Setting the (police) record straight. People experiencing psychosis are still capable of accurate memory. Discounting the recall of people who experience psychosis leaves them vulnerable to ongoing abuse , violence. Revisiting experiences of psychosis can be empowering and validating. “If I correctly fill out Joe Biden’s 2020 cabinet, will you let me go?” I ask. It’s 12:45 a.m. on February 16, 2019, and I’m handcuffed and kneeling on the ground of the second-floor lobby at the Warfield Theater in San Francisco with a police officer ’ s hand firmly on my back. “How about Corey Booker as Attorney General?” The police officers ignore me. “Are you guys strippers?” “Ma’am, you’re being placed under arrest for theft .” “Theft? You mean because I didn’t ask my mom first before I borrowed her shoes? She wasn’t home!” Years later, on October 21st, 2021, I read the report the police officers wrote of our encounter during my first severe manic and psychotic episode. One paragraph in particular stood out: Littlefield appeared to be under the influence of unknown type of narcotic. Littlefield would make nonsense remarks, then attempt to leave, then would complain about the 2016 election and the state of U.S. politics and other topics. Littlefield did not appear to understand that she was being placed under arrest but did admit she was wearing her mother’s sandals. These are the most validating words I’ve ever read in my life. When I tell the story of that night—the story of breaking into houses, of climbing on top of cars, of getting tackled by police officers—people often ask me, in disbelief, “And you remember all of that?” As though my brain completely broke when I was in psychosis. As though I were incapable of logical thought, reason, and encoding memories. As though, on some level, I ceased to be a person and became nothing but a mental illness. My dehumanization was reinforced by all the doctors who dismissed me, who talked to me like I was five and incapable of any complex cognitive process. All just because I believed a team of psychologists had assumed control of my life and was experimenting on me against my will. I think that’s why I wanted to obtain my police records. I wasn’t sure what I was looking for or what I’d find. But I had to know what really happened. I had to know whether my memories matched everyone else’s reality. I had to know if I was crazy after all. I was scared to read the report. What if it contained stigmatizing language that mirrored the worst of my internalized ableism, born out of my diagnosis of schizoaffective disorder , bipolar type? What if the narrative of the report was completely off-base from my memories, in which case I’d have to admit my brain had essentially ceased to function during psychosis? I had my mother read the report first so that she might soften the blow in case any of the above came to fruition. But when she called me after I sent it to her, she told me it was fine–humorous, even, which goes to show the enormous amount of privilege I exuded in this situation as a white woman. Moreover, she told me, “It was pretty much what you told me happened during the conversation we had when you were in the psych ward. Save for the part about the psychologists, of course.” I let out a deep, cathartic breath, hung up the phone, and opened the file that contained the police report. And there it was—proof that my account of the night was valid. As I read the police officer’s notes from his interview with the woman whose backpack I stole, I remembered how I found the backpack inside a janitor’s closet at the Warfield. A woman had exited the small, inconspicuous door, looked me in the eyes, and winked and smiled at me. Surely, it was a sign from the psychologists. So maybe the psychologists never existed. Maybe the signs I thought were their breadcrumbs guiding me on a wild adventure through the streets of San Francisco were actually just run-of-the-mill, everyday objects. But everything else about my memories of that night, from the blue Jacksonville Jaguars beanie I’d found in the backpack, to their obsession with my mother’s shoes, to my rants about U.S. politics, was real. This police report documented it all. I always had a hunch that my memory of that night held up better than most people thought, but for years, others’ skepticism about my account of the night in question had slowly eroded my confidence that ‘Psychosis Sally’ had been capable of encoding actual memories. Even in psychosis, as my mother confirmed, I was still able to give an accurate account of the events that transpired, even if it was through a fictitious lens of an all-consuming psychological experiment. And this police report proved it. People experiencing psychosis are still capable of logic, of feelings, of love, and, as it turns out, of accurate memories. There’s something at stake here that’s bigger than just my personal, vindictive desire to prove wrong all those people who doubted the validity of my memories of that night. If we brush off the memories of people experiencing psychosis—if we don’t believe their accounts of what they experience—then what happens when their recall is also the only avenue to safety? It devastates me to think about all the people who experience ongoing abuse, violence, and crimes who aren’t believed because we as a society don’t trust the accounts of those who break from reality. I am more than my mental illness, both now and when I was in active psychosis. I was and am a person capable of the full spectrum of thought, emotion, and, it turns out, memory. It’s time we set the record straight: People experiencing psychosis are still people. Let’s give their accounts and perspectives the weight they deserve. Sally Littlefield - Website - References Copyright Sally Littlefield

How to understand narcissistic traits and tendencies in children. High-achieving child narcissists cope with narcissistic vulnerability through exceptional performance. Child bully narcissists have an underlying “mean streak” that they exercise in controlling others. Manipulative child narcissists use others to achieve their goals, often without regard for their feelings. It is hard to imagine that your precious youngster could be developing in such undesirable ways that they would be considered a narcissist . However, children can reveal certain tendencies and traits that indicate they are on the path to a narcissistic disorde r . Technically speaking, a narcissist cannot be diagnosed until the age of 18; however, specific attitudes and behaviors that presage narcissistic personality disorder (NPD) may be evident earlier. Even so, it is essential to realize that narcissism looks different in an adult than in a child . How to Spot an Adult Narcissist This list isn't exhaustive, but it's a good starting place. A narcissist: needs recognition. believes they're special. overestimates their skills and abilities. thinks far too highly of their own opinion. needs to be "right." lacks interest in things that do not involve the self. becomes overly sensitive to real and perceived slights. idealizes or devalues others. expects special treatment. makes unrealistic demands. maintains superficial and exploitative relationships. fails to take responsibility for their behavior. blames others for errors and misunderstandings. lacks empathy Two major types of narcissists are recognized in adults: vulnerable and grandiose. The vulnerable narcissist presents as more anxious, worried, and sensitive to criticism and is often high achieving. The layperson less frequently recognizes this variety of narcissists. The grandiose narcissist, on the other hand, is earlier to spot, tending toward flamboyant, charismatic, controlling, and manipulative behavior. This second type can be popular, socially prominent, and perceived to be a leader while at the same time being mean-spirited and interpersonally exploitative. Grandiose and vulnerable narcissists don't present the same way, which explains why so many people don't recognize that both these types are suffering from the same negative core qualities of self-centeredness, a sense of entitlement, and a lack of empathy. They also suffer the same negative outcome of problematic and impoverished interpersonal relationships. What a Child Narcissist Looks Like Identifying narcissism in children, rather than adults, is complicated. Emerging child narcissists (N2Bs, or narcissists-to-be) come in all sizes and shapes—or so it seems. While such children generally fall within the broad categories of vulnerable or grandiose, several subtypes within each can be identified. The wide range of types can be challenging. 6 Presentations of Emerging Child Narcissists-to-Be 1. The High Achieving Narcissist (coping with narcissistic vulnerability through winning). High-achieving narcissists cope with their narcissistic vulnerability through exceptional performance. They must be the best or practically perfect in every way. The effort they put into achievement often has a maniacal quality. They work harder because they must perform and be better than everyone else. Areas of exceptionality vary, but these children make straight A's or are the teacher's pet. High-achieving narcissists are the kids most challenging to diagnose as their perfectionistic performance masks any underlying deficiencies or distress. It is important to emphasize that the diagnosis of a high-achieving narcissist is not based on their exceptional performance but rather on what drives the need to achieve. 2. The Non-Achieving Narcissist (coping with narcissistic vulnerability and fear of failure through avoidance). Non-achieving narcissists are the children who value recognition and attention but have been unable to achieve their lofty goals. Frustrated and hurt by their underachievement, they cope through avoidance. Some withdraw from the competition and display a "don't care" attitude. Others will act out in maladaptive ways, trying to get attention through misbehavior or risk-taking. All have given up on the idea that they can succeed in a way that wins recognition and positive regard. 3. The Bully Narcissist (coping with narcissistic vulnerability and values through unchecked aggression). Bully narcissists have an underlying "mean streak" that they exercise in controlling others. They abuse others socially through exclusion and physically through ridicule and teasing, which can turn into hazing in young adulthood. Some are the "queen bees" and the most popular boys on campus. They often mediate inclusion and exclusion in social groups without regard for fairness or honor, with a concern only for their power. Often charismatic and likable, their flaws are difficult to see. Their social skills are strong, so their misbehavior can be hard to catch. 4. The Daredevil Narcissist (coping with narcissistic vulnerability through unchecked grandiosity). Daredevil narcissists are youngsters whose grandiosity has not been softened through the years. In the school-aged years, their grandiosity can be seen in eye-catching clothes or schoolyard feats like riding a bike alarmingly fast down a steep hill. In older children, they can engage in risky behaviors that range from drug or alcohol abuse to dangerous driving and sexual promiscuity. Lack of good judgment is their fatal flaw. 5. The Closet Narcissist (coping with narcissistic vulnerability through association with a narcissist). Closet narcissists do not look like narcissists at all. Aware of their narcissistic vulnerability, they cope by aligning with a powerful narcissistic friend or classmate, basking in the reflected glory they experience from the relationship. Content with attaching to an exhibitionistic or achieving narcissist who has high social value, they are often compliant and ingratiating, working to find a place near the throne of their popular high-status peer. 6. The Manipulative Narcissist (coping with narcissistic vulnerability through the exercise of power, getting one's way). The manipulative narcissist is intent on getting their way. Manipulative narcissists use others to achieve their goals, often without regard for their feelings. Their self-validation comes through wielding power and their ability to control others and the environment. Some manipulative narcissists are gifted leaders who can influence groups to reach higher, more expansive goals, and this type of narcissist often seeks political or other high-status positions. In childhood, some may earn a place on the student council or be elected team captain. Others have an antisocial component, which means they tend to be dishonest or live outside the rules. In childhood, that may mean they steal pencils from the school store or take desired items from a classmate's backpack. Many manipulative narcissists come from families of wealth, prestige, and power. Parents and educators need to realize that the development of narcissism begins earlier than you might think and that understanding the variety of "childhood types" is critical. Hard as it might be to believe, a narcissist who fits the more nerdy, perfectionistic valedictorian category has the same psychological structure as the narcissist who presents as the popular football captain with controlling, manipulative, and bullying behaviors. The good news is that recognizing narcissistic tendencies and traits earlier—rather than later—provides more opportunities to get a child back on course. Early intervention not only makes correction easier but produces far better outcomes. Mary Ann Little, Ph.D., - Website - Book -

Lessons for today from the last 50 years. The American Psychiatric Association deleted homosexuality from the DSM 50 years ago. The process triggered intense debate that research, allies, and activists successfully addressed. Recently, governments in the U.S. and elsewhere are considering record numbers of anti-LGBTQ+ laws. The successes 50 years ago offer vital lessons in how to combat these anti-LGBTQ+policies today. “The normal outcome of male adolescent development is heterosexuality,” a child psychiatry professor told other trainees and I in 1989, during our residency education. “What if you’re gay?” a fellow trainee asked. The professor frowned. “The normal outcome of male adolescent development is heterosexuality,” he repeated with annoyance. I was stunned because 16 years earlier, in 1973, the Board of Trustees of the American Psychiatric Association (APA) had, in fact, deleted homosexuality as a psychiatric condition from the Diagnostic and Statistical Manual, or DSM, the book that dictates what constitutes a mental health disorder. “Just because homosexuality is no longer a disorder,” the professor continued, “doesn’t mean it isn’t a symptom.” To him, it was still pathological. “Why is it so bad?” my fellow resident inquired. “Homosexuality is a disease because it has an increased risk of morbidity and mortality,” due to AIDS. “Anything with an increased risk of morbidity and mortality is a disease.” “But isn’t that partly because it has been seen as a disease? Because it is stigmatized?” the trainee asked. “Mothers would not want their children to be born that way,” he said. “Why would you want your child to differ from others in a way that will induce ridicule?” “What about left-handedness then?” the trainee pursued. “Shouldn’t that then be a disorder, too?” The professor became irate. “Why are you being so recalcitrant and resistant?” he demanded. His voice rose. The resident decided not to push, I have recently been thinking about this interchange for two reasons. First, over the past year, states are now passing record numbers of anti-LGBTQ+ bills, along with anti-abortion laws. Secondly, this year marks the 50th anniversary of the APA’s Board of Trustees historic decision on December 15, 1973. This anniversary marks an important moment for reflecting on how far we have come as a nation, but also how far we still have to go, and for assessing what insights and lessons we might learn about progress in these battles and overcoming obstacles. Despite support on certain issues from the Pope and others, in 2023, state legislators introduced over 520 anti-LGBTQ+ bills and enacted over 70. Large numbers of congregations are leaving the United Methodist Church and other denominations over LGBTQ+ issues, the Supreme Court allowed a website designer to refuse gay couples as clients and hate crimes against LGBTQ+ individuals continue to rise. The spread of such anti-LGBTQ+ policies increasingly frustrate and depresses many members of the LGBTQ+ community. The example of the APA is thus important, both to inspire us that change is possible and to remind us of barriers that can arise and ways of surmounting these. The APA’s decision, occurring just four years after the Stonewall Riot, required courageous, concerted efforts by allies, both LGBTQ+ and straight. Since 1918, the APA had classified all homosexuality as a “disorder,” justifying so-called conversion therapy and discrimination in countless areas of life, preventing LGBTQ+ individuals from working in schools, the military, and innumerable jobs. Slowly, scientific data helped begin to alter attitudes. In 1948, The Kinsey Report found high rates of LGBTQ+ activity among Americans. In the 1950s, the psychiatrist Evelyn Hooker began to meet with and publish studies about gay men who were not patients seeking psychiatric treatment and were instead well-adapted and satisfied with their sexual orientation. Still, despite these scientific facts, psychiatry continued to categorize homosexuality as a disease. Hence, in 1971, gay activists snuck into the annual APA convention and directly confronted psychiatrists who supported this classification. Only after these activists threatened to confront speakers again at the following year’s annual convention did the APA agree to invite gays and lesbians to speak on a panel. In 1972, this panel included, for the first time at an APA meeting, a self-identified gay psychiatrist. Yet he appeared only as “Dr. Harry Anonymous,” and wore a crude cartoon-like paper bag mask over his head to disguise his identity. Today, this protective measure sounds absurd, but it reveals the depth of the discrimination and fear at the time. Only several years later did Dr. Anonymous publicly reveal his name—John Freyer. The following year, in 1973, APA Trustees cast their historic vote. Heralded on the front page of the New York Times and major newspapers, this decision aided millions of people throughout the U.S. and abroad, leading state governments to eliminate sodomy laws and prompting other professional and religious organizations to end discriminatory policies. Nonetheless, other psychiatrists continued to fight the Trustee’s decision, arguing that it occurred only under pressure from gay rights groups. Opponents demanded a referendum on the entire APA. Such a vote was unprecedented, but the Trustees agreed, and the membership referendum passed, in 1974, by 58 percent, a decisive majority. Some then demanded an investigation into the conduct of the referendum—asking whether a flyer sent to members and paid for by a gay organization had been “unethical.” An APA committee determined that the sponsorship should have been clearer but was not unethical. Yet, as I witnessed during my own training, homophobia persisted in psychiatry into the 80s and 90s. Gradually, through these years, additional LGBTQ psychiatrists spoke out and made themselves known, at times risking their careers. Eventually, resistance abated. In responding to current political threats against the rights of LGBTQ+ Americans, the APA’s decision offers critical lessons. First, it used scientific data, demonstrating that the supposed harms of heterosexuality were largely illusory. Secondly, it took courageous individuals to step forward to engage opponents and tell their stories in panel discussions before wary, if not hostile, audiences. Thirdly, it required hard work and allies, including researchers and APA leaders from both inside and outside the LGBTQ community. Fourthly, this change took time, occurred slowly, and met resistance. In today’s battles, anticipating a realistic timeline can help set appropriate expectations. Fifthly, it took brave activism and non-violent protests, following the examples of peaceful marches for civil rights. When other psychiatric trainees and I heard our professor’s homophobic comments, we were unsure how to respond. Yet, history has shown the problems and errors of psychiatrists' homophobic arguments. Especially given our nation’s current challenges, we should remember and celebrate the APA’s decision and how far we have come since then, and recall the courageous psychiatrists and others who fought, spoke out, and ultimately succeeded. Though restrictive policies are increasing in many realms, progress, even if it meets resistance and takes time, can ultimately succeed. Robert Klitzman, M.D.,

5 tips to stop the time warp. People with ADHD frequently experience a warped perception of the passage of time known as time blindness. People may mistakenly label those with ADHD as unprofessional due to symptoms such as running late. Strategies to cope with time blindness include time logs, planners, and harnessing the tendency to hyperfocus. Do you have ADHD and feel like you are constantly losing track of time? If so, you might be experiencing time blindness, or a warped perception of the passing of time. While time blindness is not listed as an official symptom of ADHD in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is a common experience for those with ADHD. Usually, people can sense what time it is and how much time has passed using environmental elements like light and sound. Time blindness occurs when the process of perceiving time is disrupted. People with ADHD often struggle with estimating how much time has passed and how much time there is before an event (perceiving time), recounting the order of when events occurred (time sequencing), and replicating a task that has occurred previously in the same amount of time (time reproduction). In German studies on children with ADHD, researchers found that children with ADHD overestimated or underestimated the amount of time that had passed to a much greater extent than children without ADHD. While the reasons behind time blindness are not fully understood, ongoing research is being conducted on the potential mechanisms. One study found that when performing tasks in studies that are perceived as uninteresting or repetitive, participants with ADHD tend to perform worse than participants without ADHD. However, participants with ADHD tend to be quicker at detecting emotionally relevant or situational stimuli than participants without ADHD. While intense emotions can disrupt cognitive functions for people without ADHD, these intense emotions might be what people with ADHD need to perform cognitive functions effectively. In a study comparing the perception of time on neutral and emotionally charged tasks, they found that while participants with ADHD performed poorer than those without ADHD on neutral time perception tasks, they outperformed them on emotionally charged time perception tasks. The findings of this study suggest that time blindness could be connected to attention, emotion, and motivation. Recent research has also linked time blindness with dopamine deficiencies, and dopamine boosters like stimulant medication and monetary rewards can improve time perception in those with ADHD. One study on the influence of medication found that children with ADHD who took medication performed better than those who did not take medication, even when distractions were added to the experiment. Similar results were found when participants were offered monetary rewards for tasks in studies. While everyone runs late occasionally or loses an hour scrolling on social media, time blindness impacts the lives of people with ADHD every day. Time blindness can lead people with ADHD to repeatedly miss deadlines, arrive late even for events they are excited for, lose track of time constantly, have difficulty making and/or sticking to a schedule, experience slow reaction times, and have difficulty regulating their speed of movement. Some of these effects, like running late and missing deadlines, can lead people to view those with ADHD as unprofessional or lazy, but really, they just perceive time differently. How to Cope with Time Blindness So, how can those with ADHD cope with time blindness? Listed below are multiple methods recommended to those with ADHD to improve their focus and accommodate their time blindness. 1. Time Logs: One recommendation for those with ADHD is to time how long it takes for you to complete the tasks you perform in your daily life or that you need an accurate perception of time for. Even though the exact amount of time it takes to complete these tasks can change on a day-to-day basis, it can help people with ADHD gain a better idea of how long it generally takes them to complete the task. 2. Pomodoro Method: The Pomodoro Method is a technique used for studying and completing work tasks. With this method, you set a timer for 25 minutes and work on one task until the time is up. Once the timer goes off, you can take a 5-minute break before returning to your task for another 25 minutes. This pattern of working for 25 minutes and then taking a 5-minute break is repeated until the task is complete. Every fourth round, you can take a longer break, like for one hour. By committing to brief periods of focus, this technique can help people stay on task and avoid taking longer breaks or procrastinating. Another benefit of this method is that it is easily customizable. If you are working on a task that is more mentally draining or you are struggling to focus, you can set a timer for 15 minutes of work time and take a 2-minute break. 3. Timers: Similar to the use of timers in the Pomodoro Method, it can be beneficial to set timers for any activity where you might get lost in time. Setting a timer in advance can help pull you back, remind you to check the clock, and help you externalize how much time has passed. With tasks like cooking, setting a timer before leaving the kitchen will remind you to check on your food and prevent you from overcooking your meal or having your water boil over. With activities like scrolling through social media, setting a timer for a set amount of time will ensure you don’t spend hours doomscrolling on TikTok. Timers can also be used to help prevent you from losing hours to a single task or remind you to eat lunch. Sometimes when a timer goes off, you can ignore it and forget. To overcome this, try setting multiple alarms. If you struggle with leaving on time, you can set one for 15 minutes before and another for 5 minutes before, that way you don’t lose track of time between timers. If you have a difficult time visualizing the passing of time with a timer on your phone, you can use a digital timer that changes color or an hourglass where you can see the sand slip through. 4. Planners: While some with ADHD struggle with planners, they can help others with ADHD visualize what they need to do and how much time they have before a deadline. For a big project, you can use a planner to work backward from a due date, dividing the project into smaller chunks with their due dates. Another way to use planners is to divide a day into chunks and mark out times that you can work on homework or a big project. Using a planner can help you plan things in advance, but it can also help you feel accomplished and more motivated by checking off the tasks listed on paper. 5. Time-Warp Activities: While people with ADHD sometimes have trouble focusing, the opposite can be a problem as well. When a topic or activity particularly interests someone with ADHD, they can hyperfocus or have long-lasting episodes of highly focused attention. Hyperfocus can be beneficial in some situations but can lead to more time blindness. It can be helpful to schedule a time to engage in these “time-warp activities” so that you don’t miss a deadline or event. Kathleen Bogart, Ph.D., and Mollie Greenblum - Website - Mollie Greenblum is an alum of Dr. Bogart’s Psychology of Disability class. She recently graduated from OSU's Honors College with a B.S. in Psychology.

Three trainable skills can radically help you to improve your social life. Science has identified effective approaches to challenge loneliness and build a more fulfilling social life. Cognitive restructuring is a technique for challenging negative thinking patterns and creating healthier ones. In behavioral activation, you break cycles of avoidance by intentionally engaging in hard social situations. This post is part 2 of a 3-part series. Part 1 of this series introduced how global efforts to create a less lonely world are gaining steam. Social bonds are crucial to human life, shaping our perceptions of ourselves and the world around us. Just as our relationships are usually our greatest sources of joy and meaning, isolation can be a profound psychological burden . Over the past century, the field of clinical psychology has developed an evidence base of effective approaches to challenging loneliness and building a more fulfilling social life. These approaches aim to counter the cycles of negative thoughts and actions that perpetuate loneliness. They are easy to learn but require consistent effort and some bravery to put into practice. Challenge Negative Thinking Patterns One particularly daunting aspect of chronic loneliness is how it biases one’s thinking toward pessimism and hypervigilance. Despite wanting to find friends, a seriously lonely person battles a persistent flood of negative, automatic thoughts—often self-doubts and flashbacks to times they were left out. Likewise, they consistently fail to remember their positive social experiences—the times they felt appreciated, had fun, and made new friends. Although these emotionally charged negative thoughts are almost never entirely true, we tend to accept them uncritically as facts. Cognitive restructuring is a technique for identifying and replacing biased thoughts with healthier thinking patterns. For example, if someone gives you a strange look at a party, you might be suddenly struck by the thought, “Everyone thinks I’m weird.” To use cognitive restructuring, first, you need to notice the thought as it flashes by. Next, note the feelings that accompany the thought (i.e., a wave of dejection). Finally, consider if there might be a more accurate and optimistic version of the thought; for example, “I had one awkward interaction, but I know plenty of people like me, so it’s no big deal.” Cognitive restructuring is a simple skill, but when trained enough to become a habit, it can be potent, preventing negative thoughts from spiraling and perpetuating loneliness. Take Action Despite Doubts The defining behavioral characteristic of loneliness is avoiding stressful social situations: For example, staying home instead of reaching out to an acquaintance because they might respond negatively. Avoidance may spare us from discomfort in the moment, but it reinforces our fear, making us more likely to avoid social challenges in the future. As a result, we miss out on the serendipitous, good times and good people that we would surely encounter in the social world. Behavioral activation is a powerful technique for breaking this cycle of avoidance. In it, one intentionally engages in positive social behaviors despite doubts that their efforts will pay off. The key to behavioral activation is to engage in positive social behaviors, especially when you think they are unlikely to be successful. Behavioral activation works because it provides real-world evidence that social situations often go far better than one feared they would. Even if our efforts to connect are unsuccessful, we learn that an awkward social situation is really nothing to be afraid of. If I’ve been avoiding talking to new people, asking a coworker to get lunch probably won’t solve my loneliness; it will likely go just OK. However, each time I make the effort to connect, I build skills and momentum in the right direction. In the long term, behavioral activation interrupts avoidant cycles and creates opportunities to enjoy social life and form meaningful connections. It takes effort and bravery to expose oneself to the uncertainty and stress of the social world, but it’s an adventure worth pursuing. Earn Confidence by Practicing Social Skills Another science-backed strategy for challenging one’s loneliness is building social skills. Social skills improve confidence in communication and thereby help to form and strengthen relationships. Active listening is a skill that can make interactions more enjoyable and meaningful. One example is active listening: using eye contact, sharing genuine reactions, and asking open-ended questions to convey attention and appreciation to a conversation partner. Another is assertiveness: learning to stand up for oneself while also taking the wishes of others into account. Even those of us who feel confident in our social skills likely have plenty of room to improve. While practicing social skills may seem awkward or inauthentic, doing so allows for more genuine interactions and helps your conversation partners feel more comfortable. Work Through Barriers Although they are simple, building these skills is by no means easy or painless improvement requires a willingness to consistently leave the safety of avoidance and face the possibility of social rejection. Therapy is one way to get help. It is also easier to find high-quality support for loneliness than ever before. Research exploring ways to share skills for overcoming loneliness with as many people as possible, like Anton Käll’s work at Linköping University and my work at the University of California, Irvine, and the Northwestern Feinberg Medical School , is showing promising results. For people suffering from loneliness, reaching out to strangers or practicing social skills can feel impossible. Without friends or family to contact, it is easy to feel trapped in solitude. But the truth is that there is almost always a way to try to connect. One place to start is volunteering in your community—in helping others, you help yourself. Websites like MeetUp can also help you to find friendly groups of people nearby who share your interests. Online communities count, too. While these spaces are not replacements for face-to-face interaction, they have unique advantages over in-person alternatives, helping many to overcome barriers to connection and find genuine validation and belonging. Conclusion Serious loneliness can skew our thinking towards hypervigilance and self-doubt, making us believe that our efforts in reaching out for connection are doomed to fail. As a result, many lonely people learn to avoid social situations altogether. Scientific evidence has demonstrated that strategies like cognitive restructuring, behavioral activation, and social skills training can be profoundly impactful, challenging negative patterns in the ways we think, feel, and act. Access the Overcoming Loneliness Program , a free resource that my team and I created. These science-based tools are effective because they are simple and near-universal. In other words, they might be just as useful for lonely monkeys as they are for humans. Yet, for many of us, the problem of loneliness involves deeper questions . Part 3 of this piece draws from philosophers and wisdom traditions to explore loneliness as a human problem. Benji Kaveladze, Ph.D.,

At its core, perfectionism is disowning your true self. We all know perfection is an illusion. If perfection is unattainable and unrealistic, why do so many people strive to achieve it, setting themselves up for a perpetuating cycle of disappointment and shame? For many perfectionists, there is an underlying fear that they are not “good enough,” “won’t succeed,” or “won’t be loved” if they don’t strive for perfection. At its core, perfectionism may essentially be an act of disowning our true selves. It’s often a coping mechanism for shame and inadequacy. Perfectionism thrives in convincing us that striving for it will make us our “best self,” when, in reality, it can cause us to play small and take us away from our true selves. Perfectionism can be like a coach who initially appears to want you to succeed but then berates you, makes you practice to the point of exhaustion, and yells at you when you try to take a break. You may think that without this type of pressure, you won’t be able to achieve your goals⁠—but the opposite is actually true. If you allow yourself to rest, acknowledge your progress, and engage in positive self-talk, you’re much less likely to burn out and more likely to achieve your goals without sacrificing your health and quality of life along the way. Perfectionism can be like a coach who initially appears to want you to succeed but then berates you, makes you practice to the point of exhaustion, and yells at you when you try to take a break. If you’re struggling with perfectionism, remember that it doesn’t go away overnight and that it takes time to learn how to overcome it. Below are seven tips to help you start letting go of perfectionism and being kinder to yourself. 1. Identify the beliefs and rules that drive your perfectionism. It can be helpful to identify the underlying beliefs and rules that drive your behavior. For example, many perfectionists have an underlying belief that they are not “good enough.” As a result of this belief, they may adhere to certain rules and all-or-nothing thinking, such as “I must be perfect, or I will be rejected,” or “I must be perfect, or I will fail.” Often, these beliefs and rules were formed in childhood. Bringing awareness to these beliefs and rules, as well as how they impact different areas of your life, can be the first key in the process of deprogramming these beliefs. 2. Honestly evaluate your expectations. Take some time to evaluate your expectations honestly. It’s not realistic to expect that you will never fail or make mistakes because you are human, and you will inevitably make mistakes as we all do. Consider how you can create more realistic expectations for yourself. When you create realistic expectations, you are able to meet them. You’ll also build up your self-trust and self-confidence, two tools that can help you combat perfectionism. 3. Acknowledge the costs of perfectionism. Perfectionism often leads to loss. These losses include loss of quality time spent with others, loss of enjoying the present moment, and loss of connection with oneself. Many perfectionists struggle with modifying their standards due to fear they will fail as a result. Reflecting on what perfectionism has cost you in different areas of your life can help you realize that the costs outweigh the benefits. This realization can help boost your motivation to tackle perfectionism and be a helpful reminder for those times you feel tempted to give in to your inner critic. 4. Practice self-compassion. One of the most helpful ways to combat one’s inner critic and address perfectionism head-on is to practice self-compassion regularly. If perfectionism were a physical illness, doctors would most certainly prescribe self-compassion as a way to treat it. Perfectionists are often their own worst critics. While they can be compassionate towards others, they may have difficulty being supportive of themselves. When you’re feeling critical of yourself, some questions that can help you increase your self-compassion are: What would I say to a friend in this situation, and how can I apply that to myself? What would a friend say to me? How can I take care of myself right now? What do I need right now that I’m not getting? What are some ways I show others compassion that I can apply to myself? Certain meditations are designed to improve your relationship with yourself and others, such as the loving-kindness meditation and the self-compassion break. 5. Engage in activities that build resilience. Individuals who struggle with perfectionism often over-prepare and actively avoid making mistakes or putting themselves in situations where they may be bad at something. This fear can hold them back from learning that mistakes do not define their self-worth and most likely won’t cause others to reject them. It can be helpful to engage in activities you fear you will be bad at. Think of these activities as experiments that can help you challenge your assumptions about yourself, practice letting go of unrealistic expectations, and build resilience . Consider starting off with low-stakes activities that don't feel as anxiety -provoking and working your way up to more high-stakes activities over time. This can be an anxiety-provoking process that takes time, but it can ultimately be very freeing for many perfectionists. 6. Reach out for support from others. Perfectionism thrives in silence and isolation. Often perfectionists are surprised to find many others struggle with similar issues once they start opening up about it; this can reduce the feelings of shame that typically accompany perfectionism. You can start by identifying one person in your life that you trust and share with them about some of your struggles. Another option is attending a support group with others who are also struggling with perfectionism. The more you practice being vulnerable with people whom you trust, the less isolated you will feel and the freer you may become. 7. Reduce your social media use. Social media contributes to frequent social comparison, which can exacerbate perfectionism. Try taking a break from technology for a half or full day and see how you feel. When you start using social media after the break, notice how you feel. Are you engaging in social comparison and feeling “not good enough?” If so, consider implementing a regular break from social media a few times per week. Keep in mind that it’s helpful to have realistic expectations for yourself as you’re working on your perfectionism—it’s a process that takes time. If you find yourself getting stuck during the process, it can be helpful to find a therapist who specializes in perfectionism and can help you combat your inner critic. This post was also published at Good Therapy. Disclaimer: This post is for informational purposes only. This post is not intended to be a substitute for professional or psychological advice, diagnosis, or treatment. Always seek the advice of your mental health professional or another qualified health provider with any questions you may have regarding your condition or well-being. Roxy Zarrabi, Psy.D., - Website -

New research shows effects even for those at genetic risk for depression. Mood disorders like depression are often caused by a combination of genetic and environmental factors. A new study shows how factors like solid social support can help offset the genetic risk of depression. This suggests that for people biologically predisposed to depression, there's no guarantee it will develop. It has long been understood that mood disorders like depression , much like most psychological disorders, are often caused by a combination of genetic and environmental factors. Most likely, there is a nuanced interplay between someone's genetic risk for a disorder and the environmental stressors that trigger it: the more genetically vulnerable you are to a given disorder, the lower the amount of environmental triggers you need for it to come into being, and vice versa. Now, a new study shows how factors that protect against a disorder may behave differently depending on your level of genetic risk as well. Specifically, this research shows how environmental factors like solid social support can help offset the genetic risk of depression, lending itself to a growing body of evidence that positive social relationships are crucial for mental and physical health , and suggesting that social support may even be the most helpful for those who have a high genetic risk for depression. The study was led by a team at the University of Michigan whose first author was Jennifer Cleary, M.S., a psychology doctoral student and senior author Srijan Sen, M.D., Ph.D., of the University of Michigan Medical School. Two groups of people undergoing phases of life traditionally understood to be very stressful were studied: newly minted physicians who were in their most grueling year of training, and adults in later stages of life who were grieving the recent loss of a spouse. Interestingly, both groups tended to have somewhat different changes in their social support during their stressful times. While physicians in their first year of residency may have typically been more isolated from friends and family than they were before, recently bereaved spouses often had an uptick in social support—even if temporary—as friends and family circled around them in order to support them in their grief. Study participants, who numbered more than 1,000 physicians and more than 400 bereaved spouses, were assessed for their genetic risk of depression using what's called a polygenic risk score, which takes into account small variations in several genes that have been tied to the risk of depression. Social support was assessed using self-report measures. In both groups, depression significantly increased during stressful times. But a striking interaction between social support and genetic risk for depression was found. Specifically, those who had a higher genetic risk for depression had higher rates of depression after losing social support but also lower rates of depression when social support was gained, even as compared to those with a lower genetic risk for depression. This suggests that when people carry a biological predisposition toward depression, it is anything but a guarantee that they will develop it—and, in fact, they can be most helped by the environmental factor of social support. Though this study was correlational in nature, meaning that we can't be certain that social support was the cause of the lowered depression, or the sole cause, the association was striking. And though further research is needed to solidify this potential causation, the research suggests two important ideas: that those with high genetic risk for depression may also get greater gains from those factors that protect against it, and that social support in stressful times can potentially have tremendous beneficial effects—even for those thought to be genetically "destined" for depression. Both notions bring a lot of hope, especially in a time of increased self-reported depression, stress, and loneliness. Andrea Bonior, Ph.D., - Website - References Jennifer L. Cleary, Yu Fang, Laura B. Zahodne, Amy S.B. Bohnert, Margit Burmeister, Srijan Sen. Polygenic Risk and Social Support in Predicting Depression Under Stress. American Journal of Psychiatry, 2023; DOI: 10.1176/appi.ajp.21111100

And if so, how common it is really? There is skepticism surrounding the legitimacy of Relationship OCD as a genuine condition linked to OCD. A recent study analyzed obsessions described by a substantial number of individuals with OCD. The results highlight the widespread prevalence of relationship-related obsessions among individuals with OCD. In recent years, the concept of “Relationship OCD (ROCD)” has emerged in scientific literature, media, and within therapeutic circles. It characterizes individuals who exhibit intense preoccupation and doubts regarding the suitability of their romantic relationships or partners, leading to significant distress and impairment in daily functioning. References to ROCD1-7 typically classify it as a distinct manifestation of obsessive-compulsive disorder (OCD). Those with OCD often experience distressing intrusive thoughts (obsessions) and feel compelled to engage in behaviors or mental rituals (compulsions) to alleviate the resulting distress. While OCD themes encompass concerns like contamination, symmetry, harm, morality, and religion, ROCD centers on relationship-related obsessions. However, skepticism exists regarding the legitimacy of ROCD as a clinical condition. Some argue that it merely reflects common relationship challenges exaggerated by media and clinicians, while others perceive it as a milder form of OCD wherein individuals are “just a little too focused on their relationships.” Furthermore, there are assertions that ROCD is uncommon and affects only a minority of OCD sufferers. A recent study examining different OCD subtypes shades light on these debates. In their 2021 study, Feusner and colleagues investigated prevalent obsessional themes of people with OCD by analyzing data from a mobile app designed for OCD treatment. Their analysis focused on extracting the vocabulary individuals used when spontaneously describing their obsessions, compulsions, and triggers. While previous studies have delved into the primary themes occupying those with OCD, Feusner and colleagues’ approach introduced two notable advancements: Large sample size. By leveraging data obtained via a mobile app, the researchers gathered responses from over 25,000 individuals who self-identified as having OCD. This is a notably large sample in comparison to typical studies that include dozens to hundreds of participants. This large dataset potentially provides a more comprehensive understanding of the themes of OCD obsessions. Free-form reporting. Previous studies regarding obsessional themes of individuals with OCD frequently relied on predetermined symptom checklists. These checklists encompass a variety of established OCD-related themes, including fears pertaining to harm, contamination, and religious concerns. However, because these checklists were devised before ROCD was recognized, they fail to include relationship-related themes, potentially resulting in the underrepresentation of relationship-related obsessions. Through the analysis of individuals’ spontaneous descriptions of their obsessions and compulsions, Feusner and colleagues bypassed the constraint of depending on predefined checklists, allowing for the identification of themes not included in such lists. The researchers obtained 7,001 unique words representing obsessions from 25,369 individuals. They focused their analysis on the top 7% of the most commonly appearing words in the dataset. Notably, terms such as relationship, partner, love, break, attractive, girlfriend, boyfriend, wife, husband, and other relationship-related expressions appeared prominently among the top 7% of words. The study identified three main clusters of obsessive preoccupations, each centering around distinct themes reflected in the words examined. The second-most-frequent cluster featured relationship-related themes alongside “not-just-right” experiences. This cluster closely trailed the most prevalent cluster, which included contamination, somatic, or harm themes. The third-most-common cluster encompassed doubt or checking themes. Through analyzing the free responses provided by participants, this study underscores the notable prevalence and relevance of relationship-related obsessions among individuals seeking treatment for OCD. This finding resonates with the expanding scientific comprehension of ROCD and echoes the observations of clinicians specializing in OCD treatment. These professionals often encounter relationship-related obsessions in their clients, witnessing the profound distress they induce. Raising awareness of ROCD among therapists and clients could facilitate better recognition, comprehension, and implementation of suitable treatment for those affected by this condition. Ran Littman, Ph.D., - Website - References Brandes, O., Stern, A., & Doron, G. (2020). “I just can't trust my partner”: Evaluating associations between untrustworthiness obsessions, relationship obsessions and couples violence. Journal of Obsessive-Compulsive and Related Disorders, 24, 100500. Doron, G., & Derby, D. (2017). Assessment and Treatment of Relationship‐Related OCD Symptoms (ROCD) A Modular Approach. The Wiley handbook of obsessive compulsive disorders, 1, 547–564. Doron, G., Mizrahi, M., Szepsenwol, O., & Derby, D. (2014). Right or flawed: Relationship obsessions and sexual satisfaction. The Journal of Sexual Medicine, 11(9), 2218–2224. Fernandez, S., Sevil, C., & Moulding, R. (2021). Feared self and dimensions of obsessive compulsive symptoms: Sexual orientation-obsessions, relationship obsessions, and general OCD symptoms. Journal of Obsessive-Compulsive and Related Disorders, 28, 100608. Kılıç, N., & Altınok, A. (2021). Obsession and relationship satisfaction through the lens of jealousy and rumination. Personality and Individual Differences, 179, 110959. Melli, G., Bulli, F., Doron, G., & Carraresi, C. (2018). Maladaptive beliefs in relationship obsessive compulsive disorder (ROCD): Replication and extension in a clinical sample. Journal of Obsessive-Compulsive and Related Disorders, 18, 47–53. Mısırlı, M., & Kayanak, G. K. (2023). Relationship Obsessive Compulsive Disorder: A Systematic Review. Current Approaches in Psychiatry, 15(4), 549–561. Feusner, J. D., Mohideen, R., Smith, S., Patanam, I., Vaitla, A., Lam, C., Massi, M., & Leow, A. (2021). Semantic linkages of obsessions from an international obsessive-compulsive disorder mobile app data set: big data analytics study. Journal of Medical Internet Research, 23(6), e25482.

Most conflicts with aging parents are unnecessary. Adult children need to recognize that their parent's identity changes over time. A parent's memory loss is not necessarily an indication of dementia. While it's natural to hope for a pleasant future, it's important to have realistic expectations. For example, your parents may need a locked memory facility one day. When I was a caregiver counselor, I heard a litany of reasons for conflicts my adult clients had with their parents. As I listened to each, I invisibly shook my head and silently said, "Me too." Intergenerational conflict seems to possess a certain universality[i], whether it was my parents becoming annoyed because I made decisions for them or my adult children wondering if my addled brain permitted me to hike alone in the wilderness. Although I heard many permutations of intergenerational conflicts, four out-paced all others: ones related to identity, memory, independence, and planning for the future. Identity Sociologists maintain that a person's identity involves their beliefs, history, abilities, and expectations. [ii] It is like a summary statement of a person's life, analogous to how a novel is described on a book jacket. For example, this is how someone summarized Ernest Hemingway's 128-page novella, The Old Man and the Sea: "An old man, a small boat, and a few days reveal the story of human struggle throughout the ages." Not bad for a classic. But what changes if instead of Santiago taking three days to land the fish, it takes 20 minutes? We have a very different story that might not even qualify for a mention in a fishing magazine. The same principle applies to the identity of your aging parent. The Takeaway. When interacting with your parent, understand that at 70 years of age, they don't have the same identity as they did at 40. If they did, their life would have been static for 30 years, which is difficult to imagine. Treat them as they are today, not how they were nor how you would like them to be. Memory Loss Is Not Necessarily an Indication of Dementia Yes, your mother may misplace her glasses five times a day—every day. And she may occasionally forget the name of your son, her favorite grandchild, but are these signs of Alzheimer's or other types of dementia? Not necessarily. Memory is more complex than popular "memory improvement" programs would like you to believe. It can be short-term, sequential, long-term, or working (executive function).[iii] Each can be affected by drugs[iv], poor sleep[v], lack of exercise[vi], unresolved issues[vii], or a declining age-related information-processing ability[viii], just to mention a few. The Takeaway: Before assuming your parent is "losing his marbles," approach the problem as if you are a clinical scientist. Note the "strange" behavior's context, frequency, or severity, not for a single incidence but for several occasions, before you make an appointment for them with a neurologist. You Are Not Your Parent's Parent We all want to be as helpful as we can with our parents, often trying to anticipate their needs before they ask for help. You believe doing something before being asked shows compassion, but your father becomes annoyed because he thinks you are treating him as if he reverted to his childhood. Some of the pain parents and adult children cause each other may result when there is a gap between expectations and reality. [ix] The Takeaway. Yes, you can assume that your parent's abilities, from physical to cognitive and everything in between, declined over the years. However, there is no fixed point where they require help. It's a moving target. To avoid unnecessary conflict, discuss when it is appropriate to offer help and when they prefer to struggle. Plan for the Future Today I visualize stalking wild trout in fast-moving streams at 90 as well as I do now at 78. But I know that's as ridiculous as believing I'll ever again run a marathon. The more I allow "hope" to replace reality, the more difficult I'll make my adult children's lives when my brain becomes as addled as they think it currently is. It may be difficult for adult parents to face a future less pleasant than the 1950s Ozzie & Harriet TV sitcom, where every problem had a simple solution. One of the most difficult counseling tasks I had was convincing a client and his family that because of their dynamics, it was time to explore locked memory facilities, even though he was years away from needing one. The Takeaway. Thinking about a rosy future is uplifting. Thinking about one that is uncertain can be threatening. But thinking about one you know will be unpleasant is necessary. Stan Goldberg, Ph.D., - Website - Book - References [i] Rothenberg WA, Hussong AM, Chassin L. Intergenerational continuity in high-conflict family environments: Investigating a mediating depressive pathway. Dev Psychol. 2018 Feb;54(2):385-396. doi: 10.1037/dev0000419. Epub 2017 Oct 23. PMID: 29058932; PMCID: PMC5788736. [ii] Guenther, C.L., Wilton, E., Fernandes, R. (2020). Identity. In: Zeigler-Hill, V., Shackelford, T.K. (eds) Encyclopedia of Personality and Individual Differences. Springer, Cham. https://doi.org/10.1007/978-3-319-24612-3_1132 [iii] Stan Goldberg, Preventing Senior Moments: How to Stay Sharp Into Your 90s and Beyond, (Lanham, MA: Roman & Littlefield, 2023). [iv] Sanjay Gupta, Keep Sharp, (U.K., Headline Home, 2021) [v] Arianna Huffington, The Sleep Revolution (New York: Harmony, 2016) [vi] Mandolesi L, Polverino A, Montuori S, Foti F, Ferraioli G, Sorrentino P, Sorrentino G. Effects of Physical Exercise on Cognitive Functioning and Wellbeing: Biological and Psychological Benefits. Front Psychol. 2018 Apr 27;9:509. doi: 10.3389/fpsyg.2018.00509. PMID: 29755380; PMCID: PMC5934999. [vii] Stan Goldberg, Lessons for the Living, (Boston, Trumpeter 2009) [viii] Murman DL. The Impact of Age on Cognition. Semin Hear. 2015 Aug;36(3):111-21. doi: 10.1055/s-0035-1555115. PMID: 27516712; PMCID: PMC4906299. [ix] “The gap between expectations and reality” BMJ. 2000 May 20;320(7246):A. PMID: 10818048; PMCID: PMC1118022.

A form of institutionalized estrangement, shunning hurts health of the excluded. Religious shunning is a social death penalty that results in long-term detrimental effects on mental health. The brain registers exclusion as physical pain that cuts deeper and lasts longer than bodily injury. Ostracism instigates actions to recover thwarted needs of belonging, self‐esteem, and a meaningful existence. Over one million disfellowshipped (shunned) Jehovah's Witnesses are alive today—10 percent of active members. A former member of the Jehovah’s Witnesses, Josh Caswell Sr., reached out to me after reading one of my posts about estrangement. He asked that I explore the policy practiced in some religions of shunning. In religious communities, shunning means cutting ties with members—even family —who don’t explicitly follow religious beliefs and the leaders’ demands or who wish to break with their religion. Religious shunning is a form of institutionalized estrangement and emotional abuse . Shunning is widely practiced among certain religions—including the Jehovah's Witnesses, the Church of Scientology, the Amish, and Orthodox Judaism—to control the conduct of its members. A silent form of bullying and rejection, the practice—more common among cult-like denominations—ensures that the identity of a collective group does not tolerate individual thinking. The Watchtower, the official Jehovah’s Witnesses magazine, reports that 1 in every 100 Jehovah's Witnesses is “disfellowshipped” each year—a total of more than 80,000. Of these, fully two-thirds will not be reinstated. This means that more than 1 million disfellowshipped Jehovah's Witnesses are alive today who are being shunned—more than 10 percent of the number of active Jehovah's Witnesses. One man's personal journey after shunning “I was raised a Jehovah’s Witness in Massachusetts,” says Caswell, 45, who now lives in Arizona and works as a diagnostics specialist for Pep Boys auto services. “In my 20s,” he says, “I ‘faded out’ of religion. I felt it was too restrictive and didn’t allow me to be a human being. The cost was losing all my family and friends.” That’s a high price to pay for being human. Recent studies show that shunning has a long-term, detrimental effect on mental health, job possibilities, and life satisfaction. Intense loneliness and a feeling of loss of control over one’s life are common after leaving. The culture of informing on other members inside the Jehovah's Witnesses also leads to a continued sense of distrust and suspicion long after leaving. “The religion teaches that if someone decides to leave the religion,” explains Caswell, “the entire congregation—including family members—shuns that person by not talking to them and avoiding them as much as possible. My family has shunned me for over 25 years. I know first-hand that the result is devastating.” Research has shown that shunned individuals often experience feelings of depression , helplessness, hopelessness, low self-esteem , suicide ideation, and self-harming behaviors. That’s certainly what happened to Caswell. “I was very smart in school. I was taking 11th-grade subjects when I was in 9th grade. I had a full scholarship to MIT, but I wasn’t able to go to college because that’s not something they believe in. Why waste your time going to college when the end of the world is just around the corner? I was forced to give up that educational opportunity.” Caswell says that pursuing any career was discouraged because religious leaders preferred that potential husbands devote their time to the church, as elders in the congregation, or as pioneers who preach some 90 hours a month. To protect these priorities, he was allowed to date only within the congregation. At 17, Caswell left the religion. He says his father, an elder in the congregation, had raped six of his eight sisters. The church said it would handle the abuse internally, but his father was disfellowshipped for only a month before being reinstated. He believes his mother orchestrated the sexual abuse. “I honored my parents when I was living with them,” he says. “But I was never happy. So I set forth to find out who I was.” By the time Caswell was 20, everyone in the congregation, including three sisters, had stopped communicating with him. In abandoning his religion, Caswell left a safe “bubble”—but he knew nothing of the outside world. Consequently, he went from one extreme to another, following a dangerous path on which he drank to excess and used crystal meth. Eventually, he became suicidal and ended up living in his car. For the last 19 years, he has been clean. However, he has had no relationship with his mother or other family members for decades. His father passed away years ago; they were estranged at the time of his death. Studies on ostracism Humans have a primal need for social support. Without a sense of belonging—a feeling of emotional safety and context—people come to fear that their very lives are at risk. They lose the ability to trust and connect with others, instead becoming consumed by the task of surviving alone. Shunning, therefore, is like a social death penalty—and studies prove this point. Exclusion has been found to cause pain that cuts deeper and lasts longer than a physical injury, according to Dr. Kipling D. Williams, a distinguished professor of psychological sciences at Purdue University who is noted for his unique studies of ostracism. When someone is shunned—even by a stranger, even only briefly—Dr. Williams has found that they experience a strong and harmful reaction, activating the same area of the brain that registers physical pain. The crucial difference between physical and psychic injury is that physical damage heals, while social injuries linger. In his studies of more than 5,000 people, Dr. Williams used a computer game to show how just two or three minutes of ostracism can produce ongoing negative feelings. “Our studies indicate that the initial reaction to ostracism is pain,” he explains, “which is similarly felt by all individuals regardless of personality or social/situational factors. Ostracism then instigates actions aimed at recovering thwarted needs of belonging, self‐esteem, control and meaningful existence.” Caswell, who asked me to use his real name because he wants his voice heard, says that religious leaders know full well the profound psychological impact of shunning. “That’s exactly why they do it,” he says. “Shunning is not love; it’s how Jehovah’s Witnesses discipline members. It’s a form of punishment.” Fern Schumer Chapman - Website - Book - References Williams, Kipling D., NidaView, Steve (2014) Ostracism and Public Policy, Sage Journals, Volume 1, Issue 1. Harper, Janice (2011) A Reason (and Season) to Stop Shunning, HuffPost. Luther, Rosie (2022) What Happens to Those Who Exit Jehovah's Witnesses: An Investigation of the Impact of Shunning, National Library of Medicine, PubMed

When emotions are strong, our thinking can go offline. Anger leads us to act before we think, and when under its influence, the activity in our brain changes. Stress is a contributing factor to anger that inhibits the activity in the thinking part of the brain. Regulating our anger requires using skills that bring the thinking part of the brain back online. Anger is a normal, natural human emotion. In many situations, it's a healthy and appropriate emotional reaction. Everyone gets angry at times. While the emotion of anger is part of being human, it becomes problematic when its expression is so frequent, intense, or out-of-proportion to the situation that there are negative effects on one's life. Depending on how and how often people express their anger, it can damage relationships with family , friends, and partners or at their jobs—creating conflict, estrangement, anxiety , and fear. Most of us know someone whose anger seems to be on a "hair-trigger," igniting easily, quickly, and ferociously. But even when people don't demonstrate intense anger outwardly, they can nonetheless experience powerful internal effects that make it extremely difficult to respond skillfully when they get angry. Why Anger Generates Strong Reactions Usually, anger has a context embedded in personal experience. Anger arises when we feel unfairly or unjustly treated, diminished, exposed, devalued, coerced, scared, or powerless—whether in connection with present-moment experience or triggered based on something from our past. Anger defends these unpleasant and vulnerable emotional states, providing a sense of power and control—at least temporarily. Intense, out-of-proportion anger can also represent a response to past trauma . Operating under the influence of intense anger (or other highly-charged emotions) is not unlike being under the influence of alcohol or other drugs—it can be a form of impairment that deteriorates people's decision-making, judgment, and ability to think intentionally and rationally. The Brain With Anger Anger leads us to act before we think, and when we are under its influence, the activity in our brain changes. The emotional part of the brain goes into hyperdrive while the thinking part of the brain becomes less active, effectively going offline. Two areas in the emotional part of the brain can activate too much when we are angry: the amygdala, which encodes the emotional quality (positive/safe or negative/threat) and intensity of our experiences; and the insula maps how our body feels during situations, including what we know as "gut feelings." The degree of activity in the amygdala and the insula is controlled, in part, by two areas in the thinking part of the brain: the orbitofrontal cortex, which helps us consider and assess the potential consequences of our behaviors and the ventromedial prefrontal cortex, which helps us empathize with others. The more active the thinking part of our brain is, the greater our ability to consider our behaviors in advance, including how they might affect others—and the more consciously we can guide our choices and actions. Stress is a common contributing factor to anger. Stress levels correlate with how much norepinephrine is released in the brain. Norepinephrine is a neurotransmitter needed for everyday thinking tasks. It activates the above two thinking parts of the brain and allows us to think in focused and flexible ways. However, as stress increases, so do norepinephrine levels. When norepinephrine is excessive, it stops activating those thinking parts of the brain[1] and instead starts activating the emotional parts of the brain.[2] By dampening the ventromedial prefrontal cortex activity, stress inhibits the capacity to feel connected with others. People often become stuck in emotion-driven interpretations of events and are rapidly propelled into fight-or-flight mode, which limits our ability to respond flexibly and intentionally.[3] Once anger subsides, norepinephrine levels decrease, and our brain's thinking part returns online. Our ability to empathize returns, frequently evoking remorse and guilt over our unskillful behavior and the damage it may have done. Strategies for Regulating Anger Regulating our anger requires bringing the thinking part of our brain back online, and there are several ways to accomplish this. Pause—take a few moments to establish a mental-emotional space where your thinking ability can be recovered. Step away from the interaction or situation to give yourself time to consider how you want to respond consciously. Practice identifying and allowing yourself to feel the underlying emotions that anger may be superimposed upon—such as hurt or fear. Strive to be present with and accept these feelings and the vulnerability they elicit. As difficult as it may be, try to identify how you may have contributed to the situation that you are angry about. Be aware that people (including you) frequently play a part in the circumstances that brought about their anger. Learn and practice self-calming skills that improve overall emotional regulation, such as meditation and other mindfulness practices, progressive relaxation, yoga, Qi Gong, and intentional breathing. Intentional breathing can take multiple forms. Breathing is an involuntary bodily function that we can significantly influence voluntarily. We can deliberately alter the rate and quality of our breathing to change the activity in our nervous system. Stress and highly charged emotions—including anger—can lead to rapid, shallow breaths that feed into and exacerbate distress.[4] Practice deepening and slowing your breathing—taking long, deep in-breaths and full, complete out-breaths (timing each to a specific count can help maintain a rhythm and sense of stillness). Such controlled breathing can limit respiratory rate, decrease fight-or-flight reactions, improve mood, lower cortisol (the primary stress hormone) levels, and facilitate greater calm.[5] Learning and practicing the skills of being more consciously aware of our anger as it arises, observing it, being present with it, and making peace with it gives us the ability to respond to and express it intentionally rather than react to it unconsciously, automatically, and reflexively in ways that create suffering for us, as well as those closest to us. Dan Mager, MSW - Website - References [1] Frontiers in Systems Neuroscience, 17 April 2023 Volume 17 - 2023 | https://doi.org/10.3389/fnsys.2023.1173326 2] Stephen Maren, The Threatened Brain, Science 317,1043-1044(2007). DOI:10.1126/science.1147797 [3] Teed AR, Feinstein JS, Puhl M, et al. Association of Generalized Anxiety Disorder With Autonomic Hypersensitivity and Blunted Ventromedial Prefrontal Cortex Activity During Peripheral Adrenergic Stimulation: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(4):323–332. doi:10.1001/jamapsychiatry.2021.4225 [4] Pierre Philippot , Gaëtane Chapelle & Sylvie Blairy (2002) Respiratory feedback in the generation of emotion,Cognition and Emotion, 16:5, 605-627, DOI: 10.1080/02699930143000392 [5] Perciavalle, V., Blandini, M., Fecarotta, P. et al. The role of deep breathing on stress. Neurol Sci 38, 451–458 (2017). https://doi.org/10.1007/s10072-016-2790-8

Get to know your anger. Try Cognitive Behavioral Therapy (CBT). Extreme anger does not just strain your closest relationships; it negatively impacts your social and professional life. Two gentle but effective techniques to reduce your anger levels are getting to know your anger and cognitive behavioral therapy . Explaining yourself clearly without letting your emotions get the best of you is the most effective way to resolve an anger-inducing situation. Many people come to therapy unable to control their anger. They ask questions like: “I always end up hurling personal insults when I’m arguing with my partner . How do I stop myself from escalating things when we disagree?” “I sometimes worry I will damage all my relationships irreparably because of my anger. How do I safeguard my loved ones from my outbursts?” “I cannot imagine myself as a calm and composed individual. Is there any hope for me?” Extreme anger doesn’t just strain your closest relationships; it negatively impacts your social and professional life. Unfortunately, for many people with anger issues, the harder they try to control it, the angrier their outbursts get. This is often because people gravitate toward suppression as an anger control technique. But there are better ways to address the issue. Here are two gentle but effective techniques to bring down your anger levels. 1. Get to know your anger Most people with extreme anger are aware of the problem and develop a deep disdain for it. As a result, they tend to avoid thinking or even talking about their issues. However, ignoring your anger issues is equivalent to ignoring an allergy – it rarely goes away by itself, and, in many cases, it can worsen the problem. The first thing any individual with an anger problem can do is identify what triggers them. Is there a person, event, or area of your life that you hate to discuss? Is there a particular pet peeve you have that sends you over the edge, like being spoken over? Does excessive stress and/or lack of sleep have something to do with your outbursts? Small questions like these can bring you closer to the root of the problem and can help you predict when your anger might flare up instead of being blindsided by it. Another thing to tune into is to sense what anger feels like in your body. Do you experience a headache or a sharp rise in temperature? Do your thoughts go a mile a minute? According to research published in Behavior Modification, you may be able to kill both of these birds with the singular stone of mindfulness training. Noticing your thoughts, feelings, and sensations when you are angry and when you are calm can help you understand and control your anger. Shifting your attention to the soles of your feet when you are in an agitated state is one research-backed meditation prompt that can help quell your urge to react with hostility. While meditation can work wonders for anger, journaling and mindfulness-based therapy are also great options. 2. Try Cognitive Behavioral Therapy (CBT) While mindfulness can help us become aware of our anger and ground ourselves in the present moment, CBT can help us take action, suggests research published in Aggression and Violent Behavior. Through tools like cognitive restructuring, you will be able to recognize and decrease negative thought patterns that would previously send you on a rampage. Once you have learned to spot a negative thought pattern, you can use behavioral techniques like role-playing a triggering situation. The role-play session can be followed by a "debrief," where your role-play partner gives you feedback, and you can describe your state of mind more clearly. Explaining yourself clearly without letting your emotions get the best of you is the quickest and most effective way to resolve an anger-inducing situation. Conclusion Like most aspects of our personality, anger is subject to change. We are all works in progress. Keen observation of your thoughts and feelings coupled with therapy can bring your anger down considerably. Mark Travers, Ph.D. - website