Higher scores on social media addiction were related to higher infidelity. Higher scores on social media addiction were related to higher scores on social media-related infidelity. Younger participants scored higher on social network site addiction and social network infidelity. Men scored higher on the social media infidelity compared to women. Social media can be used to facilitate contact with friends, former friends, or even former romantic partners, through messaging or via interactions and comments on social media posts. Sometimes, although more rarely, we may even begin to perceive social media friends as possible romantic alternatives to our current partners. In addition to this, we know that social media interaction and online interaction are characterized generally by lower levels of inhibition, whereby people are bolder and more candid in what they say. What is the level of social media interaction that is acceptable between us and those outside of our romantic relationships ? Furthermore, is there a connection between social media interaction and possible infidelity? This was investigated by Irum Saeed Abbasi from San Jose State University, California. Abbasi employed 365 participants ranging in age from 18 to 73. About one-third of participants reported being married, half reported casually dating, and the remainder said they were in a committed relationship . In order to assess infidelity related behavior on social media, participants in the study completed the Social Media Infidelity-Related Behavior Scale. An example item: “'I sometimes like to chat or message old romantic partners online or on social networking sites." Participants responded from strongly agree to strongly disagree. Participants also completed the Modified Facebook Intrusion Questionnaire that measured behavioral addiction. An example item from the scale: “'I feel connected to others when I use social media.” Responses were again ‘strongly agree’ to ‘strongly disagree.’ Initially, Abbasi found a simple relationship in that social networking site addiction was found to be positively related to social networking site infidelity. Participants who scored higher on social media addiction also scored higher on social media-related infidelity behavior. However, this relationship was to an extent affected by age. Younger participants scored higher on social network site addiction and also social network infidelity in comparison to those who were older. More specifically as age increased, the association became weaker. This age difference is explained by the researcher as being a consequence of younger individuals perhaps taking more risks compared with older individuals, and therefore also more likely than older individuals to take more risks while online. Furthermore, Facebook use is generally higher in younger people, mainly driven by a wish to use new technologies. This explains why younger individuals are more likely to develop an internet addiction. Older individuals use social media less, generally because the need to compare and connect with friends, reduces with age. In terms of gender, Abbasi found no difference between males and females, although men did score higher on the SNS infidelity measure compared with women. Numerous previous findings have linked Facebook use with higher levels of jealousy between romantic partners, driving them to engage in social media surveillance behavior, eventually leading to lower levels of relationship trust. Social media interactions can become compulsive, which may ultimately lead to flirting and perhaps unfaithful behavior. The study described here adds to our understanding of infidelity driven by social media use in finding that younger individuals are more likely to engage in social media infidelity because they are likely to take more risks online. Martin Graff, Ph.D., - Website - References Abbasi, I., S. (2019). Social media addiction in romantic relationships: Does user's age influence vulnerability to social media infidelity? Personality and Individual Differences. 139, 277-280.

Body dysmorphia can lead to unrealistic expectations about cosmetic procedures. Body dysmorphia is often revealed through behaviors like frequent mirror checking and excessive grooming. This history can be traced back to the term imagined ugliness syndrome. Cosmetic interventions may exacerbate psychological distress in some cases. Body dysmorphic disorder, BDD, a psychiatric condition marked by excessive concern over imagined or minor defects in appearance, is intricately linked to the prevailing cultural ideals of beauty. Research suggests these standards of attractiveness, heavily influenced by societal norms, play a significant role in the development of BDD, contributing to a distorted self-image and body dissatisfaction. Origins and Evolution of BDD BDD’s history can be traced back to when it was termed imagined ugliness syndrome. Recognized formally in psychiatric literature with the advent of the DSM-III, BDD has since evolved in its diagnostic criteria. The DSM-V categorizes BDD under obsessive-compulsive and related disorders, emphasizing its compulsive nature and the significant distress or impairment it causes in one’s life. Identifying BDD BDD is often revealed through behaviors like frequent mirror checking, excessive grooming, or seeking reassurance about one’s looks. The relentless belief that one is unattractive or repulsive dominates the patient’s thoughts, overshadowing any reassurance they might receive. This disorder can lead individuals to pursue unnecessary dermatological treatments or cosmetic surgeries, often with the unrealistic expectation that these procedures will fix their perceived flaws and, by extension, their life problems. Demographics and Prevalence BDD typically emerges in adolescence, with a significant number of cases reported before the age of 18, although it can also appear later in life. Estimates suggest that up to 1 percent of the U.S. population may suffer from BDD, with higher prevalence noted in aesthetic medical settings, such as dermatology and plastic surgery practices. Etiology of BDD The causes of BDD are multifaceted, involving psychological and physiological factors. Experiences such as childhood teasing, bullying, and abuse can contribute to the condition, as can complex psychological processes like the displacement of emotions. The proliferation of social media has introduced another layer, providing a platform for comparison and cyberbullying that can aggravate BDD symptoms. Cosmetic Procedures: A Growing Trend There has been a notable rise in individuals seeking cosmetic procedures, with millions undergoing surgeries worldwide. This increase has led to more frequent encounters between medical professionals and patients with BDD. Historically, BDD has been considered a contraindication to cosmetic surgery. Patients with BDD often harbor unrealistic expectations and are typically dissatisfied with surgical outcomes, which do not align with their distorted self-perception. This dissatisfaction can lead to severe repercussions for both the patient and the surgeon, including legal actions and, in extreme cases, acts of violence. For instance, one study found that 2 percent of plastic surgeons had been physically threatened by a patient with BDD. Assessment and Treatment: A Multi-Dimensional Approach A more nuanced approach to understanding BDD suggests differentiating between mild and severe cases. Patients with less severe symptoms who do not exhibit significant life impairment may benefit from cosmetic procedures if their expectations are managed appropriately. Treating patients with mild BDD symptoms requires careful screening and collaboration with mental health professionals to ensure the best outcome. Screening for body dysmorphic disorder is an essential step in the diagnostic process, particularly for professionals in the fields of dermatology, cosmetic surgery, and mental health care. Using validated screening tools can help clinicians determine the presence and severity of BDD symptoms and make informed decisions about the appropriateness of cosmetic interventions. There are two widely used questionnaires for BDD screening. The BDD Questionnaire-Dermatology Version (BDDQ-DV) The BDDQ-DV is a specific form of the Body Dysmorphic Disorder Questionnaire, adapted for use in dermatology settings. It’s designed to be a self-administered screening tool. Patients can fill it out while waiting for their consultation, which can then inform the clinician’s assessment and subsequent discussions about treatment options. The BDDQ-DV consists of questions that gauge the patient’s preoccupation with their appearance, the extent of their concern, behaviors they may engage in because of their appearance concerns, such as checking mirrors or seeking reassurance, and the impact of these concerns on their daily life. If the responses indicate a possible case of BDD, the clinician can pursue further evaluation, possibly involving a mental health professional. The Dysmorphic Concern Questionnaire (DCQ) The Dysmorphic Concern Questionnaire is another screening tool for BDD, though it is more complex and comprehensive. It includes questions that are not exclusively about BDD symptoms, which can help to identify broader concerns that may require attention, including other mental health issues. For instance, the DCQ asks about worries over body odor, sweating, and general appearance and assigns points to responses. A cumulative score can indicate the likelihood of BDD, with a higher score suggesting greater concern and possible BDD diagnosis. This tool is beneficial for identifying individuals who may be at risk for BDD but may not be aware that their concerns are disproportionate or indicative of a deeper psychological issue. Both the BDDQ-DV and the DCQ have been validated, meaning they have been tested for their effectiveness in accurately identifying BDD in patients. Validation gives clinicians confidence in using these tools as part of their practice. Moreover, these tools can facilitate communication between the patient and the clinician, providing a structured way to discuss concerns that might otherwise be difficult to articulate. When BDD is identified, treatment can focus on psychological interventions, which are the first line of treatment for BDD, rather than cosmetic procedures, which may not address the underlying disorder. In summary, screening tools for BDD should be an integral part of the assessment process for individuals considering cosmetic procedures. These tools provide a standardized way to identify symptoms of BDD, ensure that patients receive appropriate care, and prevent procedures that may not be beneficial. Clinicians are encouraged to incorporate these validated questionnaires into their practice to support the well-being of their patients. Concluding Thoughts As cosmetic procedures become increasingly common, both cosmetic professionals and mental health practitioners must recognize and understand the implications of BDD. Using a multidisciplinary approach, including careful patient screening, can aid in distinguishing those who might benefit from cosmetic procedures from those for whom such interventions may exacerbate their psychological distress. Further research is needed to refine treatment strategies for BDD, aiming to enhance the psychological well-being of those struggling with this often-debilitating disorder. Tara Well, Ph.D., - Book - References Dufresne RG, Phillips KA, Vittorio CC, et al. A screening questionnaire for body dysmorphic disorder in a cosmetic dermatologic surgery practice. Dermatol Surg 2001; 27: 457-62. Higgins S, Wysong A. Cosmetic Surgery and Body Dysmorphic Disorder - An Update. Int J Womens Dermatol. 2017 Nov 20;4(1):43-48. doi: 10.1016/j.ijwd.2017.09.007. PMID: 29872676; PMCID: PMC5986110. Mancuso SG, Knoesen NP, Castle DJ. The Dysmorphic Concern Questionnaire: A screening measure for body dysmorphic disorder. Aust N Z J Psychiatry. 2010 Jun;44(6):535-42. doi: 10.3109/00048671003596055. PMID: 20397781.

A constant need to please others is not the same as natural generosity. People-pleasing behavior can be the result of childhood emotional injury and trauma. Parents with symptoms of certain personality disorders demand that the children put the parents' needs first. People-pleasing behavior is driven by fear and is different from generosity driven by self-expression. Children raised by unhealthy parents are often trained to please their parents above pursuing their own interests and proclivities. Significantly impaired parents, such as those suffering from symptoms of borderline personality disorder (BPD) , narcissistic personality disorder (NPD) , and other serious mental illnesses, often traumatize their children if they do not do what they want. This often occurs through parents lashing out at their children when they are not pleased. These children grow up to be adults who consistently put the well-being of others ahead of their own. They do not do this out of generosity. Instead, they do this to feel safe. Allowing generous people to be generous to you can create a healthy bond, but allowing people-pleasers to please you can create a trauma bond and retraumatize those who are trying to please you. Healthy individuals whose personality predisposes them to be generous with others enjoy the experience of sharing with others. They offer their time and other resources to others and feel closer to others when their generosity is accepted and reciprocated. They are not significantly impacted when others decline their generosity. In many cases, they give anonymously, which makes them feel closer to humanity. Donations to special groups such as the homeless, veterans , cancer survivors, etc., are common examples. The giver generally does not meet the recipient. People who volunteer their time at soup kitchens, fundraisers, or fighting fires are other common examples. These individuals offer their resources to anyone who might need them. They don’t seek recognition because the satisfaction comes from self-validation. They are expressing the best part of themselves, and it makes them feel good to do so. People-pleasers have a different motivation and a different method. Most people-pleasers are motivated by fear. Many of them grew up in families where if they didn't, please others they were either punished, rejected, or ignored. This often occurs when children are raised by a parent or parents with symptoms of personality disorders. For example, parents with symptoms of BPD tend to lash out at their children when their child fails to please them. Parents with symptoms of NPD tend to ignore their children when they don’t, please them. These children often grow up to be people-pleasers as adults. They generally approach others feeling they need to please them to be safe or accepted. When others are not pleased, they become fearful that they will be punished or abandoned. They need to know that others are pleased by them, so anonymous giving does not satisfy them. They need to be recognized or celebrated when they give to others. There are many ways that people give to others out of fear. They present gifts to individuals in person, or they leave cards or notes with their signature. They expect that for others to like (love) them, they must consistently put the feelings and needs of others above their own. They do this because they have been raised to believe that they will only be loved for what they give and not for who they are. Almost all people-pleasers have low self-esteem. People with high self-esteem please themselves first most of the time. Allowing generous people to give to you is healthy. If you fall and a random stranger offers you a hand, take it. If you are hungry, go to a food kitchen and let them feed you. This gives healthy people a chance to do something that makes them feel good. They will not ask anything of you in return. Allowing people-pleasers to please you is unhealthy. Allowing others to give you gifts, services, or other resources without reciprocity confirms to them that they are only worth what they can offer to others. It repeats the patterns of behavior that resulted in the development of people-pleasing, and therefore it is enabling. It may also be retraumatizing to the person if their childhood experience was traumatic. Refusing to allow a people-pleaser to please you is giving them a gift. It gives them the chance to experience someone accepting them and wanting to be with them for who they are, not for what they can give. The sample conversation that follows models how you can turn an unhealthy enabling experience into a healing and growth opportunity. Jeff and Ray went to high school together. They hadn’t seen each other since graduation, and they reunited at their 10th high school reunion. Jeff was very happy to see Ray, but he quickly remembered that he was uncomfortable being around Ray because of his constant efforts to please. In the past, he just let Ray keep paying for things and yielding to all his choices and whims because it was easier than arguing, but this time he decided to handle it differently. Ray: Great to see you again, Jeff. How about you and your wife come to dinner? I will cook you the best dinner you ever had. Jeff: How about we go to a restaurant? Ray: Sounds great. You pick the place, and I will treat. Jeff: I am sure you know some wonderful places. Ray: OK. What do you like to eat? Jeff: It is not about what we eat. I just want to catch up with an old friend. Ray: Nobody has ever spoken to me that way before. Jeff: You deserve to be treated this way. If you are a people-pleaser, you will do well to take a chance and let others like you for who you are without pleasing them first. It is the only way that you can experience healthy relationships. It is possible that some people might lose interest when you stop giving. You should focus on cultivating relationships with those who don’t. Relationships with individuals who punish you if you don’t, please them are unhealthy and possibly abusive and should not be tolerated. Daniel S. Lobel, Ph.D.,

The neurological and psychological differences between hoarding disorder and OCD. Hoarding disorder (HD) has been considered a type of obsessive-compulsive disorder (OCD). David F. Tolin, Ph.D., and colleagues have examined the organic basis of the categorization in several ways. Research has led to a recategorization of hoarding disorder in the DSM-5. Hoarding disorder (HD) has been considered a type of obsessive-compulsive disorder (OCD) . Now, there is mounting evidence against this notion. One of the most compelling is a research examination performed by Tolin et al. (2012). David F. Tolin, Ph.D., is from the Institute of Living in Hartford, Connecticut. The other authors are from various institutions. Research 2012: The Neural Mechanism In this study, the researchers examined three groups: patients with HD and OCD, comparing them to healthy controls (HC). In all, there were 107 subjects, 43 of whom had been diagnosed with HD, 31 with OCD, and 33 who were HC. Each group was asked to bring a piece of junk mail from home to the laboratory. This mail, as well as junk mail furnished by the lab, was photographed. Then, the subjects’ brain activation in deciding whether a piece of mail should be retained or discarded was measured using functional magnetic resonance imaging (fMRI). Patients with hoarding disorder displayed minimal activation levels in the insula and anterior cingulate cortex (ACC) while they assessed what to do with the experimenter’s mail. These are brain areas involved in decision-making and emotional regulation. On the other hand, when the HD group was deciding what to do with their own mail, these same brain regions burned brightly. Consistent with this, the patients with HD opted to remove fewer pieces of personal junk mail compared to the other groups. This observation and others like it gave the organizers of the Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) important information. From that time on, they designated hoarding disorder differently than previously. Originally, it had been considered a form of OCD. Now, it is a distinct condition included under "OCD and related disorders." Clinical Differences Between HD and OCD Hoarding disorder is characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value. There is a perceived need to save them, and personal distress is associated with discarding them. This leads to significant clutter that disrupts the hoarder's ability to use living spaces as intended. A hoarder might say, “If I were to throw away any of my stuff, it would cause me too much pain and anxiety to bear.” Obsessive-compulsive disorder, on the other hand, involves intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce the distress associated with obsessions. Such an afflicted person might say, “I am compelled to wash my hands repeatedly so I don’t have germs on them that could cause disease.” Treatment Differences Between HD and OCD Selective serotonin reuptake inhibitors (SSRIs), commonly used to treat OCD, are often less effective in treating HD. This suggests different underlying neurochemical pathways. Cognitive-behavioral therapy (CBT) tailored for HD focuses on decision-making, organizational skills, and cognitive restructuring related to attachment to possessions. It is less effective for OCD, again suggesting different pathways for the two. A new therapy for HD advertised by the Mood Center in Annapolis, Maryland, combines ketamine and transcranial magnetic stimulation (TMS). To my knowledge, it has not been rigorously tested for this purpose, so any benefit would be anecdotal. Research 2023: Trial of CBT for HD In one of several follow-up examinations to that 2012 study, Tolin and colleagues used group CBT (2023) for 16 weeks for 64 treatment-seeking patients with HD. They were compared to those on a waiting list. Again, as in the 2012 study, functional magnetic resonance imaging was used to examine neural activity during simulated decisions about whether to acquire and discard objects. The aim of the study was to determine whether the therapeutic benefits of CBT follow improvements in the ACC dysfunction noted in the 2012 examination or abnormalities previously identified in other brain regions. During both acquiring and discarding decisions, activity decreased in several regions. In this study, however, the ACC activity did not show any dramatic change. As the researchers concluded, “Therapeutic benefits of CBT for HD do not appear to be mediated by changes in ACC activation.” By implication, it is my understanding that the insula was also not affected. Summary HD and OCD, despite some superficial similarities, are fundamentally different in terms of their neurological underpinnings, clinical manifestations, and responses to treatment. Future research should continue to explore these distinctions, particularly through longitudinal studies and larger sample sizes. Shirley M. Mueller, M.D., - Website - Book - References Tolin, D. F., Stevens, M. C., Villavicencio, A. L., et al. (2012). Neural Mechanisms of Decision Making in Hoarding Disorder. Archives of General Psychiatry, 69(8), 832-841. Tolin DF, Levy HC, Hallion LS, Wootton BM, Jaccard J, Diefenbach GJ, Stevens MC. Changes in neural activity following a randomized trial of cognitive behavioral therapy for hoarding disorder. J Consult Clin Psychol. 2023 Apr;91(4):242-250. doi: 10.1037/ccp0000804. Epub 2023 Mar 6. PMID: 36877480; PMCID: PMC10175200. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

"Lifestyle medicine" can be as powerful as prescriptions" New research makes it clear that daily habits can boost or diminish mental health. A healthier lifestyle can ward off depression , even in those with genetic predisposition. “We are what we repeatedly do.” —Aristotle Your answers to these seven questions have serious implications for your mental health: Do you get between 7 and 9 hours of sleep a night? How much junk food do you consume? Do you make time for friends and family ? Do you exercise regularly? How many hours a day do you sit at your desk? Do you smoke cigarettes? How much alcohol do you consume? A new study published in Nature Mental Health found that a healthy lifestyle can prevent depression , even in those who have a genetic predisposition. While pharmaceutical advertisements have led many to believe that major depressive disorder is caused by a lack of neurotransmitters, it has become increasingly clear that depression is much more than a chemical imbalance. Remember the classic Zoloft commercial from the early 2000s showing a sad blob with a cloud following it around? The voiceover explains: “While the cause is unknown, depression may be related to an imbalance of natural chemicals between nerve cells in the brain. Prescription Zoloft works to correct this imbalance.” Zoloft transforms the sad blob into a smiling blob and the cloud literally dissipates. More recent evidence paints a more complicated picture that debunks this model: Antidepressant medications work for some people, but not because they correct a chemical imbalance. What remains unclear is exactly how they work. What is clear is how daily habits can boost mental health. Researchers examined data from almost 290,000 people—of whom 13,000 had depression—over a nine-year period, and identified seven healthy lifestyle behaviors linked with a lower risk of depression: 1. Prioritize sleep. Sleeping seven to nine hours per night reduced the risk of depression including single depressive episodes and treatment-resistant depression by 22 percent. Of all the depression-reducing factors, getting a good night’s sleep on a regular basis made the biggest difference. 2. Cultivate connections. Frequent social connection reduced the risk of depression by 18 percent and was the most protective against recurrent depressive disorder. Put simply, happiness doesn’t only come from within, it also comes from “with.” 3. Drink less. Moderate alcohol consumption decreased the risk of depression by 11 percent. Less is clearly more. Greater than one drink a day for women and two drinks a day for men can actually increase the risk of depression. 4. Eat wel l. Refined carbs, processed foods, and sugary drinks are bad for the body and the brain. People who maintained a healthy diet were 6 percent less likely to report an episode of depression. Increasing evidence shows that the Mediterranean diet can boost mood and dial down symptoms of depression and anxiety. 5. Move regularly. Frequent exercise can improve daily mood and also cut one's risk of depression by 14 percent. A related study published in the British Journal of Sports Medicine found that physical activity was 1.5 times more effective than medication in reducing depression. Not surprisingly, the sports that give people the biggest boost typically involve others—tennis, soccer, and other team-related activities. 6. Don’t smoke. Never smoking decreased the risk of depression by 20 percent. Enough said. 7. Get up, stand up . A sedentary lifestyle was considered independent of exercise. Taking breaks and stepping away from screens regularly reduced the chances of depression by 13 percent. If you’re reading this sitting down, please stand up and stretch. These lifestyle factors are more than icing on the cake. I would argue that they are the cake. People who maintained most of these seven healthy habits—five or more—had a 57% lower risk of depression. We all know that a healthy lifestyle is important for our physical health. It’s just as important for our mental health. Bottom Line: While many with depression benefit from medication and therapy, lifestyle medicine can make a meaningful difference in reducing symptoms and preventing them altogether. Samantha Boardman, M.D., - Website -

How we experience fear may be altered by the language we use to talk about it. How we experience emotions like fear and love may vary depending on a speaker's native language. Hearing a threat in one's native language seems to intensify psychophysical correlates of fear. Fear is something that can be altered by cultural and linguistic experience. Lately, there seems to be plenty to fear in the world: threats of war, political divisiveness, mass shootings. But it turns out that how we talk about what we fear might actually moderate our reactions, offering clues to how we are socially and culturally conditioned to experience that emotion . A fearful history The word fear has a long history in English. In Anglo-Saxon times, “fær,”as it was written, primarily referred to impending peril or sudden danger. But the root of the word dates a lot farther back than English, all the way to a much more ancient root, pēr, from a hypothesized language known as Indo-European that existed about 6,000 years ago. It is believed that this root meant “to pass through or travel,” suggesting that fear ultimately developed from the sense of a sudden (frightening) experience you passed through. The perseverance of this word over time certainly suggests it usefully describes a longstanding human emotion , but research suggests how different language speakers conceptualize fear is less consistent than we might expect. Is fear universally negative? We might assume that basic emotion words like “love” or “fear” translate similarly across languages, but whether these emotions are viewed positively or negatively (a language’s “emotion semantics”) can show cultural variation based on what people have learned to associate with those words. Some research has examined how this happens by looking at what is called colexification patterns across languages. Colexification occurs when a language has more than one concept associated with a word, typically arising from how and in what contexts people use those words. For instance, in English, “anxious” is often used to mean “worried” (as in “I am anxious about the test”) but also to mean “eager,” as in “I am anxious to see that new movie.” Thus, it colexifies those two meanings. However, in Dargwa (a language spoken in Dagestan), the word which means “anxious” can’t mean “eager” but can be used to mean “regret.” This suggests that many English speakers conflate anxiety and eagerness in a way not experienced by Dargwa speakers – and, since being eager is not always a bad thing, they may not view anxiety as negatively as Dargwa speakers. A fearful pattern? In looking at such patterns across the major language families (languages related historically), researchers found that the word “fear” was often associated with anxiety, envy and grief in Indo-European languages (e.g., the family including English). But in Austronesian languages (languages spoken in the Indonesian archipelago such as Malay, Tagalog, Balinese and Javanese), “fear” more often was associated with just the concept of surprise. In other words, in languages that associate the concept of fear with an emotion like “surprise” rather than a more negative emotion like “grief, it may moderate how speakers perceive that emotion toward a less negative sense. The foreign language effect Another fascinating finding is that hearing something in your native language seems to make you experience emotions like fear more intensely than hearing about it in a foreign language. This seems to be related to a richer encoding of experience in your native language than when you learn a second language and/or that there is an increase in psychological distance to an event when a non-native language is used. This emotional distancing effect of a foreign language has long been noted – in fact, Freud wrote of bilingual patients shifting to their non-native language to describe anxiety inducing topics. However, this so-called “linguistic detachment ” associated with using a foreign language has only recently been empirically studied. In a 2018 study, researchers asked participants to complete a verbal fear-conditioning experiment in either their native or a foreign language to explore whether simply changing language reduced emotional reactivity, as measured by pupil dilation and electrodermal response (e.g., sweat gland activity). In the fear-conditioning condition, participants were told they might receive a mild electric shock when certain colored squares appeared on the screen while they were saying numbers aloud (no actual shock was delivered). The study showed that, regardless of the language used in the interactions, hearing the possibility of a threat increased participant’s psychophysical response compared to non-threat conditions. However, both pupil dilation and skin conductance activity increased to a greater degree when participants heard the threat in their native language. As well, initial psychophysical response decreased more rapidly when a foreign language was used. All of this suggests that hearing a threat in a foreign language may indeed decrease a person’s fear-conditioned reaction. Changing our perception of fear The fact that how we talk about fear changes how we react to it certainly suggests there may be some value to trying to disrupt the language or associated meanings we use when talking about what frightens us. As well, some work (Argaman 2010) has suggested that fear increases the tendency for self-focused language such as the use of “I” and “we” pronouns and a greater tendency to put emotions into words by using affect-language (e.g., happy, sad, scared). All of this may indicate that talking about what one is experiencing in fear-inducing situations helps to regulate that emotion – as might gaining distance from fearful situations by using a second language, if available. As well, how our language categorizes an emotion (in relation to other emotion concepts) seems to impact whether we perceive those emotions negatively or positively. Unfortunately, there has not been a lot of research on clinical applications for language and emotion linkages, but it does tell us that fear is something that can be altered by cultural and linguistic experience, opening the door to potential avenues to change how we talk about and react to it. Perhaps Roosevelt was right when he infamously said, “The only thing we have to fear is fear itself.” Valerie Fridland, Ph.D., - Website - References Argaman, O. (2010). Linguistic markers and emotional intensity. Journal of Psycholinguistic Research, 39, 89-99. Chamberlain, Alex. (1899). On the Words for “Fear” in Certain Languages. A Study in Linguistic Psychology. The American Journal of Psychology, 10(2), 302–305. Jackson, J. C. et al. (2019). Emotion semantics show both cultural variation and universal structure.Science 366,1517-1522. Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S., Pfeifer, J. H., & Way, B. M., (2007). Putting feelings into words: Affect labeling disrupts amygdala activity to affective stimuli. Psychological Science, 18, 421-428. Lindquist KA, Satpute AB, Gendron M. (2015). Does language do more than communicate emotion? Curr Dir Psychol Sci. Apr 1;24(2):99-108. Oxford English Dictionary, s.v. “fear, n.”, September 2023.

Children and animals are natural teachers of mindfulness. The lessons we can learn from children and pets include gratitude, mindfulness, communication, and wonder. Engaging in simple, joyful, mindful activities can help to reduce feelings of anxiety . Gratitude allows a cognitive shift from thoughts of worry and dread to thoughts of comfort and contentment. When we are anxious and worried, we lose sight of the present moment as our minds fixate on possible future outcomes and worst-case scenarios. If we pay attention, children and animals can serve as guides back to the present moment. These small yet inspirational beings can remind us of the importance of play, presence, wonder, gratitude, and communication. Here, we will explore some of the ways in which kids and pets can educate us about how to be mindful when we are experiencing anxiety , worry, and stress. Presence and Mindfulness If you’ve ever been walking your dog and felt irritation that she was taking too long or sniffing and exploring too much, you may have missed an important lesson from your companion: The present moment is all that there is right now. Dogs, cats, and other animals have a way of focusing intensely on what is happening in the now. They simply do not possess the cognitive ability to fixate on potentialities or future outcomes. While we humans do have that ability for better or worse, we can take a lesson from the animal kingdom and work to refocus our attention on the present when we are feeling overcome and overwhelmed by future thoughts. Recently, during a rain shower, I looked out the window and observed three deer simply lying on the grass, seeming to contentedly allow the raindrops to shower them. It made me wonder, how often do we simply stop and experience what is happening? Through an anxiety lens, probably not often enough, as we constantly get hung up on the next task, the next “what if,” and the next thing on our to-do list. Mindfulness is a proven, timeless antidote to anxious and catastrophic thinking. Just watch the way animals soak in every moment of whatever they are doing with complete, uninterrupted focus. Wonder and Play The next time you are feeling a “joy deficit” because you are overstressed, stretched too thin, or fatigued by “adulting,” think about how a young child plays and experiences the world with a sense of wonder. In Virginia Axline’s psychology classic, Play Therapy, she writes that the only need of a child at play is “the need to be unshackled, to be freed, to be permitted to be expanded into a complete self without a frustrating and warping struggle.” When kids play, they experience freedom, autonomy, and a sense of endless possibility. If we are able to tap into this mentality when we are stressed, it can free us from the chains and constraints of anxious thinking. Echoing Axline’s concept, the psychologist Ernst Kris wrote of the value of “regression in service of the ego.” In simple terms, Kris means healthily “regressing” at times to simple, joyful, childlike activities as a way to rebalance our stress levels and live more mindfully and less anxiously. Children can teach us the benefits of wonder and play, and the freedom that comes from a joyful, playful view of the world and of our lives. Gratitude When you pet your cat, the purr you hear is an expression of comfort and gratitude. Animals and children alike have a way of showing us how to be thankful for positive, soothing moments. We, too, can work to incorporate gratitude into our often-stressful lives. A simple act like pausing to look around and feeling grateful for our surroundings can help us to soothe ourselves during moments of overwhelm. Gratitude allows for a cognitive shift from thoughts of worry and dread to thoughts of comfort and contentment. These types of mental reframes, which come so naturally to children and animals, can help us to refocus our emotional attention and reduce and soothe feelings of anxiety and worry. Asking for Help Though a young child crying can be jarring, it does the important work of communicating the child’s needs. As adults, we often choose to suffer in silence. Though we experience intense feelings of worry at times, we are hesitant to share those feelings, concerned that we will burden others or that we are being “weak.” What we can learn from children is that we can only receive the soothing we need if we communicate that we are experiencing that need. Obviously, we are more mature and sophisticated than an infant or toddler, which means we possess more adaptive means of expressing our needs. Whether this means letting a loved one know we are struggling or seeking assistance through therapy, the power of expression, which kids naturally have, is a vital part of our ability to cope with anxiety and overwhelm. Phil Lane, MSW, LCSW, - Website - References Axline, V. (1974). Play Therapy. Ballantine Books. Kris, Ernst. (1952). Psychoanalytic Expressions in Art. International University Press.

The Link to Child Abuse Self-harm refers to inflicting injury to one’s own body. There is a high incidence of self-mutilation among survivors of child sexual abuse (CSA), who may resort to inflicting self-harm when memories or feelings of despair and self-loathing emerge. Some of my clients use self-mutilation as a way of managing flashbacks and see self-harm as an act that can convert emotional pain to physical pain. When a flashback occurs, it can last minutes or even hours, and for some clients, self-mutilation is a way of gaining control of the memory by placing their attention and focus on hurting themselves. When memories of abuse and their corresponding feelings emerged, my client Jessie often resorted to a pattern of self-mutilation as an act to gain control and to decrease the tension and the anxiety associated with the memories that were surfacing. Rather than unwillingly re-experience the traumatic event, Jessie would take control by inflicting pain on herself. For her, self-mutilation was a way of staying in the present and managing the flashbacks, which she says “can feel like an intrusive surge of pain.” Rather than be overcome and flooded with feelings and memories of an event that was horrific and terrifying, Jessie took control by cutting. Jessie exclaimed, “It’s just me and the cutting, and the cutting and me, and nothing else exists.” I asked Jessie what would happen if she did not cut. She said she thought she would detach from her body and never be able to find her way back. She believed she would permanently disconnect from reality. Cutting was her attempt to stay sane, and to her, the self-inflicted pain kept her connected to herself. Self-mutilation can take on many forms. The parts of the body that were involved in the abuse are usually the parts that are targeted for self-mutilation, and many times the self-mutilation is related to the emerging traumatic memory or flashback. One client would take hot baths to clean her genitals and would also cut her breasts and vagina with a razor. Another client with visual memories of abuse would very slowly cut her eye lids, making small and consistent slash marks with a razor to avoid re-experiencing the trauma via a flashback. She was meticulous and took great pride in her ability to hide the marks from her partner and her children. Some of my clients have expressed that when they feel guilt and/or a deep sense of shame they may engage in self-injury as a way of punishing themselves for their sense of inadequacy and self-contempt. It is important to realize that self-mutilation does not indicate suicidal ideation; rather, it is a measure taken to reaffirm the self and to take control using pain, this time inflicted by the hands of the abused. Women who have experienced sexual trauma as children often feel hopeless, powerless, and angry , unprotected, confused, and hold negative beliefs about themselves and the world. Survivors may resort to self-harm and like my client Jessie, who self-mutilated and cut her body with a razor when she became overwhelmed with flashbacks related to her early CSA. Although there are many differences in the stories of women with CSA histories, the one commonality many share is their abuse is linked to their present pain and limited capacity to function because of unhealed child abuse. Self-harm is a temporary coping strategy to deal with overwhelming feelings. It is important the survivor understands what prompts the triggers and find alternative coping strategies and techniques. Teresa Gil, Ph.D., References Excerpt From: Gil, T. (2018). Women Who Were Sexually Abused as Children: Mothering. Resilience, and Protecting the Next Generation. New York, NY: Rowman & Littlefield.

Use these 4 tips to avoid financial disaster in your relationship. Talk about money early, openly, and often (even if it's uncomfortable). Make a plan for if the relationship ends. Figure out the best way to split expenses, but also use money to make each other happy. Ah, money. It can feel like a silver bullet for happiness if used effectively. Or it can feel like a loaded gun pointed in your direction if it's a source of constant tension in your relationship . Fighting and bickering about money is the number one source of tension and stress in romantic relationships. Winning the lottery with a scratch ticket or hitting the jackpot in Las Vegas might alleviate money problems in your relationship, but then again, I wouldn't bet on it (no pun intended). So, what are some realistic strategies to avoid being like the average couple who bickers about money? 1. Talk Early, Openly, and Often About Money (Even if It's Uncomfortable). Some say talk is cheap. But talking about money with your partner will pay dividends. Money is naturally a taboo topic, but that doesn't mean you can ignore it. Establish a rapport surrounding the topic of money within the first year of your relationship. Ideally, you can broach the subject within your first six months together, even if it's more general at first, in an attempt to open a dialogue if you see the relationship going somewhere. You'll want to have this conversation before moving in together and certainly before getting engaged or married. Plan for this conversation, starting and ending with an open mind. During this conversation, ask each other questions such as: Would you consider yourself a saver or a spender? Do you hold any debts? Are you satisfied with your income and career projection? How were your parents with money when you were growing up? What are your best and worst financial habits? What kind of wedding do you envision having (if any)? How many kids do you want (if any)? Do you prioritize travel and new experiences, or are you more of a homebody? Actively listen and learn from your partner as you work through this conversation. 2. Make a Plan if the Relationship Ends This is the least fun tip of them all but it's also potentially the most important, especially for couples that are engaged. Nobody wants or plans for their relationship or marriage to end. Yet about 50 percent of marriages in the United States end in divorce . Consider talking through what would happen if, God forbid, the marriage ends in divorce. What would happen with the house? The car? If one partner has substantially more assets than the other, it's worth considering a prenup agreement for protection. During this conversation, let your partner know that you love them and the relationship ending is the last thing you want. Frame it as a fire drill. Having a blueprint is important, even though we never realistically expect it to happen. 3. Figure Out the Best Way to Split Expenses Note that 50-50 is not a no-brainer here. Having the higher earner cover most expenses might not be the answer either. This point is where you can use some creativity. For example, let's say one partner earns roughly double the other. You might decide to split the rent or mortgage such that the higher earner pays two-thirds, whereas the lower earner pays one-third. Or maybe you agree that the higher earner pays the mortgage in full, and the lower earner covers groceries, the car payment, and the phone bill. There is no one-size-fits-all solution for this point. But again, talking about the optimal way to share expenses so that both people are authentically happy is a good starting point. 4. Use Money to Make Each Other Happy Let's end on a positive note, shall we? Money is a tool that can increase happiness. Research finds that spending on others has surprisingly powerful effects on our well-being (Dunn, Aknin & Norton 2008). And, of course, everyone likes a gift. Take advantage of this finding and treat your significant other as often as you can. Pick up their favorite wine bottle next time you make a store run. Get them a knick-knack from the airport when you're headed home from a work trip. For a big birthday or anniversary, plan the surprise trip you know your partner has been wanting to go on if it's within your budget. This point will add compassion and excitement to your relationship. So don't hold back. Max Alberhasky, Ph.D., - Website - References Dunn, E. W., Aknin, L. B., & Norton, M. I. (2008). Spending money on others promotes happiness. Science, 319(5870), 1687-168

Understanding the connection could promote greater resilience. Stress is correlated with depression. Correlation does not equal causation. How can we really know whether stress makes us depressed? Stress gets blamed for a lot of things. Did you gain a few pounds? Blame stress. Say something you regret. Blame stress. But what about something more serious like major depressive disorder? Stress often gets the blame for serious mental illness, but we know that our genetics play a role as well. Depression afflicts an estimated 280 million people worldwide, many of whom would point to stress as a contributing factor to their depression. Is it possible to tease apart the complex causes of disorders like major depressive disorder? Researchers have tried to do so, with limited success. Let's highlight some research that has benefited our understanding of this. Do stressful life events cause major depression? Answering this question comes with several challenges. One of them is the chicken-or-egg question: how do we know that stress causes depression? Or whether someone’s depressive mood and behavior caused them stress? One way to address this is through a prospective, longitudinal study in which stress and depression are measured in the same people over the years. This allows us to determine which came first, the stress or the depression. To address this, researchers asked over 2,000 female twins about their stressful life experiences and symptoms of depression at three different times over about five years. Stressful life events included divorce , the death of a loved one, and job loss, among other events. The researchers took note of the timing of both the stressful event and the onset of the depression symptoms. Their findings should come as no surprise: Stressful events often lead to the onset of depressive symptoms. When those who reported depression were asked whether something stressful happened to cause the depression or whether it came out of the blue, 85 percent said that the stressful event came first. None of them reported that depression came before the stressful experience. Next, the researchers looked at the characteristics of the stressful events. At the risk of blaming the victim, events such as divorce could be partly due to the depressive nature of the individual. By contrast, events such as the death of a loved one should be independent of the depressive nature of the individual. Researchers found that even these independent stressful events, in which the individual had no role, led to the onset of depressive symptoms. The researchers next took advantage of the fact that their participants were twins. This allows for the assessment of the impact of genetics on the stress-depression relationship. Monozygotic (identical) twins share 100 percent of their genes. Examining the relationship between stress and depression in these twins effectively controlled for the effects of genetics on the development of depression. Within these monozygotic twin pairs, researchers found that stressful life events predicted the onset of depressive symptoms. These findings provide strong support for the idea that stressful life events—even those we have no control over—can lead to the onset of major depression regardless of our genetic makeup. It's not all doom and gloom, however. The good news is that of the over 2,000 women tested in the study over five years, only about 300 (7 percent) of them developed major depressive disorder. What are the characteristics of these 1,700 women who did not develop depression? The answer to this question may allow us to promote resilience to lessen the negative effects of depression. Tony W. Buchanan, Ph.D. - Website - References Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx). Kendler, K. S., Karkowski, L. M., & Prescott, C. A. (1999). Causal relationship between stressful life events and the onset of major depression. American Journal of Psychiatry, 156(6), 837–841.

The battle is to engage outwardly while fighting depression's implosive force. KEY POINTS There are two opposing energies in the fight against depression and rediscovering your vitality. Three hurdles are waiting for motivation, discounting small changes, and giving up too soon. Engagement is what's important—with life, with others, and with nature, which will bring vitality and hope. Healing from a depressive episode involves what can seem like a battle between two opposing forces. Andrew Solomon wrote in his book The Noonday Demon, "The opposite of depression isn't happiness, it's vitality." It requires determination and energy that's focused on getting reconnected with life. But there's an innate problem. Depression itself can feel as if your known world is collapsing. So healing, confronting that implosion, is tough. The fight is taking place on two opposing battlefields. You're fighting to become engaged outwardly while struggling to break free of depression's implosive force. "I know I should exercise. It's hard to make myself want to do it." "I don't like to journal. I do it, but nothing changes." "Therapy doesn't work. And it's too expensive." Or "I took pills one time and they made me sick." All of these statements are common to hear. Here are the hurdles they reflect—and what you can do about them. 3 Hurdles to Taming Depression 1. Waiting to feel motivated If you're actively trying to confront your depression but are waiting to be magically motivated to change, nothing will happen. You have to make yourself do the things that are likely to help, even when you don't have a lot of energy or even hope. It's tough. But putting motivation before action is putting the cart before the horse. Afterward, you'll be enjoying the benefits of walking a mile, swimming a lap, or making yourself get out of bed. Whether it's getting dressed for the day or calling an old friend whose friendship you've let slip, action creates motivation. Kate fought me tooth and nail over the importance of exercise in managing her depression. Then one day, after a couple of years of struggling with suicidal thoughts, she came in: Well, I made myself put on a bathing suit and get into the pool. And it really helped. I've always loved to swim and, suddenly, I found myself energized. I have to get up really early to get it done, and I still have to make myself go sometimes, but after it's over, I feel so much better. Getting regular physical exercise didn't "cure" Kate, but it helped a lot. Just as importantly, it gave her a sense of control and a sense of hope—when her depression seemed unmanageable. 2. Discounting small changes Healing comes from the cumulative effect of many small changes. I wish I had a nickel for every time a patient had said, "This isn't really a big deal, but yesterday I...." Any change, any risk is a big deal, because you're confronting your depression or anxiety in small ways. Those changes add up. What can seem unimportant—what you tell yourself is no big deal—can be a very big deal. A patient who came into therapy after reading about perfectly hidden depression said, The other day, I actually told my husband I didn't have the same perspective he did, and I couldn't go along with what he was saying. We talked and it went pretty well. He told me later that he couldn't believe I actually said what I was feeling. He doesn't think he knows me. And, actually, he's right. Because I don't let him know me. I've always avoided any kind of conflict. Maybe this sounds easy for some. But it's not for someone who's been hiding what they really feel for years. 3. Giving up because you had one experience that wasn't helpful Depression can create tunnel vision. a tunnel where you only see the negative. For example, deciding that nothing will work because your first attempt wasn't effective is problematic and paralyzing. You wouldn't say to a child you cared about, "If one idea doesn't work, don’t bother trying anymore.” Or, “If you can’t do it easily the first time, give up.” Nope. Persistence can pay off. Sometimes this is an excuse because it can be hard to admit there's something wrong. You did it once, and you don't want to face another so-called failure. It takes courage to not give up. If one therapist doesn't help, ask around and find one with a different style or treatment regimen. If you found yoga boring, take a Zumba class. If you're nervous about prescription medications, then look for homeopathic alternatives. Sometimes you'll be surprised at what actually helps. Sitting in the sunshine, walking around the block, striking up a conversation with the 6-year-old next door, striking up any conversation, in fact. Engagement is what's important. Engaging with life, with others, with nature—which will bring with it vitality...and hope. Margaret Rutherford, Ph.D. - website - books

... and what you can do to fight back. Depression can alter how we see the world, ourselves, and others. "Depressive realism" is the hypothesis that depression can enhance our perceptions. Yet evidence also suggests that depression can distort our perceptions in a negative direction. With practice, these distortions can be countered. The concept of depressive realism is a hypothesis that individuals with depression may see life more accurately than those without. I remember learning of this in college, mentioned as an aside in a course, “depressed people actually see things more realistically.” As a person who has experienced depression, this dispirited me. Depression is an expert at overshadowing me with sad perspectives on myself, others, and the world. It also led me to ask: In treating this condition are mental health professionals seeking to teach people how to delude themselves? Are people who are not depressed out of touch with reality? Is depression the most reasonable response to our times? Research into depressive realism is drenched in mixed results. How do you measure a person’s sense of reality? A meta-analysis of the topic found a small trend in favor of depressive realism. This said, the authors illuminated difficulties in the measurements used in the study as well as in external validity (Moore and Fresco, 2012). A more recent (2019) study investigated this notion of how depression affected future expectations (and whether those future expectations were correct) by asking depressed and healthy participants to gauge how they would feel in four days and then looking into how participants would rate their mood at that time (Zetsche et al). Unsurprisingly, depressed participants imagined themselves feeling lower in four days than healthy controls. Depressed participants also had a trend of feeling better than they imagined they would after the four days ended as well, healthy controls more accurately estimated how they would feel supporting a concept that cognitive behavioral therapists have preached for decades: Depression lies. While the jury may still be out on depressive realism, the cognitive distortions that accompany depression are well-founded. For a small number (Gaudiano et al, 2016), this change can reach a level of psychosis leading a person to experience depressive-congruent delusions and/or hallucinations. Although not always to this extreme, in almost all cases depression brings with it some changes in thinking. Depression’s deception is insidious. What follows are five guideposts that point to its trickery. 1. When Depression Makes Sweeping Statements Depression loves generalizations. It thrives on thoughts like “no one likes you,” “you can’t do anything right” and “everything is bad.” This lie breathes words like “always,” “never,” “everything,” and “nothing.” Depression can convince you that an entire lot is ruined before you’ve even had the chance to look through it. What You Can Do About It: Look for exceptions. Even one exception will start to untie the web that depression has woven. So, for example, if depression says “no one likes you” ask yourself if you can think of anyone who has ever liked you in the history of your life. Chances are you can think of at least one. Rarely are generalizations true. 2. When Depression Tries to Predict the Future Depression can’t tell the future. Of course not, right? Well, depression is quite good at convincing us that it can. With murmurs like “You will never learn to cook” or “Don’t ask her out, she will definitely say no” depression can push us to believe we have failed before we have even taken the shot. What You Can Do About It: Ask yourself about the topic at hand. Depression is probably telling you the worst possible scenario. Write that down. Now, try to think of two other possibilities. You might look for the best possible scenario or a middle-ground scenario. Remind yourself that only time will tell which (if any) are correct. 3. When Depression Harps on You About What You "Should" Have Done If there is anything depression likes more than sketching you a terrible, horror-filled fate, it’s looking back at the past and telling you about all you’ve done wrong. Depression tends to act like it knows what would have happened if you would have made any choice other than what you did, and it will usually tell you that whatever would have happened is better than what occurred. Truth is, depression has no idea what would have happened if you took a different turn. What You Can Do About It: Remember these two words: hindsight bias. Just like we can’t tell the future, we don’t know the future while we are in the past. Depression might like to have you judge yourself for what there was no way for you to have known. 4. When Depression Tells You It Can Read Minds Depression loves to tell you what other people are thinking. Usually, the message is that people are thinking negatively about you. What You Can Do About It: How much time do you spend thinking about any given person? Chances are, it’s just a fraction. If you are worried that someone might have something on their mind about you, consider asking. That’s the only way we can read minds. 5. When Depression Says That Everything Will Be Bad Forever Depression’s preferred environment is a sort of fatalistic landscape full of awful predictions and negativity to absurdity. This can feel totally deflating. What You Can Do About It: Practice flexibility. Rarely do all things fall into such a fixed space, so look for a middle ground. Depression might tell you it plans to set up camp and stick around, but many people recover. In sum, depression can place itself like a fun house mirror. Yet no one is their depression. With practice, you can catch depressive thinking in its tracks and see through its illusions. Jennifer Gerlach, LCSW - website References Gaudiano, B. A., Weinstock, L. M., Epstein-Lubow, G., Uebelacker, L. A., & Miller, I. W. (2016). Clinical characteristics and medication use patterns among hospitalized patients admitted with psychotic vs nonpsychotic major depressive disorder. Annals of clinical psychiatry: official journal of the American Academy of Clinical Psychiatrists, 28(1), 56-63. Moore, M. T., & Fresco, D. M. (2012). Depressive realism: A meta-analytic review. Clinical psychology review, 32(6), 496-509. Venkatesh, S., Moulds, M. L., & Mitchell, C. J. (2018). Testing for depressive realism in a clinically depressed sample. Behaviour Change, 35(2), 108-122. Zetsche, U., Bürkner, P. C., & Renneberg, B. (2019). Future expectations in clinical depression: Biased or realistic?. Journal of Abnormal Psychology, 128(7), 678.