI was calculated to be 0.932, which is in the “unhappy” zone. At stage four of our coaching sessions, a customized PDR (or personal daily routine) that was unique to her circumstances was designed and given to her for actualization. AJ was to return after six weeks of performing and actualizing her PDR. Instead of six weeks, she showed up three months later with copious apologies for her tardiness. When she was re-tested, she had a PHI of 2.314—a very impressive progress. She moved from the “unhappy” Zone C straight to “very happy” Zone A—bypassing the “happy” Zone B. That was an unusual progress but much welcome. As I was quietly marveling about what an effective happiness coach I had become, AJ smiled broadly and said she had some good news to share: “I have been promoted to the rank of a full principal, and guess what? I also have a wedding engagement” as she flashed a diamond ring on her finger. At that moment, I realized why she had taken three months instead of six weeks to return for stage five of our client-coach relationship. I also realized that her impressive rise in PHI might have very little to do with my coaching efficacy. Although it remains questionable how consequential I truly was, as a coach, in AJ’s progress; the Edo Questionnaire very accurately captured her progress. Without the use of the Edo Questionnaire, there was no way to objectively and accurately quantify the progress she made. For Whom Is the Edo Questionnaire? Without exceptions, we all want to be happier and there is a myriad of happiness-promoting methods and exercises recommended to us—but without any proven tool to objectively verify progress. Therefore, the Edo Questionnaire is recommended for use by happiness seekers, happiness coaches, research psychologists, chief happiness officers, directors of human services (or resources), happiness advocates, and those policymakers, who are directly or indirectly involved in the “business” of happiness. Alphonsus Obayuwana, M.D., Ph.D., - Website - References The Happiness Formula, A Scientific Groundbreaking Approach to Happiness and Personal Fulfillment (Obayuwana, 2024).

Learn to switch off of the worry channel and experience more moments of peace. Does this scenario seem familiar? You’re going about your day and suddenly you’re overtaken with butterflies in your belly and worried thoughts in your mind. Your worries might be attached to certain situations in your life, or they may not even have a specific topic or target. All you know is that the pit in your stomach and the tightness in your chest is back (or rarely leave) and your mind is swirling with unpleasant, unhelpful thoughts. You know that there’s nothing you can or need to do in the moment to tend to the topics you’re worried about, yet your mind is off and running with worry and your body is coursing with the chemical cocktail of cortisol. Now, see if this scenario sounds familiar. You’re sitting on the couch watching TV. A movie comes on and you quickly realize that you don’t like it at all. Maybe it’s a scary movie and you’re not a fan of scary movies. Maybe you don’t resonate with the characters. Maybe you don’t like the dialogue or the sound. What do you do? I’m guessing that you pick up the remote and change the channel. So, how do worry and changing the TV station relate to each other? When we realize that our minds are playing their worrisome movies, we have the option of changing our internal channel. This is really good news. Our minds may be accustomed to regularly playing their stressful programs, but we have the remote control. Is it easy to change our internal channels? Not at first for most of us, especially if we’ve been playing and replaying scary movies for a while. We also might continue to experience unpleasant physical sensations after we’ve switched to a pleasant or present channel. Just like we might feel the uneasy aftereffects of watching a horror movie, many people feel some lingering sensations after a bout of worry. But, with consistent channel changing, feeling present, calm, and self-compassionate can become our most viewed networks. Then, feeling worried and anxious begin to feel like old reruns that signals us right back to the remote. So, how do we know when it’s time to change our internal channel? Our bodies will tell us. Worrisome thoughts don’t feel good. So when we worry, our bodies give us feedback. All we need to do is stay aware of how we’re feeling and what thought patterns we’ve been thinking. Awareness enables us to break the trance of unpleasant or un-present programs like worry or fear. Awareness gives us the option to choose alternative channels to focus our attention on rather than allowing our painful thought patterns to repeatedly play. Awareness is waking up to the fact that our minds have returned to the fear, worry, or anxiety channels. Then, we can decide what to do with the remote. We do not have to sit powerlessly and watch worrisome mind movies all day and night. So, what are some of our alternative channels if we realize our minds have been binge-watching the worry network? One option is to switch to the presence program. Here we can tune into our senses in the present moment. We can notice what we’re touching, hearing, seeing, tasting, or smelling. We tune into our breathing and the surface beneath us. There will always be a breath and a surface to turn our attention to. We can switch to the compassion channel by offering ourselves compassion, understanding, acceptance, and validation. Whatever emotions or sensations we’re experiencing can be softened by the comfort of our own compassion. We can click on the nature channel. We can think about nature or appreciate our favorite things in nature. We can go out in nature. We can watch videos or shows about nature. We can change our internal channel to the appreciation station. We can think, say, or write about anything we appreciate. This could be as simple as our blankets and pillows, as profound as our loved ones, or anything in between. There’s always something to appreciate. Similarly, we can watch the gratitude channel by expressing gratitude for the people, pets, places, or things that we feel grateful for. We can turn on the love network and tap into anyone, anyplace, or anything that feels easy to love. We can tune into the happy channel where we smile, laugh, or listen to some comedy. We can click on the relaxation station and do something that feels soothing, calming, or relaxing to us. We can turn on an inspirational channel and watch, read, or listen to something that inspires us. We can watch the music channel by playing music, singing, dancing, or watching music videos. We can switch to the creative channel and immerse ourselves in a hobby, craft, or any type of creative project. There are so many channels we can click on. All it takes is the awareness of the channel we’re on, and the willingness to change the station as needed. Over time, we get better at spending more time on desired networks and our bodies reap the benefits. Let’s try a little experiment. Think of one thing you’re worried about (just for a moment!) Notice how you feel in your body. Now, change the channel by thinking of something, someplace, or someone you appreciate or feel grateful for. Spend a moment here and notice how this feels. Hopefully, you experienced the difference in your body right away, even if it was slight. Of course, we can always reach out to supportive people if our minds are stuck on the worry channel, but since we spend 24/7 with our minds, who better to change our internal channels than us? With increased awareness and consistent practice, we can learn to take charge of our focus and reap the benefits of a calmer nervous system, a clearer mind, and more moments of peace and ease. It’s important that you don’t berate yourself if your mind grabs the remote and switches the channel back to some old unpleasant reruns or future fearful movies. This is about being aware of what our minds are up to and remembering that we have the option to compassionately and consistently change our focus. I hope you will practice soothing your worried mind whenever it needs soothing. Then, resume the channels that feel the most compassionate, calming, uplifting, and inspiring to you. Andrea Wachter LMFT - Website -

Mindfulness and cognitive therapy both help women restore their libidos. Many women struggle with low sexual desire. This common problem distresses many relationships. A recent study shows that two treatments help—mindfulness and cognitive behavioral therapy. The recent report corroborates a great deal of research on the sexual benefits of the two therapies. Persistent low sexual desire bedevils many women—and their partners. The one drug approved for low desire in women, Addyi (flibanserin), is not particularly effective and has possibly problematic side effects . Meanwhile, a growing body of research shows that two easy-to-implement psychological approaches often help: mindfulness and cognitive behavioral therapy . A recent study adds to the evidence in favor of both. The Study German researchers worked with 51 cis-women who complained of low libido. Participants ranged in age from 22 to 69 (average 39). More than three-quarters said they were heterosexual and involved in monogamous relationships. Half were married. Half had children. Their education ranged from vocational training to graduate degrees. Half worked full-time. The rest worked part-time or were students, homemakers, or retired. (The researchers did not specify the women’s race/ethnicity.) The participants worked their way through an eight-week online program that included text, illustrations, audio recordings, and videos. Half the material provided sex education, while the other half introduced them to either mindfulness-based therapy (MBT, 24 women) or cognitive behavioral therapy (CBT, 27 women). Mindfulness involves a meditative focus on the present moment. Cognitive behavioral therapy corrects misconceptions; for example, I can’t get aroused. In addition, the program included sex therapy exercises, including self-examination to improve body image, self-sexing with and without vibrators, and sensual touch with their partners. Finally, all the women received personal email coaching from women being trained as clinical psychologists who had also been trained in both MBT and CBT. With only 51 participants, this study is on the small side, but it had a reasonably wide range of participants. In addition, many sex studies have between 30 and 100 participants, so this one is reasonably in line with similar research. Overall, it appears credible. The large majority of the women (86 percent) said they found the program effective. Helpfulness differed somewhat by therapy—in the MBT group, 91 percent found it helpful, and in the CBT group, 81 percent. But both groups showed what the researchers called “a high level of helpfulness.” Mindfulness Helps Women Overcome Low Desire Mindfulness helps eliminate emotional “noise” that may derail women’s erotic interests. Instead of obsessing about other responsibilities (school, work, the next load of laundry), mindfulness teaches practitioners to focus on how they feel and experience their lives from moment to moment. Lovemaking also involves detaching from daily responsibilities and focusing on the moment. Mindfulness helps eliminate emotional “noise” that may derail women’s erotic interests. Instead of obsessing about other responsibilities (school, work, the next load of laundry), mindfulness teaches practitioners to focus on how they feel and experience their lives from moment to moment. Lovemaking also involves detaching from daily responsibilities and focusing on the moment. Many previous studies have shown that mindfulness helps women rediscover their libidos: A research team at the University of British Columbia recruited 117 low-desire women. Forty-nine were placed on a waitlist. Sixty-eight participated in three 90-minute classes over six weeks that explored the causes of low libido, with counseling to minimize causes and instruction in mindfulness meditation. Between classes, the women practiced mindfulness daily at home. After six months, the treatment group reported significantly greater desire, arousal, and lubrication, easier orgasms, and greater satisfaction. Investigators at Willamette University in Oregon analyzed eleven studies of mindfulness involving 449 women who complained of low libido, arousal, and orgasm difficulties. “All aspects of sexual function and well-being—exhibited significant improvement.” Cognitive Behavioral Also Helps Low Desire In Hamlet , Shakespeare writes: “There is nothing either good or bad but thinking makes it so.” CBT corrects mistaken thinking that may interfere with sexual interest. A robust literature shows that CBT helps resolve low desire. Two examples: Canadian researchers provided 16 sessions of online CBT to 19 couples, with an average age of 43, whose women complained of low desire. After treatment, the women reported substantially less sexual distress and “large improvements” in desire. Surveyed six months later, the couples reported continued benefits from CBT. Researchers in Texas and Canada provided eight group sessions of CBT to 26 women aged 25 to 63 who complained of low desire. The treatment program combined classes with at-home exercises. After treatment, the women reported reduced sexual distress and “significant improvements” in sexual desire and function, regardless of the duration of the women’s relationships or their low desire. If you’re in a couple with a woman troubled by low libido, you might consider using internet resources to learn more about mindfulness and cognitive behavioral therapy and how they can improve women’s sexual desire. If self-help doesn’t provide sufficient benefit, then I suggest working with a sex therapist familiar with MBT and CBT. Michael Castleman, M.A., - Website - Book - References Bouchard, KN et al. “Feasibility of Cognitive-Behavioral Couple Therapy Intervention for Sexual Interest/Arousal Disorder,” Journal of Sex Research (2024) 9:1. Doi: 10.1080/00224499.2024.2333477. Brotto, LA. et al. “Mindfulness-Based Sex Therapy Improves Genital-Subjective Arousal Concordance in Women with Sexual Desire/Arousal Difficulties,” Archives of Sexual Behavior (2016) 45:1907. Brotto, L.A. and R. Basson. “Group Mindfulness-Based Therapy Significantly Improves Sexual Desire in Women,” Behavior Research and Therapy (2014) 57:43. Brotto, L.A. et al. “A Mindfulness-Based Group Psychoeducational Intervention Targeting Sexual Arousal Disorder in Women,” Journal of Sexual Medicine (2008) 5:1646. Meyers, M et al. “A Qualitative Study of Women’s Experiences with Cognitive-Behavioral and Mindfulness-Based Online Interventions for Low Sexual Desire,” Journal of Sex Research (2022) 549:1082. doi: 10.1080/00224499.2022.2056565. Patterson, L.Q. et al. “A Pilot Study of Eight-Session Mindfulness-Based Cognitive Therapy Adapted for Women’s Sexual Interest/Arousal Disorder,” Journal of Sex Research (2017) 54:850. Stephenson, K.R. et al. “Effects of Mindfulness-Based Therapies for Female Sexual Dysfunction: A Meta-Analytic Review,” Journal of Sex Research (2017) 54:832. doi: 10.1080/00224499.2017.1331199.

Boosting emotional intelligence enhances well-being, too. It's hard to manage our emotions. That's why we end up saying or doing things we later regret. Micro-moments of upliftment, breathwork, and self-awareness exercises can boost your emotional intelligence. Ever reacted to a situation in a way you later regretted? Or sent a message in the heat of the moment you wished you could unsend? We all have. Our emotions can sometimes get the best of us. When we lack emotional intelligence it can cost us relationships, both at work and in our personal lives. Learning how to manage our emotions with skill is critical to having highly successful relationships. So how can we do that? Having taught emotional intelligence to thousands of high-level leaders at the Yale School of Management as well as the military , I've observed firsthand how emotional intelligence can significantly predict one's success. Key elements of emotional intelligence include building positive connections, self-regulation, and self-awareness. In my latest book, Sovereign , I explore science-based strategies to enhance these skills. In this post, I divulge three simple yet science-backed strategies to help you get started. The best part? They only take a few minutes. 1. Micro-Moments of Upliftment Have you ever noticed how some people leave you feeling drained—so called "energy vampires"—while others make you feel energized and positive? The difference often boils down to whether you’re interacting with a “positive energizer”—someone who understands the power of small, uplifting moments. Research on positive relational energy shows that people who are good at creating these moments not only boost others’ well-being and vitality but even improve their productivity. They have a life-giving effect. The good news? You can become a positive energizer yourself. This doesn’t mean forcing cheerfulness or wearing a fake smile. Instead, it’s about genuinely connecting with people through humility, empathy, compassion, honesty, integrity, and forgiveness. Every interaction you have with another person—whether your barista at Starbucks or a professional colleague—is an opportunity to uplift them. A genuine compliment, a shared laugh, a kind word, or even a simple smile can make a big difference. The best part? Studies show that not only will the other person feel better, but you will too—if your actions are sincere. 2. Stressed? Get Yourself from a 10 to a 2 in Minutes. Feeling overwhelmed or stressed? Everyone does at times. So, what can you do in those moments to get yourself from a high stress level (like a 10 on a 1-10 scale) to a much calmer one (like a 2)? The fastest way to reduce anxiety in the moment, according to our research and studies by our colleagues: the breath. Studies by our research team and others show that breathing exercises are one of the quickest and most effective ways to manage emotions in real-time. By changing the ration of your inhales to exhales, you can significantly lower your stress levels in minutes. The key? Extend your exhalations. When you inhale, your heart rate speeds up, but when you exhale, it slows down. To practice, close your eyes and breathe in for a count of four, then breathe out for a count of eight. Repeat this for at least two to five minutes. This practice activates your parasympathetic nervous system, helping your body relax and counteract the “fight-or-flight” response. You’ll find yourself calming down quickly and effectively—and you'll be in a much better place to handle a stressful situation. 3. Get in Touch with Your Self-Awareness in Two Minutes Have you ever reacted to a situation at work in a way you weren’t proud of? Or sent an email when you were upset that you later regretted? No matter how successful or accomplished we may be, we all struggle with managing our emotions at times — and suffer the consequences afterward. Self-awareness is crucial for managing your reactions and improving your relationships. It’s about tuning into what’s happening in your mind and body—taking a moment to reflect and ask yourself, "What do I need right now?" Here’s a quick exercise to boost your self-awareness: Get Comfortable and Focus Inward. Sit down, close your eyes, and take a few deep breaths. Scan Your Body. On a scale from very tired to very energized, where are you today? Notice any areas of tension or relaxation in your body. Evaluate Your Thought Traffic. If your thoughts were cars, what’s the traffic level? Is your mind a bustling highway or a calm country road? Is your mind buzzing or steady? Recognize Your Emotions. Are your emotions pleasant or unpleasant? How intense are they? This exercise helps you quickly assess your internal state and stress levels. It can show you if you’re in a good place to move forward with whatever you’re about to do next. For example, if you’re gearing up for a tough conversation and find yourself feeling tense and distracted, it might be wise to either delay the chat or work on improving your mood first. Incorporate Regular Practices Incorporating these techniques into your daily routine can make a huge difference. Another key practice is meditation. Research shows it can significantly improve your relationships . Regular meditation has been shown to enhance brain areas related to self-control, self-awareness, and emotional regulation. Meditation creates more space between your thoughts and emotions, allowing you to respond more thoughtfully rather than reacting impulsively . By nurturing your emotional intelligence through self-awareness, self-regulation, and positive interactions, you can improve your relationships, boost your overall well-being, and become a more balanced and empathetic person. It's a win-win. Emma Seppälä, Ph.D., - Website - Book - References Excerpted with permission from Sovereign: Reclaim your Freedom, Energy, and Power in a Time of Distraction, Uncertainty, and Chaos by Emma Seppälä.

Explore these 9 factors so you can make an informed decision. Lucy and Larry are the best of friends, and both are in long, unhappy marriages. Lucy complains that her husband is remote and withdrawn, and Larry complains that he and his husband are constantly quarreling. Lucy feels lonely in her relationship, while Larry is often triggered and upset by the tension and arguing. For months they debate whether to divorce or stay in their unhappy relationships. The decision to stay or go depends on finding clarity, but finding clarity depends on these factors. Think about the dynamics of your relationship. What are the patterns of interaction? Is there mutual respect, admiration, and emotional support? Do you still share common goals, values, and interests? Are you able to support each other's personal growth and development? Think about your needs, your wants, and your goals. If you stay in your relationship can you fulfill your long-term goals? Do you believe divorce would realistically offer greater opportunities for personal fulfillment and growth? How will staying together or divorcing affect your overall quality of life, including your emotional well-being, financial stability, and mental health? Often there are unexpected losses during divorce. Making well-informed decisions is crucial. Do you have children ? How will divorce or staying together impact your children? Try to make decisions that prioritize their stability and happiness. With few exceptions, divorce negatively impacts children, especially when parents are in conflict. Educate yourself about how to divorce in a way that reduces the negative effects on your children. For example, will you work with your spouse to co-parent your children should you decide to divorce? Do you believe that your spouse will co-parent well with you? Have you sought help? Seeking guidance from a qualified therapist or marriage counselor can help improve communication, identify underlying issues, and provide strategies for resolving conflicts. Lucy and Larry both spend months in marriage counseling with their spouses and feel it helps them to consider whether they’re facing temporary challenges or deeper fundamental incompatibilities. Look for specially trained discernment counseling in your area. If you have children, try to explore avenues for reconciliation through couples therapy, individual self-improvement efforts, and open communication. Perhaps, with effort, motivation, and commitment to change, you and your partner can find new ways to strengthen your bond. Be realistic: divorce can have significant financial and health implications. Most divorcing partners experience a serious drop in their standard of living and lifestyle. You’ll be dividing assets, and debts, and paying or receiving child support or spousal support. Non-working parents are often expected by the courts to contribute to their own support. If you haven’t worked for a while, you may need retraining or vocational counseling. Some of the hardest things about divorce are unpredictable. The stress of divorce can affect your physical and mental health unless you learn to minimize it. Consult with a qualified family law attorney to obtain personalized legal advice and guidance. Laws relating to divorce vary in different jurisdictions, so you’ll need to understand the costs, requirements, procedures, and potential outcomes if you decide to divorce. Consider mediation or a collaborative divorce instead of a court-involved process. Consider a trial separation: In some cases, a trial separation can provide respite, clarity, and perspective. During this time apart, both partners can reassess their feelings, priorities, and the feasibility of reconciliation. Counseling during a trial separation can help you decide whether or not to reconcile. Ultimately, you’ll need to listen to your intuition and inner wisdom. Your feelings and instincts about the relationship are important data. While it's important to think through the factors above and seek advice, in the end, you are the best judge of what is right for you and your family. Whether you choose to stay together or pursue divorce, strive for a resolution that promotes mutual respect, dignity, and emotional health for all involved parties. After thorough consideration and exploration of options, Lucy and Larry want to make decisions that match their values, priorities, and mental health. Ultimately, Lucy falls in love with a co-worker and leaves her marriage. She is now happily remarried and is no longer lonely in her marriage. Larry is afraid to be alone, and so he stays in a volatile relationship. However, over the years, he and his husband have learned to defuse arguments more easily, and have found new pleasure as grandparents. When Lucy and Larry reflect on their decisions many years later, they talk about the “road not taken,” but neither has regrets about their decision. Ann Gold Buscho, Ph.D., - Website -

Part 3: Identifying and understanding major depression subtypes Anxious distress is not the same as having an anxiety disorder along with major depressive disorder. Physical tension, feeling something bad will happen or you'll lose control, are signs of anxious distress in a major depressive episode. Anxious distress within depression is believed to elevate suicidal thinking and activity. It's no secret that anxiety conditions and depression co-occur. In fact, most researchers agree they co-occur at least 60 percent of the time. They're so interrelated that most antidepressants are also often effective for anxiety; both conditions are highly associated with decreased serotonin. With these facts in mind, it's no surprise that some people, when they experience a Major Depressive Disorder (MDD) episode, there is an onset of some specific anxiety that is congruent to the depression. The presentation: MDD patients with Anxious Distress are down and out. They're tormented by inner restlessness and anticipating worst-case scenarios that compound the negative thinking already present from the depression. Unfortunately, it seems like anxious distress is more common than meets the eye. Researchers like Zimmerman et al. (2018) have noted that, in a sample of 260 people with MDD, 75 percent met the criteria for the specifier; this was after controlling for co-occurring anxiety disorders. Imagine the compounded misery of patients, like Liz: The case of Liz: Liz, a 26-year-old part-time college student, was no stranger to anxiety. She struggled with Social Anxiety Disorder (SAD) throughout her teens and 20's. It was tough for her to get through college, but she was gaining on it. Nonetheless, like many suffering from SAD, Liz was prone to MDD. For Liz, the episodes would come on when she began dwelling on how stalled her life was from SAD. Many peers were already in careers and had a family, and she wondered if she'd ever make it. Liz made an appointment with Dr. H, her long-term psychologist, because the depression felt different this time. In her voicemail to Dr. H, she said, "Doc, I've dealt with being depressed, I've dealt with getting through socially anxious situations, but I'm not handling well whatever is happening to me this time." At her appointment, Dr. H noticed Liz not only going to that dark place again, but she also appeared to have a tense jaw and was prone to hand wringing; she looked very uneasy on top of being depressed. Liz confessed that the past couple of weeks she was increasingly dreading that she will never get out from under this psychological roller coaster. "I'm so stuck!" she lamented, noting she worries about the depression never ending and being alone forever. "It seems so futile, I may as well give up," Liz mumbled through tears. Courtesy of page 184 in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the criteria for With Anxious Distress (which must be present more days than not during the current Major Depressive episode) are: Poor concentration due to worry Feeling tense Restlessness The feeling something bad will happen The feeling of losing control. Critical thinking about what qualifies as an Anxious Distress specifier: Though Liz experienced an anxiety disorder at baseline, Social Anxiety, it does not make the fact she experienced an anxiety disorder and a depressive episode together as "with anxious distress." These would be considered independent, co-occurring diagnoses. The anxiety symptoms that arose with the MDD episode were a direct consequence of her mood; "owned by the depression," if you will, and therefore meet the criteria for With Anxious Distress specifier. Interested readers are directed to Yang et al. (2014) who explores this in detail. You may be asking yourself, "What about if the person develops panic attacks from being so overwhelmed by the depression?" Panic is "special" in that any condition can have a "with panic" specifier. Just because someone experiences a panic attack or occasional attacks, also doesn't mean they have panic disorder. There must also be significant fear of future attacks and or maladaptive behaviors to try to keep future attacks at bay, like avoiding exercise and sex because the exertion can lead to feelings that are reminiscent of panic symptoms and there is fear it may evolve into an attack. Of course, someone may have MDD and Panic Disorder if full criteria for the latter are also met. Readers are directed to page 214 of the DSM-5 for more information on this nuance. Though uncomfortable, panic is often sporadic and fleeting, while the symptoms of With Anxious Distress must be specifically noted because they are chronic and gnawing, adding torment to the person's condition. Imagine suffering the low feeling of serious depression, coupled with a feeling that you can't gain control, feeling physically tense, and worrying it will never end. This is quite a problem in that, as seen with Liz, the depression encourages the anxiety, and that added anxiety encourages intensifying depression. Treatment implications: This additional insult of anxiety on the MDD episode can induce so much havoc that Barlow and Durand (2015) note, "The presence of anxiety [in depressive episodes] makes a more severe condition, makes suicidal thoughts and completed suicide more likely, and predicts a poorer outcome." Research is not clear if Anxious Distress tends to be a trend in every episode for people prone to it, or if it may vary. Regardless, given the gravity of the matter, clinicians must be vigilant to the possibility of arising Anxious Distress amid their patients' MDD episodes, and evaluate accordingly. Patients may not be as forthcoming and obvious as Liz. Perhaps it is more of an inner tension they are experiencing, and the patient assumes worrying their life will never get on track is just part of being depressed. Directly asking depressed patients if they've begun to develop muscle tension, worry, and feeling they're losing control takes mere minutes and can have big clinical payoffs. Assuaging the anxiety will help in managing the MDD. Clinical considerations if Anxious Distress is suspected: Suicide prevention: Suicide attempts may be more prevalent with anxious distress, evaluating for risk is even more important. Be sure to consult with the person's prescriber if you are concerned about Anxious Distress. They should be aware because some medications could exacerbate the anxiety, and there is always the possibility the anxiety will not get reported or noticed in the prescriber's office. Evaluate if the person's lifestyle may be exacerbating the anxious distress. Namely, are they caffeine consumers, eat a lot of junk food or sugar, and get no exercise? It's no surprise that caffeine and sugar can make things worse. Exercising, if they are capable, can help "burn off" some anxiety; it can also provide further structure and occupation rather than being 100 percent stuck inside their mind. The old saying is particularly true for sufferers of depression and anxiety: "idle mind = devil's playground." The positive effects of exercise on anxiety and depression are well-documented. If the person does not already exercise, of course suggest they consult their doctor before initiating a regimen. Once beginning to stabilize, the job of a therapist is to not only help the episode to continue to remit but continue to evaluate for any return of the Anxious Distress. In the long run, prevention is the best option. If we know a patient is prone to Anxious Distress, it is of utmost importance to have a plan in place to immediately return to treatment if they or friends and loved ones recognize the onset of a depressive episode. Keeping the MDD at bay likely will help keep the Anxious Distress away. Stay tuned for the next post on Monday, October 11, for a tour of Melancholic Features , perhaps the "darkest flavor" of Major Depressive Disorder. Anthony Smith, LMHC, References Barlow, D.H. and Durand, V.M. (2015). Abnormal psychology: an integrative approach. Cengage. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013. Yang, M.J., Kim, B.N., Lee, E.H., Lee, D., Yu, B.H., Jeon, H.J., & Kim, J.H. (2014). Diagnostic utility of worry and rumination: a comparison between generalized anxiety disorder and major depressive disorder. Psychiatry and Clinical Neurosciences (68), 712–720 doi:10.1111/pcn.12193 Zimmerman, M., Martin, J., McGonigal, P., Harris, L., Kerr, S., Balling, C., Keifer, R., Stanton, K., & Dalrymple, K. (2018). Validity of the dsm-5 anxious distress specifier for major depressive disorder. Depression and Anxiety (36) 1, 31-38.

Why caregivers fail to support kids who disclose abuse. Up to a third of children abused in the home may not receive a supportive response when they disclose. Poor parental attachment , patriarchal beliefs, and emotional and economic dependence may cause non-support. Lack of support or disbelief has been linked to poorer, more severe long-term outcomes post-disclosure. Andrea Robin Skinner, the daughter of late Canadian author and Nobel Laureate Alice Munro, wrote an essay in the Toronto Star in which she described how she was sexually abused by her stepfather in 1976. Her story of intrafamilial child sexual abuse is unfortunately not uncommon, but what has shocked many was that Skinner wrote that when she told her mother in 1992, Munro acted “as if she had learned of an infidelity," returning to her husband, whom she stayed with until his death, causing an irreparable rift between mother and daughter. Many are struggling to understand how a lauded and respected author who wrote about trauma failed to support her own daughter. Why would a non-abusing parent disbelieve or fail to adequately support their child post-disclosure of CSA? This is a complex question, and answers can vary based on the individual. Little recent research has examined this question, and many existing studies have small samples, with most focusing on the role of mothers, as it is often the stepfather or biological father who the perpetrator is. In cases of intrafamilial CSA, it is estimated that between 15 and 35 percent of non-abusing parents disbelieve some aspects of their child’s report. One study of 10 mothers found that those mothers who were rated as “unsupportive” of their children post-disclosure adhered more strongly to patriarchal cultural or religious beliefs and values, causing them to remain in contact with the abusing partner. Several studies have found that mothers were more likely to believe their children when the perpetrator was a biological father or extended family member than when it was a boyfriend or stepfather. Economic and/or emotional dependence on the abusing parent was also found to be related to disbelief or unsupportive responses. The findings regarding the age and gender of the child are inconclusive, but some studies have found that mothers are more likely to believe younger children and male children than adolescent, female children. Other studies have found that poor attachment between mother and child can result in disbelief or non-support. It is also speculated that perpetrators engage in familial grooming, such that the perpetrator not only engages in the sexual grooming of the child but also of the non-offending family members, thus increasing the likelihood that the abuse will not be detected or believed. What happens when children are disbelieved or not adequately supported when they disclose CSA? There are many negative long-term consequences of CSA, however, research suggests that they are exacerbated when a survivor comes forth and is not supported. Parental support post-disclosure has consistently been associated with the adjustment of sexually abused children, such that children who are believed and supported have better long-term outcomes. A recent meta-analysis found that this relationship was not as strong as previously believed, but perhaps that was because of the way support was conceptualized. That is, perhaps the long-term outcomes were less about whether the child was believed or disbelieved than about the quality of the parental attachment to the child and the child’s perception of the parent-child relationship. However, the worst outcomes result when a child discloses the abuse, nothing is done, and they remain in the abusive situation. Thus, it is imperative for children who have disclosed abuse to be supported by caregivers, and the quality of this support should be a focus of the healing process. Elizabeth Jeglic, Ph.D., - Website - References Jeglic, E.J., & Calkins, C.A. (2018). Protecting you child from sexual abuse: What you need to know to keep your kids safe. New York: Skyhorse Publishing. Winters, G.M., & Jeglic, E.L. (2022). Sexual Grooming: Integrating Research, Practice, Prevention, and Policy. Springer.

How self-views evolve over the lifespan. Some types of narcissism are more interpersonally harmful. Many people age out of narcissism over their lifetime. In contrast to narcissism , self-esteem often includes prosocial orientation. Most people know a narcissist—at least in the practical, although not necessarily clinical sense. Usually, this is someone who holds themselves in high esteem and puts themselves first, both personally and professionally, at the expense of others if necessary. Yet, as we age, beauty fades, physical prowess diminishes, and mental acuity declines. Perhaps healthy self-concepts adjust accordingly. Narcissism impacts not only the individual but also the lives of those around him or her. Although many narcissists are extraverted, flashy, and fun, they also experience relational difficulties, often stemming from some of the same traits that make them popular. If you love a narcissist as a family member, friend, or potential future paramour, research has some positive news for you. More Than a Number: The Impact of Age Ulrich Orth et al. (2024) examined the development of narcissism across the lifespan and studied changes over time.1 They describe three models of narcissism. Agentic narcissism is characterized by assertiveness and leadership but also the need for admiration, as well as feelings of grandiosity and superiority. As we might imagine, they note that agentic narcissism results in fewer interpersonal problems as compared to the other two models. Antagonistic narcissism embodies the disagreeable and antisocial facets of narcissism including qualities such as deceitfulness, callousness, arrogance, exploitative Ness, a sense of entitlement, and a low level of empathy. Neurotic narcissism is characterized by hypersensitivity, emotional dysregulation, and propensity to experience shame. Among other things, Orth et al. note that the three-factor model helps to comprehend the relation between the characteristics of different types of narcissism and self-esteem, described as including subjective evaluation of personal worth. They also note that self-esteem and narcissism are distinguished conceptually because high self-esteem is often linked with prosocial attitudes and does not necessarily indicate personal feelings of superiority. Examining data from 51 samples, including 37,247 participants, Orth et al. found that narcissism usually decreases from age 8 to 77 years, with small differences due to the type of narcissism experienced. They also discuss the concept of rank-order stability, which encompasses the stability of interindividual differences in a construct across time. They note that the rank-order stability of narcissism is high, even across long time periods, suggesting that narcissism should be considered a personality trait. Is Generation “Me” a Myth? In terms of popular ideas about whether narcissism is tied to generational differences, Orth et al. found that birth cohort was not a moderator of mean-level change for narcissism factors. The mean year of birth in their samples ranged from 1923 to 2002, and the narcissism trajectory has not changed over the generations, meaning their results fail to support the popular idea that “Generation Me” (people born in the 1970s to 1990s) express more narcissism than previous decades. Orth et al. note, however, that as with some of their other findings, more research would be beneficial here as well. The bottom line is that narcissism, even viewed as a personality trait, can change—for the better. With age comes wisdom, acceptance of less-than-perfect traits, and enhanced appreciation of others. With acceptance, love, support, and respect, narcissistic individuals can turn over a new leaf, slowly but surely. Wendy L. Patrick, J.D., Ph.D., References 1. Orth, Ulrich, Samantha Krauss, and Mitja D. Back. 2024. “Development of Narcissism across the Life Span: A Meta-Analytic Review of Longitudinal Studies.” Psychological Bulletin 150 (6): 643–665. doi:10.1037/bul0000436.

Better be more friendly and less boastful to win friends. Being liked by others is important for our survival and well-being. Research has explored which behaviors predict liking in social situations. Communal behaviors predict both general popularity and being liked in one-on-one situations. Agentic behaviors may help your popularity but may hinder you in one-on-one situations. When meeting other people for the first time, how should one behave to be liked? When given a choice, most of us would prefer being liked by—and popular with—members of our social group. Human beings spend much energy on becoming socially accepted, and for good reasons. Those who like and esteem us are more likely to offer protection, encouragement, and support when times are bad. And times will get bad at some point. Social standing is an evolutionary insurance policy, shielding one from all kinds of risks. No wonder psychologists have long been interested in the dynamics of interpersonal liking and group popularity. A useful framework for studying social relations was developed by David Kenny of the University of Connecticut. In his Social Relations Model , one person’s view of another is broken into three components: perceiver, target, and relationship. “The perceiver effect reflects how the person tends to see others; the target effect reflects how a person is seen in general by others; and the relationship effect reflects how a perceiver uniquely sees the target,” he writes. By way of analogy, if we wish to analyze the relation between Mary and her little lamb, “the perceiver effect would represent how much Mary, on average, likes little lambs; the target effect reflects how much the little lamb is liked by others; and the relationship effect is how much Mary likes her little lamb.” Thus, in the model, liking can be examined in two ways. On a more general level, we can study how certain behavioral choices and tendencies make one popular within a group (target effect). On a more personal level, we can study how certain behaviors make one uniquely liked by their immediate dyadic partner (relationship effect). Both are socially advantageous, yet they are not one and the same, and the forces that shape them may differ. Psychological research has long shown that when judging others, people tend to base their evaluations on two main categories: agency and communion (also known as warmth and competence). We look at how competent or powerful a person is, and how friendly and trustworthy they are. As I’ve written before, both qualities are important to judge early and accurately. From an evolutionary perspective, separating friend from foe and competent from incompetent is crucial for survival. You want to surround yourself with people who not only want to but also can help you. A recent (2023) study by German psychologists Michael Dufner and Sascha Krause set out to explore whether specific behaviors associated with agency and communion predict popularity and/or unique liking. They designed a round-robin pre-post study in which 139 young adults were assigned to same-sex groups of four to six members, all previously unacquainted. In each group, members first provided liking ratings of each other based on pictures and a brief group introduction. Then, every member of the group had a five-minute one-on-one conversation with every other member, after which they completed similar liking ratings again. Additionally, the conversations were recorded on video and the individuals in each interaction were rated by trained observers on four agentic behaviors (leading, dominant, confident, boastful) and four communal behaviors (polite, benevolent, warm, friendly). The authors ran a series of analyses to explore how various behaviors affected popularity within groups and unique liking within dyads. Results showed that all agentic and communion behaviors significantly predicted popularity, although, taken together, the communion behaviors were a stronger predictor than agentic behaviors. When it came to unique liking, however, two specific communion behaviors (benevolent and friendly behavior) and the composite score of communion behavior were significantly and positively correlated with higher ratings. Further analysis found that “when communal behavior is held constant, behaving in a uniquely agentic fashion toward specific others might even reduce one’s unique liking.” Regarding general popularity, the authors conclude: “The current findings indicate that actors who generally behaved in a communal fashion toward others were generally popular,” yet “popularity was also incrementally predicted by agentic behavior, which means that…people who generally show agentic behavior might also be generally liked.” As for unique liking, the authors conclude: “The results indicate that uniquely behaving in a communal fashion toward a specific other evokes unique liking... By contrast, uniquely behaving in an agentic fashion toward a specific other does not appear to evoke unique liking by that other. Quite the contrary, when communal behavior was controlled for, showing higher than usual levels of agentic behavior toward a particular other was even linked to being uniquely disliked by that other.” The study is not without limitations. The authors note that the sample of young, Western adults may not represent the population at large well. The effects may differ by age or culture. Moreover, people’s reactions may differ in different social contexts, and it may depend heavily on the goal. Interaction partners may approve of agentic behavior if it serves their own goals and disapprove of it if they feel undermined. Likewise, the interactions in this study were few and short, without future expectations. People’s reactions may follow a different pattern if they expect further encounters down the road. Moreover, aspects of the interaction not studied here (e.g., nervousness) may significantly impact early impression formation. Finally, the study focused on same-sex pairs. The dynamics may shift with opposite-sex interactions. Still, the study provides useful data to suggest that when looking to become more socially accepted and liked, communion behaviors—warmth and friendliness—are across-the-board winners. Agentic behaviors (boastfulness, domination), however, are a mixed bag. While they may advance your general popularity within a group, they may also hinder your ability to make new friends. Noam Shpancer, Ph.D.,

Research on normative male alexithymia. So many adult men find it difficult to know what they're feeling. There's a term for this: normative male alexithymia. Boys are born with similar emotional capacity as girls; emotional fluency is discouraged as they grow older. Men can re-learn and reclaim their feelings through self-confrontation and a trusted partner. As is the case with many men, it’s always been hard for me to know what I’m feeling. I would observe my behavior and from there try to deduct what’s going on inside me. I believe this difficulty might have played a role in my choice to be a therapist. Clinical training has taught me firsthand how to better recognize, own, and verbalize my feelings. Over the last 12 years as a couples therapist, I’ve met hundreds of men struggling to feel. I’ve also met hundreds of their partners, feeling alone and frustrated by their emotionally unavailable mates. Covert Male Depression An important source of understanding this phenomenon is Cambridge, Mass. psychotherapist Terry Real. His seminal book, I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression , describes how boys endure the “loss of the relational”—being forced to separate from their feelings and their mothers on the way to becoming “men.” They learn to turn away from their fathers and their own pain toward work, money, success, sex, drugs, and other distractions. They covertly experience depression , which manifests mostly as numbness, boredom, apathy, limited emotional range, and cynicism. Their partners see them as emotionally handicapped, stoic, cold-hearted—and more. When I begin talking to such men about covert depression, they initially display surprise at the idea of depression but then quickly feel validated and understood. Their partner’s eyes light up as a new empathic discourse starts to emerge. Normalizing the emotional struggle of men helps the partners join forces to heal the hidden depression. Permission to Feel Accompanying the covert depression is another crucial phenomenon—what’s officially labeled normative male alexithymia. The American Psychological Association defines it as ”a subclinical form of alexithymia found in boys and men reared to conform to traditional masculine norms that emphasize toughness, teamwork, stoicism, and competition and that discourage the expression of vulnerable emotions.” The inability to feel or describe emotions—considered normative among men—was what these men (and I) have been suffering from all these years. The fact that it’s normative doesn’t mean that it's natural or good. In fact, boys are born just as sensitive as girls. But through the socialization process, boys lose permission to feel and become disconnected from their core. When a man suffers from covert depression and normative male alexithymia, he essentially is surviving and not living. He is not experiencing the whole emotional range and therefore experiences the world as hard, dull, and boring. Over time, his partner forms the impression that he is stoic, boring, and uninterested. Feeling unloved and alone, the partners often become bitter and look elsewhere for emotional companionship. Reconnecting men to their feelings, expanding their emotional range, and subsequently their emotional eloquence, I began to witness changes in such couples. Hope and newfound animation began to spread through my clinic. So You Want to Feel? Feeling is natural. We’re born feeling. But disconnection from feelings is often imposed on boys. Here are some useful suggestions for those wanting to overcome the imposed emotional handicap. Choose to see that feelings are what make us human. The unique human essence is emotional. Therefore, if you want to enjoy life to its fullest, you must dare to feel the good, the bad, and the ugly. Expand your emotional range. The wider your emotional range, the livelier you’ll be. Choose to believe that the key to your joy is in your pain, so open yourself to the darker shades of emotions as well as the lighter ones. Understand that joy is a verb, and therefore must be consciously practiced in order to rewire your brain and inscribe it in your life. If you do all this, you’ll feel free in your relationships, because after all, love is to feel free. As I apply these processes with men, they begin to open up and share their fears, vulnerabilities, and difficulties with their partners. They bravely stop running away and confront their past, their pain, and their wants. The men are returning to their full self, and their relationships began to flourish. As for me, the word “feel” is now emblazoned on my arm. How will you remember to feel? Assael Romanelli, Ph.D., - Website -

The real culprit of OCD may not be what you originally thought. It is not uncommon to hear an OCD sufferer make a comment such as “OCD thoughts are ruining my life,” or “I have to get rid of these thoughts!” This refrain is echoed by many of my clients who lament their unwanted, intrusive thoughts and the seemingly endless struggle to suppress, neutralize, and explain away their thoughts. The common belief, whether explicit or implicit, is that the presence and content of the thoughts are the problem, and getting rid of them will restore hope, confidence, and happiness. But OCD is not a thought problem — it's a feeling problem. In other words, if the thought did not have the accompanying painful feeling, you would ignore the thought, call it “weird,” and simply move on without compulsions or a second thought. Allow me to unpack this as it may seem like what I’m saying is controversial or missing some important point about OCD. Obsessive Compulsive Disorder is a condition marked by a pattern of unwanted, intrusive thoughts, feelings, images, sensations, or urges that take the form of a Feared Story. This story tells the sufferer of a potential, and as of yet fictional, outcome or truth about their actions, intentions, character, or future. This story, being completely unwanted, makes the sufferer feel an overwhelming sense of anxiety . To deal with this anxiety and to get back to a sense of normalcy, confidence, and comfort, the OCD sufferer will then engage in overt or covert compulsive behaviors as an anxiety management strategy. Compulsions can include avoidance, reassurance seeking, mental review, rituals, and other repetitive acts. Once done, the sufferer gets a false sense of security that unfortunately reinforces the anxiety cycle. OCD’s deception is that you have to struggle with and resolve the content of the thought. You have to clarify, rectify, and examine the thoughts to determine whether they are true or false. For example, the contamination OCD sufferer believes he must be sure that his hands are fully clean, or at least clean enough, before they can interact with anyone. In the brief overview of the OCD cycle above, you likely noticed that I mentioned thoughts and feelings. Wouldn’t this suggest that OCD is both a thought and a feeling issue? Yes, but in practice not really. People with OCD often get wrapped up in three potential issues: the trigger, the feared story, and the feeling. Ultimately, freedom from OCD requires you to face down the feeling, because OCD is a feeling problem. The Trigger OCD can be triggered by almost anything, including things we see, random thoughts we have, sensations we experience, and objects we encounter. Everything that you and I will ever encounter, think, feel, or experience is neutral until we place some value upon it. Meaning it is neither good nor bad, right nor wrong. Is a knife good or bad? It can be used to open to letter, but it can also be used to open a person. How about therapy? It is both good and bad. It can bring about profound positive life transformation, but it can also be emotionally draining, time-consuming, and costly. Likewise, triggers to one’s fears are also neutral. Yet those with OCD and anxiety disorders exaggerate the meaning and importance of triggering thoughts or images as they relate to the Feared Story. Each fear has any number of neutral associations. Remember the knife example? It doesn’t have just one meaning or significance. A knife can conjure thoughts of cooking shows. It can cause someone to think of their dad’s fishing knife or Julius Caesar. The thought of a knife can also spark thoughts of suicide, harm, or crime. If you blame the trigger (i.e. the feared thought or object) and label it as the problem, you are being misdirected. OCD, and the history of repeated compulsions, exaggerate the importance of a select number of mental associations. Over time, the other neutral or positive associations are downplayed or ignored leaving the feared associations as seemingly the only associations for these thoughts or experiences. When you scapegoat the trigger as the problem, you believe minimizing your contact with it will make the obsession about it go away. Unfortunately, avoiding the trigger leads to isolation and reinforces the false notion that the trigger is the problem, resulting in greater fear of the trigger and the feared story it spawns. The Feared Story Our brain tells us stories all day. Some we like. Some we don’t. OCD tells us stories too, and they are catastrophic, threatening, and at odds with who we are. These Feared Stories are a combination of distorted thoughts and mental images about the result of actions, one’s character, or an inevitable future that concludes in something terrible. Some people blame the Feared Story as the problem within OCD. They think that if they were to simply get rid of the thoughts, think the opposite of the thought, prove that the thought is wrong, or simply “just think right” that their OCD would evaporate. They believe OCD is a thought problem. To their point, treatment for OCD and anxiety disorders commonly begins by challenging the feared story using rational thought to develop a broader, reality-based view of the fear. This exercise helps the sufferer develop confidence that their intrusive thoughts are likely irrational, overvalued, and not deserving of excessive and exhausting compulsive responses. When I challenge the Feared Story in session, my clients are quick to point out how their Feared Story is wrong. They usually say, “I know this doesn’t make sense,” then proceed to point out all the reasons why it doesn’t make sense, and they are right! For example, a client with Pedophile OCD (POCD) might say, “I’m not a pedophile because I’ve never been attracted to a child in the past. I’ve never wanted to do anything sexual with a child. Whenever I have the thought about molesting a child, I always get anxious and have never felt feelings consistent with my typical feelings of attraction when I think about adults.” Generally speaking, people with OCD are capable of combating their feared thoughts with rational alternatives. However, compulsions exist because a feared thought comes with, or takes the form of, an uncomfortable and unwanted feeling that overwhelms the sufferer. Despite developing a list of rational observations and objections to the Feared Story, it does nothing long term because the issue has never been a matter of “right thinking,” but of an intolerance of the feeling brought on by the Feared Story. The Feeling Here is the actual problem of OCD. The feeling. More specifically, it is the feeling that makes you engage in compulsive behavior, which subsequently reinforces the OCD cycle. Chasing down and embracing that feeling with a welcoming and accepting posture desensitizes you to the feeling over time. Conversely, if you are unwilling to feel the feeling, but instead rely on compulsions and avoidances, desensitization cannot happen. Remember, we are able to acknowledge that the trigger is neutral and has a number of alternative associations. Additionally, we are very capable of telling ourselves why the Feared Story is irrational and wrong. However, we are unable to convince ourselves to not feel something because feelings are largely out of our control. While not bad or wrong, feeling anxiety in an OCD moment is unwanted. Typically speaking, we say anxiety feels bad, but it by itself is not “bad.” It is an unwanted feeling state at the moment you’re feeling it. When we ride a roller coaster or see a horror movie, we expect to feel butterflies in our stomach, feel our heart racing, and feel jumpy. You know, anxiety feelings. But in this context, we paid good money for the experience! So, the feeling itself is not bad, just unwanted at that moment and inconsistent with the level of actual risk. Similarly, when it comes to OCD, sometimes the feeling isn’t just anxiety, but sadness, loneliness, anger , apathy, or emptiness. The goal of Exposure and Response Prevention treatment is to intentionally feel this feeling, acknowledge this inconsistent emotional response, and let it remain without compulsive behaviors until it passes. Remember, it will always pass. Counterintuitively, your job in Exposure and Response Prevention is to engage the feeling. It’s the enemy and the problem. The solution is to show that you’re stronger than it by calling its bluff that the feeling is heralding in something terrible and that you are not strong enough to shoulder the uncomfortable experience. You are strong enough, and the terrible outcome probably is not coming. Stand firm and let the storm pass. Feel the Pain, See the Results If you are not ready to do this, you are going to have a hard time overcoming your anxiety. But you can start small, and progressively work up. If you are consistent and keep pushing yourself, you will eventually find more mental and emotional strength and freedom. Kevin Foss - Website -

Here’s why and what we can do about it. Less than half of people talk about having suicidal thoughts or behaviors. Talking about suicidal thoughts is the best way to help, and to get help. Suicidal thoughts are common, you're not alone. Many people at risk of suicide are going undetected and unsupported in our community, our research suggests. Our recently published study found under half of the people tell anyone they’re thinking of suicide, making plans, or have attempted suicide. Here are some reasons why people don’t often talk about this and what you can do to help a friend or loved one get the support they need. We’re Getting No Better at Predicting Worldwide, more than 700,000 people take their life each year. Globally, suicide is the fourth leading cause of death among 15–29-year-olds. But our ability to predict who might have suicidal thoughts and behaviors or end their life has not really improved over 50 years of research. Because suicide is relatively infrequent (as a percentage of the population), it is difficult to identify robust risk factors for suicide we can generalize across the population. We need to know who’s at risk. One of the most crucial steps in understanding and managing the risk of suicide is for individuals to disclose their suicidal thoughts and behaviors to other people. It also gives us a chance to mobilise support. However, when colleagues and I looked at the evidence, we found less than 50 percent of people tell anyone else about their suicidal thoughts or behaviors. Even if they had these thoughts or behaviors over the past month, only an estimated 38 percent of people told anyone. Most people don’t ever disclose any suicidal thoughts or behaviors, however long ago these occurred. Most people don’t ever disclose suicidal thoughts or behaviors, however long ago these occurred. Our study was a meta-analysis, which combined information from almost 100 studies to estimate how commonly people disclosed. Women were slightly more likely to disclose than men, and disclosure was more likely when associated with a psychiatric disorder. Notably, among studies of people who had died by suicide, close to 60 percent of people had no documented evidence of telling someone they had thoughts or plans of ending their life. Put simply; the findings suggest a large number of people at risk of suicide are undetected and unsupported. Why don’t people say anything? Reasons people don’t disclose thoughts of suicide include stigma and shame about having the thoughts, fear of rejection or unsupportive reactions from others, concerns about burdening other people, and believing nothing can be done. Worrying about the consequences of telling other people, such as being hospitalised or receiving unwanted treatment, might be particularly important when people have had negative experiences with disclosure. A lack of confidence in expressing oneself is another significant barrier. Some people avoid thinking or talking about it as their main coping method. Having more social support can increase the likelihood of disclosing suicidal thoughts. This is important, given most disclosures are made to family or friends. Increased understanding and knowledge about suicide are also linked with a higher likelihood of disclosure. How do we start conversations? Public campaigns to increase mental health literacy and normalize discussions about suicide have likely helped facilitate disclosures. Most times, this means talking about it. Asking someone about suicide risk indirectly can be more comfortable, such as checking in on how they are feeling or doing. But the question might be misunderstood or answered in a “socially desirable” way. A conversation might go, “How are you doing?” with a response, “Yeah, not bad.” General questions like "Are you OK?" might not work. Asking more direct questions might. But research shows asking more direct questions does not increase their distress and does not cause someone to have more suicide-related thoughts or behaviours. So, clear questions – such as “Are you having thoughts of ending your life?” or “Are you thinking about hurting yourself?” – may help draw an answer. Asking about how safe they feel now can also be useful: “Do you feel safe at the moment?” Offering the choice of not responding might lead to opportunities to ask about it later. You can say, “It’s OK if you don’t want to answer that right now.” Talking about suicide can be difficult. But it is important to know we don’t need to be perfect at it, and we’re not tasked with trying to solve all of a person’s problems. You Can Really Help For some people, thoughts of suicide reflect a negative or hopeless mental state but not an intent to harm themselves. Most people who have thoughts of suicide do not end their lives. But what you can do for someone is significant. First, the emotional support and acceptance you show by simply asking and listening are immensely important to help people feel understood and cared for. This can help normalize and de-stigmatize their experience. Depending on your relationship, you may want to know more about what drives those thoughts and being curious and non-judgmental can help. Second, you can give simple, practical support by asking someone what they might need. You could try, “Is there anything you need right now? How can I help?”. You could encourage them to tell loved ones and support them in finding professional help. This might be their general practitioner or mental health professional to call a helpline or 000 if the person seems very unsafe. If this has caused any distress from reading, please get in touch with a health professional, and talk to a loved one. If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist, visit the Psychology Today Therapy Directory. David Hallford, Ph.D., - Website -