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Learn a powerful way to explore, question, and change worries and fears. Challenging distorted thinking is hard when dealing with the emotional whirlwind of worry, fear, or panic . Help your reacting brain and thinking brain talk to each other before getting caught up in anxiety . A fears vs. facts dialogue table helps you effectively challenge worries and fears. We know that challenging distorted or “irrational” thinking reduces anxiety . But how exactly do you do that? It is hard to believe logical thoughts when your body and emotions are screaming at you. Intellectually recognizing that a fear is based on something that isn't true, that you don’t need to panic, or that you worry too much, can make no difference when your body and your emotions say you are in danger. If it feels like your mind is fighting with itself, that’s because it is! Your Two Brains Your amygdala, or as I like to call it your reacting brain, reacts instantly and automatically when it thinks you are threatened. This is terrific and life-saving in the right circumstances. The trouble is it overreacts, triggering unnecessary worry, fear, or panic . The more developed upper part of your brain, the cerebral cortex or thinking brain, is smarter. Unfortunately, it is slower than your primitive, bodyguard brain. Because the reacting brain is faster, you get flooded with adrenaline. Your body reacts as if you may need to fight or flee. Your mind gets a primitive message of “DANGER!!!” You feel worried or panicky. Your mind starts looking for possible threats. If it sees no threat from outside, it may decide your physical sensations, your thoughts, or the intensity of your emotions are dangerous. Successfully navigating this emotional whirlwind is hard. Your activated reacting brain needs to be heard, but also be willing to listen. Your thinking brain needs to look at the whole picture, not just search for danger. The parts of your brain need to talk to each other, and they are far more able to do this when you are anxious if they have practiced ahead of time when you are calm. This post and the next take you step-by-step through how to successfully listen, explore, and re-evaluate fears and worries. Help Your Two Brains Talk to Each Other Create a written fears vs. facts dialogue table. This skill was introduced in my post “Listening to Worries Can Actually Make You Less Anxious”. Make a table with two columns and several rows. Label the left column “Worries, Fears, Distressing Thoughts”. Label the right column “Facts, Evidence, Logic, Perspective”. Creating your dialogue table on a computer lets you easily add more thoughts as you go along. Uncovering your reacting brain’s fears and questioning them in a way that is credible and convincing to you is harder than it looks. Here are the first three tips. Tip 1: Listen Before Reassuring Fill out the left side first. This is important. If you jump to the right side and start refuting your worries , the reacting brain feels unheard. Instead of a dialogue, you have a “he said,” “she said” argument. Reacting brain: “This is dangerous!” Thinking brain: “No, it’s not.” “Is too!” “Is not!” “Is too.” “Is not.” This type of discussion goes nowhere. Reflect on your own experience. When you are anxious or afraid and people say, “Don’t worry. Don’t be scared.” Do you feel convinced or not heard? Even if one part of your brain knows there’s no threat, the other part believes there is. Listen attentively to everything that scares or worries your bodyguard brain. Tip 2: Get the Details What exactly does your fear predict will happen if you don’t do what it says? What if you don’t act based on fear or worry? What might happen if you don’t leave or avoid the frightening situation? What might happen if you do not stay alert or fight your reaction? What if you do not do something special to stay safe? Put into words everything the fear or worry says. State these explicitly. Tip 3: Look Below the Surface What would actually justify being afraid? What underlying beliefs make anxiety feel like an appropriate response? What unhelpful lessons from the past contribute to present worries? Drag these unspoken assumptions and beliefs into the light and write them down. Write what the fear assumes about you, other people, the situation, or the world. You may remember Jonathan from “3 Ways to Tell if Worry Is Helpful.” He worried constantly about his car and the risk of car accidents, so together we created a dialogue table. After writing the worries that came easiest to mind, he reflected on lessons he learned growing up with an abusive alcoholic father. He realized old assumptions fed his anxieties. Notice how those general beliefs easily lead to specific worries. Jonathan’s Dialogue Table In the first column, "Worries, Fears, Distressing Thoughts," he wrote: There is something seriously wrong with the car. Every sound means there’s a problem and I will have an accident. I can’t trust the mechanic; he missed something. You can’t trust anyone. Bad things happen all the time without warning. You must stay on the alert for possible dangers at all times. Your Personal Dialogue Table Start writing your own fears vs. facts dialogue table. Fill out the left column. Read my next post for tips on completing the right column. Summary Thinking logically when you are scared is hard. You need to practice ahead of time. Creating a fears vs. facts dialogue table helps the two parts of the brain listen and talk to each other. Start by listening. Get details and look below the surface. The next post gives tips on how to convincingly evaluate and change anxious thinking. Elizabeth McMahon, Ph.D., - Website - References McMahon, E. (2019). Overcoming Anxiety and Panic interactive guide. San Francisco, CA: Hands-on-Guide.

What do teens themselves say they gain from social media? This is the second of two posts devoted to the contentious issue of social media use by teens . Some researchers have reported negative correlations between social media use and indices of mental health in teens, especially for girls, and this has led some to propose that teens should be restricted from social media. Such reports motivated me to spend many hours delving into the research literature relevant to questions of social media and teen mental health. In my last post I focused on reviews of studies aimed at determining whether there is an overall correlation between time spent on social media and indices of mental health in teens. The general finding, supported by essentially all the reviews, is that, taken as a whole, research suggests a very small negative correlation between social media use and teens’ mental well-being. Reviewer after reviewer, however, points out that the effect is too small—for either boys or girls or both combined—to account for a meaningful portion of the variance among teens in mental well-being. Moreover, researchers regularly point out that whatever negative correlations are found could be the result of depression or anxiety causing increased use of social media (perhaps as a way of coping with distress) rather than the reverse. I also, in that post, reviewed attempts to determine the direction of causation of such correlations through longitudinal studies and experiments and concluded that no studies to date provide compelling evidence that social media use causes a reduction in teens’ mental well-being. In today’s post my focus is on what teens themselves say about their use of social media and on studies that look at the immediate effects of social media use on teens’ moods. Why do teens spend so much time on social media? What do they get out of it? What do they see as the positive and negative effects it has on their mental health? What individual differences exist among teens in the mental health consequences of social media use? And, finally, what precautions might teens (and the rest of us) take to use social media safely and reduce or remove risks? Why Do Teens Spend So Much Time on Social Media? Teenagers have always been attracted to public spaces where they can hang out with friends, find new friends, and talk endlessly with peers about matters that concern them, away from parents and other authority figures. This has always been true, across cultures and across time. It seems to be an essential part of growing up. In recent decades, however, teens, as well as younger children, have been increasingly deprived of opportunities to get together in physical space away from direct adult surveillance and interference. Increasingly, their time is taken up with adult-directed activities and their freedom to join peers away from adults outside the home is restricted by fearful parents and, increasingly, by security guards at places such as shopping malls where teens gathered in decades past. (I described forces that have led to such changes here.) Under these conditions, social media is a saving grace. It provides a substitute means for teens to keep in touch with one another. Through their smartphones they can share their thoughts and feelings even when not allowed to gather physically, and they can do so during free moments even when they are kept busy with adult-directed activities. Cyberspace is the new public space for teens. If we took that away from them, they would have no space—no way to engage in the intense and private (private from adults) communication that teens have always sought and needed as part of growing up. The first thorough study I’ve found of why teens use social media so much was conducted by danah boyd (who spells her name without capitals) rather early in the social media era, a bit more than a decade ago, and published as a book (boyd, 2014). She interviewed 166 teens across the country and across ethnic groups. When she asked why they used social media so much, the regular answer she received was to keep in touch with friends. When she asked why they didn’t get together with their friends in person rather than over the Internet, they regularly told her they would much rather get together in person but had little opportunity to do so because of restrictions on their and their friends’ time and freedom. Teens also told her that it was important to them to keep their communications with peers away from the prying eyes and ears of parents and other authority figures. In boyd’s words, “They want the right to be ignored by the people they see as being ‘in their business.’… They wish to avoid paternalistic adults who use safety and protection as an excuse to monitor their everyday sociality.” Further, boyd wrote, “In 2012, when I asked teens who were early adopters of Twitter, Tumbler, and Instagram why they prefer these services to Facebook, I heard a near-uniform response: ‘Because my parents don’t know about it.” In more recent studies, teens continue to say they use social media primarily to keep in touch with friends. In a study by the Pew Research Center (Anderson & Jiang, 2018), researchers asked 743 teens, ages 13 to 17, why they use social media instead of getting together with friends in person. The most common response (by 41%) was that they had too many obligations (too many scheduled activities) to find time to hang out with friends. In addition, 34% said their friends were too busy with their own obligations, 32% cited the difficulty of finding transportation, and 33% noted that it is just easier to connect with friends online than to try to connect with them physically. What Do Teens Consider to Be the Pluses and Minuses of Social Media Use? A large recent study by the nonprofit organization Common Sense (Nesi, Mann, & Robb, 2023) focused specifically on girls ages 11 to 15, because this is the demographic considered by some to be the most vulnerable to possible negative effects of social media. The survey included more than 1,300 girls. In one set of questions the girls were asked whether the effect on their mood of using various social media platforms was primarily positive, negative, or neutral. For every platform, more girls said the effect was positive than negative. For TikTok, 43% said positive, 26% negative, and the rest neutral. For Instagram, these numbers were 38% positive, 19% negative; for Snapchat. 32% positive, 26% negative; for messaging apps 50% positive, 10% negative; and for YouTube, 65% positive, 5% negative. In another set of questions, the girls were asked if their life would be better, worse, or the same if they didn’t have access to specific social media platforms. For each platform, far more said that removing the platform would make their life worse than said it would make it better, though many said it would make no difference. For example, only 9% said life would be better without messaging apps, while 43% said life would be worse. For TikTok, 16% said life would be better without it, while 34% said worse. So, all in all, girls using social media are much more likely to feel it is good for their well-being than to feel it is harmful. Why, according to teens, does social media improve their well-being? In the Pew study (Anderson & Jiang, 2018), cited earlier, 81% of teens said social media makes them feel more connected to what’s going on in their friends’ lives, and roughly two-thirds said such communication makes them feel they have people who will support them through tough times. In line with that, 71% said social media makes them feel included, compared to 25% saying it makes them feel excluded, and 69% said it makes them feel confident, compared to 26% saying it makes them feel insecure. All this is consistent with the idea that teens gain social support through social media. On the possibly negative side, in the Pew study, many said they at least sometimes feel pressure to post only content that makes them look good (43%) or will get lots of likes or comments (37%). Moreover, 45% said they at least sometimes feel overwhelmed by the drama, and many in that group said they had digitally disconnected from some others because of too much drama. The Pew researchers also analyzed their data separately for boys and girls and for each age group (ages 13 to 17) and found no large differences. They concluded that boys and girls and older and younger teens generally view their social media use in similar ways. They also found that teens at the time of their study rarely posted “selfies,” unlike teens of a decade or more earlier. The decline in posting of selfies may help explain why recent studies have revealed less anxiety among teens about their physical appearance, deriving from social media, than may have been true in the past. Experience Sampling Studies of Effects of Social Media on Mood One approach to understanding short-term effects of social media use on teens’ moods is to signal them at various times and, at each signal, have them report on their use of social media within some period (typically an hour) before the signal and their current mood. In one such study, Ine Beyens and colleagues (2020) tested the hypothesis that passive social media use (where the person is just browsing and not posting) may have negative effects on mood. This hypothesis is generally founded on the belief that when one is just looking at others posts they feel socially excluded and envious of the others’ experiences. The results failed to support that hypothesis. In fact, the researchers found that 46% of the teens tested over many such sampling trials felt better, on average, after such browsing and only 10% felt worse. The rest, on average, felt neither better nor worse. A very similar finding has since been reported in another study (Valkenburg et al., 2021)—which also showed that only a small percentage of teens felt worse after passive browsing; most either felt better or were unaffected. Beyens and colleagues also found, as had others, that active use of social media—that is, sending messages, posting or sharing on social media—regularly produced a boost in teens’ feelings of well-being. In another study, Jessica Hamilton and her colleagues (2021) tested the hypothesis that teens who are depressed and have had suicidal thoughts may be at particular risk for harmful effects of social media. They conducted their study with 100 teens who were enrolled in an intensive outpatient program for depression and suicidality. At weekly visits to the clinic, over the course of a month, the teens reported on their use of social media over the past week and were assessed with measures of depression and suicidal ideation . The results were the opposite of what some might predict. Those who used social media more showed greater improvement in mental health—less depression and fewer suicidal thoughts—than those who used it less or not at all. The researchers concluded that “among adolescents who are at high risk for suicide, social media may be indicative of adaptive or healthy social engagement.” In another longitudinal study, Stephanie Fredrick and colleagues (2022) sampled social media use and depression at four time points over two years for 800 teens who were 13 to 15 years old at the start of the study. The findings were complex, but one finding that stood out was that for girls, more than for boys, higher levels of active social media use predicted lower levels of depression. This finding runs counter to the belief that social media is especially bad for girls. In this study it seemed to be especially good for girls. Sensible Advice for Social Media Use All in all, the research indicates that teens today gain much more than they lose through social media. Cyberspace may not be as great a place to hang with friends as physical space, but in a world that makes it very difficult for teens to get together physically, social media is much better than nothing. Teens themselves say they would be worse off psychologically without social media, and to me it seems obvious they are right. We must strive to change the world in ways that enable teens to get together physically much more than they currently can, but, for now, taking social media away from them would be cruel. Yet, as teens themselves admit, there can be downsides to social media use. It would not be a bad idea, I think, for all teens—and adults too!—to take a short course on safe use of social media. I’m not the expert to design such a course, but here are some thoughts that come to mind about precautions. Time management Teens regularly admit, when questioned, that they sometimes spend more time with social media than they would like. They acknowledge being drawn into it and becoming so engrossed that they lose track of time, which may cause harm by subtracting from the time they can spend on other activities. A problem is that the smartphone is always with us (I’m including all of us, not just teens), regularly alerting us that some interesting message may be coming through, and once we get involved with any given message it may be hard to leave. This is what leads some to use the word “addiction” to describe the result, but I hate that word in this context. It implies pathology rather than something quite normal. We all (and especially teens) like to communicate with others, and we are all quite naturally curious about what might lie in that next message. I (like boyd) much prefer to call it a time-management problem. “ Addiction ” sounds like something that would be hard to cure, but “time management” sounds like something we should all be able to handle if we wish. Spending lots of time on social media is not in itself bad, but it may take away from time that would be better spent on other endeavors. It would be useful for most of us, teens included, to put some breaks on our smartphone use. Choose deliberately times of day when the phone will be on and when it will be off. For starters, off at dinner time—off for everyone at dinner, not just the kids—so the family can be together and communicate in person. Similarly, when you really are together with friends, outside the family, turn the phone off so you can be fully present with your friends, not distracted by the phone. And then off at bedtime. In fact, keep it in another room at bedtime. One of the worst effects of smartphone use is sleep loss when teens (or any of us) use it late into the night or let its beeping wake us. Beyond that, there may be other times when we want the phone off. I turn mine off whenever I’m writing something I value because I hate interruption. Each person can decide for themselves what activities are important enough to them that they don’t want to be interrupted, and the phone can be turned off at those times. Teens might worry that their friends will think they don’t care about them if they don’t respond immediately to a message, but that can be remedied by a message to all friends saying something like this: “Please know there are times when I keep my phone turned off. If you send a message then, I will respond later. If you want an immediate response, message me between the hours of ­­___ and ___, when I will most likely have my phone on.” Cyberbullying and drama In her interviews with teens, boyd found that they did not think bullying online was as big a problem as adults considered it to be. They felt that bullying in person, at school, was a bigger problem. Online you can just turn the bully off, which is not so easy when a bully confronts you in a hallway at school. It’s good to remember this. If someone is really bothering you online, ignore them. Spend time with friends, not with bullies. You have nothing to gain by engaging them. Boyd also found, however, that much of what adults call bullying is not really bullying. Some of it is a sort of verbal horseplay, which may be crude and insulting; and some of it may be exaggerated, even histrionic complaints, which the kids refer to as drama. Some teens enjoy such horseplay or drama and deliberately produce or provoke it, and some don’t. The best advice for those who don’t is to disengage from those who provoke it, which, according to the Pew study, is exactly what many teens do. Privacy Boyd and others have noted that teens use social media partly to keep their communications with one another private, away from parents and other adults who may (usually with good intentions) interfere in their lives. However, they sometimes forget that what they send out on the Internet to a friend might, in some way, get out more publicly. It is good to distinguish between public and private platforms, but keep in mind that even messages in private platforms can make their way out publicly. A good rule to keep in mind is don’t send anything into the Internet that you wouldn’t want a future potential employer to see. Concluding Thoughts Throughout history, with every new form of communication—from the written word, to the printed page, to radio, to television, to computers, to the internet—we go through a certain amount of growing pains. The new generation tends to glom on to the new and the older generation is suspicious and thinks it will be the ruination of the next generation. Let’s try to avoid that. Let’s listen to the kids and not judge them based on our prejudices. Some adults are appalled by the amount of time kids spend with other kids on social media, but, as one group of evolutionary thinkers have pointed out (Katiyar et al., 2023), kids in the past regularly spent many hours every day—often all day--hanging out with other kids. They’re still doing that, but now because of our restrictions they do it on social media rather than in person. Well, that’s it. I’m done writing about social media unless there are a bunch of questions you want me to address. In my next post I plan to expand on the idea I introduced here, that the sharp increase in anxiety, depression, and suicides in teens since about 2008 is caused in large part by increased pressure for academic performance and increased fears about their future. Keep tuned. As always, I welcome your thoughts and questions. Psychology Today does not allow comments, so I have posted this on a different platform where you can comment. I invite you to comment here. References Anderson, M., & Jiang, J. (2018). Teens’ Social Media Habits and Experiences Pew Research Center, November, 2018. Beyens, I., et al., (2020). The effect of social media on well‐being differs from adolescent to adolescent. Nature Research Scientific Reports. Peter Gray, Ph.D., - Website - boyd, d.(2014). It’s complicated: The social lives of networked teens. Yale University Press. Hamilton, J.L. et al. (2021). Social media use and prospective suicidal thoughts and behaviors among adolescents at high risk for suicide. Suicide Life Threat Behav. 51, 1203–1212. Nesi, J., Mann, S., & Robb, M. (2023). Teens and mental health: How girls really feel about social media. San Francisco, CA: Common Sense. Katiyar, T., et al. (2023). An antidote to over pathologizing computer-mediated communication: An evolutionary perspective on mixed effects of mismatch. Valkenburg, P.M., et al, (2021). Social media browsing and adolescent well-being: challenging the “passive social media use hypothesis.” Journal of Computer-Mediated Communication 00, 1–19.

Forget those frustrating resolutions; there's a new way to change habits. A mechanical-replacement model of change works great for cars but not humans with emotions . An acceptance-and-commitment model of change allows for growth and is more forgiving. Three steps define a mindful change practice. I'd like to start this blog with a few of my favorite quotes about quitting food or addictions : “Lead me not into temptation; I can find the way myself”–Rita Mae Brown “My doctor told me to stop having intimate dinners for four. Unless there are three other people.”–Orson Welles It’s been said that any journey begins with the first step. Anyone who has ever made a New Year’s resolution knows that setting the resolution might be the easiest step to take. Before you take that fateful step come January 1, I want to give you two words that will have you rethink how to be successful at your goal of changing or stopping an addiction. Drum roll, please! And the words are: mindful acceptance/commitment. Okay, maybe that's three words, or two with a slash. Either way, mindful acceptance/commitment is a proven and potent tool for changing habits. Even if you have a history of finding it difficult to incorporate new changes into your lifestyle—whether related to diet, exercise or increasing your social network—you’ll be glad to discover this path to making behavioral change stick. Old Mechanical - Replacement Model of Change Did you ever leave the doctor’s office with a prescription for a pill that was supposed to fix your problem. If so, then you experienced the mechanical-replacement model of change. It's based on the idea that the body can be treated like a mechanical object, such as car or computer, in which any defective part can be quickly diagnosed and repaired. The expectation around this approach is that change is rapid and often highly successful. But as you can guess, there is one big problem with this model: You are not a machine. Also, consider that this model puts someone else in charge. For example, this model: Requires input from an expert who diagnoses the problem. Defines success primarily by the outcome of fixing what is defective or not working. Views things as good vs. bad—good parts replace what is defective. Bases the outcome on being a success or failure Benefits of the Mindful Acceptance / Commitment Model of Change Stanford University researchers conducted one of the longest and biggest head-to-head studies of several popular diets and concluded, "Weight loss was not statistically different among the Zone, LEARN, and Ornish groups." Most subjects regained any lost weight—which was only about five pounds, at the end of a year. Diets tend to create a success-vs.-failure mentality, as well as create an obsession around a number (pounds lost), as opposed to looking at the whole person. To deal with such issues, the mindful acceptance/commitment model embraces the following concepts: Change is collaborative. You determine what you want to change. Learning from mistakes is valued and accepted as part of the process. Success is defined as experiencing the process. Acceptance is not resignation or failure; acceptance is willingness to accept and recognize current stressors in your life. Awareness of the conditions that increase the tendency to return to old habits is good. Commitment to learning, practicing and mastering new skills takes time. Change is process-based; change doesn’t happen all at once and the focus is on each day—rather than on some future outcome. Do you see how radically different this approach is? For one thing, you don’t have to be perfect at making your change plans work. If your plan goes awry one day, there’s no need to freak out and view that as a failure. Rather, it’s an opportunity to understand what happened and to revise your plan so that you can be more skillful in the future. There’s no shame and no blame here. While this model is more accepting, it also requires greater patience and long-term commitment. You'll need to put in persistent effort to change, Personally, what I like about this approach is that it's gentle and forgiving Three-Step Mindful Acceptance / Commitment Practice Write down one small behavior you want to change or start. You might want to make this a baby step of a larger goal. For example, if you want to start exercising, a baby step might mean walking down your hallway or driveway, or just walking for one minute. Set a time of day and length of practice. One way to make your baby step successful is to be specific about when and how you will practice your new skill. Again, if you're going to exercise, set the time of day and for how long you will do this activity--such as every day for a five minutes for the next week. You can get support by sharing the information with someone who can act as your accountability coach. If you don't complete your activity, try and understand why. What caused you to deviate from your plan? Be kind with yourself. This is not a time for blame or shame. Instead, think about how you can revise the plan so you can successfully complete your baby step. If you need to change the baby step, then go ahead and do so. Conclusion Sometimes you will need to dig down and notice why you couldn't maintain your plan. There might be thoughts, beliefs, or other ideas that are blocking you. Don't give up. Keep in mind that mindful acceptance/commitment is a well-known therapeutic approach to change. You can always find a workbook or someone to work with you. Donald Altman, - Book -

What you can do when you feel like you are losing yourself. It can start small, like dressing the part to fit into a particular social circle or suppressing an opinion that you have over a restaurant or movie choice. The little ways we shape-shift and put other people’s happiness above our own or feel unable to express our honest opinions and thoughts, all lend to losing more and more of who we are in the name of people-pleasing. People-pleasing is subtle. Many of us grow up unaware of how we shift ourselves to appeal to and appease others. By the time we're adults, people-pleasing can easily be well-entwined and ingrained into our personality . Areas of research that point towards the clinical understanding of people-pleasing are focused on individuals who tend to display behaviors that seek social approval and involve self-sacrifice (Satow, 1975). Current psychology theory suggests that people-pleasing behaviors have roots in childhood, primarily through developed attachment styles between parents and child (Li, 2022). For me, this was definitely the case. Growing up in a household where we were often pressured to appear perfect or to not “ruffle your Dad or Grandfather’s feathers” or “say or do the wrong thing,” I found myself constantly emotionally monitoring the people around me and taking it upon myself to avoid triggering any upset and disharmony. More so, it became normal for me to not say what I was thinking or to express my opinions in everyday conversations. The first time I remember my voice being shut down was when I was at my younger brother's little league baseball team practice. My father was one of the volunteer coaches and would bring me along to help out and mentor the little leaguers. During one practice, the bases were loaded and as the next batter stepped up to the plate, I called out the suggested instruction to the little leaguers for “everyone to run home” if the ball was hit. Though this was absolutely a correct instruction for the players given the scenario, as soon as my Dad heard my voice, he whipped his head around and snapped, “What did you just say?” My throat seized up and my face was hot with shame and embarrassment. “Was what I said wrong?” I wondered, second-guessing myself. That was the last time I shared my thoughts at my brother's baseball practice and the first time I remember the distinct feeling of needing to suppress myself to appease someone else. This became a long-time personality trait of mine; as an adult, especially in my romantic relationships , I have found myself swallowing my true thoughts and opinions more times than I can recall, and day-by-day losing a part of myself each time I unconsciously operated in people-pleasing mode with my partner. What finally began to help me overcome the feeling of losing myself through people-pleasing was my mindfulness meditation practice. As a long-time meditator, the more my self-awareness increased, the more I started to see my people-pleasing tendencies and behaviors happening in real time. Below are six ways mindfulness helps you to overcome people-pleasing and stop losing yourself for good. Increased awareness of people-pleasing patterns. The more you meditate, the more self-aware you become. Therefore, you can begin to see your people-pleasing behaviors more clearly in real time as they are happening. Some common people-pleasing patterns to watch out for are: 1) wanting others to be happy and putting their happiness above yours, 2) shapeshifting who you are based on the social situations. you are in, 3) tolerating poor and toxic behaviors , 4) apologizing all of the time. More alignment with authenticity. When we're people-pleasing, we shift who we are based on the circumstances we are in. I call this the chameleon effect. We want to mold how we present ourselves to appease others around us. Mindfulness practice helps us to get radically comfortable and more connected to our authenticity, so we have greater confidence in being our authentic selves. Easier access to self-kindness. When you meditate, not only do you become more present, but you also become kinder to yourself. Self-kindness helps with people-pleasing by mitigating the shame, guilt, or self-judgment we may feel when we start to prioritize our own needs over the needs of others. Greater inner strength for setting boundaries. Creating boundaries is majorly important when it comes to working with people-pleasing. Mindfulness helps with the clarity around what boundaries you need to set to protect your authenticity and sense of self. Practicing mindfulness meditation can foster the inner strength that is often required to set and uphold the boundaries that will truly take care of you. Speaking your truth . Mindfulness supports you in communicating your truth, thoughts, and opinions. As people pleasers, we tend to shut down our voices in the name of keeping peace or making sure others are happy. Mindful speech is a powerful practice and encourages us to always be honest and to live our truth. Breaking free from conditioning. People pleasing is not only developed through our early childhood attachment styles, it functions as a fight/flight/freeze/fawn survival mechanism and technique in our adulthood. Practicing mindfulness meditation has been shown to decrease our habituated survival and stress response and move us more into skillfully responding to others’ demands or desires. I’m confident that when you start a regular mindfulness meditation practice you will begin to see your people-pleasing tendencies decrease to the point where you will feel more satisfied in your relationships and less burnt out by constantly accommodating everyone else's preferences and approval. Mindfulness will help set you free from people-pleasing for good. Amanda Gilbert - Website - Book - References Satow, K. L. (1975). Social approval and helping. Journal of Experimental Social Psychology,

The value of treating family members as partners in care. When it comes to treating mental health disorders, the participation of family members can be a huge help. Family psychoeducation (FPE) refers to a group of psychotherapeutic interventions which aim to treat disorders by emphasizing the role of family members as partners in care. FPE programs have seen extensive success when applied to a variety of disorders, including schizophrenia. But it can be quite stressful on family members. There remain concerns regarding supporting relatives and primary caregivers of those diagnosed with schizophrenia. Research has revealed that those who remain in frequent contact are at higher risk of developing anxiety , depression , and experiencing decreases in quality of life. The Trauma and Mental Health Report reached out to Professor Brendan O'Hanlon, mental health program manager and professor at La Trobe University in Melbourne, Australia, to discuss recurring concerns he has seen over the span of 20 years in researching and coordinating FPE programs. O'Hanlon explains that relatives often lack knowledge about the nature of schizophrenia and the skills which could support family members through difficult symptoms, like delusional thinking or lack of volition. This tends to weigh on families and create a sense of inability to provide helpful support. Delusional thinking and lack of volition—symptoms commonly associated with schizophrenia—can cause family members to feel frustrated and hostile toward their relative. Given that highly tense family environments have been shown to increase relapse and readmission rates for those with schizophrenia, FPE programs focus on improving family dynamics through education, training in communication, and problem-solving skills. The most basic formats of FPE programs are Multiple-Family Group Therapy (MFGT) and Behavioural Family Therapy (BFT). Both program formats involve an assessment phase which is followed by family engagement, education, and training in skill development. In the BFT format, diagnosed individuals and family members are assessed individually, followed by group meetings in which family members are encouraged to address their concerns and are provided information about their relative’s condition. The goal of the BFT approach is to provide the family helpful problem-solving skills, which can help them navigate issues that arise. MFGT functions similarly, but instead works with five to six families at a time. The families come together for clinician-facilitated group discussions in which they share the challenges they have encountered with their relatives' condition. The particular concerns of family members are used to shape the education provided to them, as well as the specific problem-solving and communication skills that will be addressed. O’Hanlon noted several benefits to having sessions with multiple families, including that “Some clients went on to meet separately, developed educational and promotional materials for the model, and became quite engaged advocates." FPE programs are thoroughly-researched and extensively supported in clinical literature regarding their effectiveness in reducing relapse and readmission rates among patients with schizophrenia. The evidence suggests that these benefits typically start to come into effect after about 9 months of the intervention. Despite robust clinical support, FPE programs are not widely implemented. This may be due to the individualized medical model of care common to the North American mental health system, particularly in the treatment of schizophrenia. Some clinicians may be hesitant to administer mental health programs with a relational focus due to a lack of training in frameworks which are more relational. In addition, family members and their diagnosed relatives have expressed apprehension about entering into treatment together. Clients seeking treatment for schizophrenia may be estranged from their families, or reluctant to enter into treatment due to a history of trauma within the family. Recent changes in clinical recommendations point to a trend valuing the role of family in the treatment of mental illness, acknowledging that family members contribute significantly to the condition and well-being of their relatives. O’Hanlon notes that “the valuing of lived experience in co-design and co-production of therapeutic interventions will help bring families' concerns to the forefront, and services won’t be able to brush them off in the way they’ve done historically.” Robert T. Muller, Ph.D., & Emma Puric - Website - Book -

Needfully lavishing praise on someone is unlikely to get you into their heart. When you’re not enough for yourself, you’ll seek a union to offer you the reassurance you desperately need. No person depended upon to be the center of your universe will remain comfortable in such a confining role. We all need a deep connection with another, but by depending on it needy individuals minimize its possibility. Non-assertive, needy people with poor self-esteem can, paradoxically, be unusually demanding, even abusive. Fiercely Trying to Cajole Another into Loving You In the context of a romantic relationship , if you’re not enough for yourself, you’ll likely be driven to depend on your partner for validation. Or, in your emotional quandary, pursue a partner who, given their own neediness, may be just as desperate as you are. As in: If you’ll let me depend on you, I’ll let you depend on me. Regrettably, that’s not a good solution for overcoming deficits in your self-image. Yet if you are unable to generate a loving relationship with yourself, this pseudo-solution is certainly understandable—maybe, inevitable. After all, if you’re to have steadfast self-esteem, it’s crucial to view yourself as self-reliant and complete within yourself. Otherwise, you can’t stand steady and balanced on your own two feet. Rather, harboring lingering deficits in your sense of self, you’ll be reduced to depending on another to soften (if only temporarily) the personal doubts tormenting you. Ultimately—vs. immediately—what’s the price of such neediness? The short answer here is A Lot. Pressuring—indeed, harassing—someone to fill the troubling void inside you typically boomerangs, quite possibly leaving you worse off than you were before. So what are the reasons that this anxiety -induced tactic is rarely effective? Why Needy, Clinging Behavior Ends Up Not Endearing You to Another But Alienates Them I’ll enumerate the different, though intimately related, reasons that neediness fails to get from the depended-upon individual what the needful person craves. And all these explanations can be seen as variations on a theme. This theme is based on the well-established finding that to be happy all of us (in this instance, both the needed and the needy) must create, and maintain, a balance between personal autonomy and social dependency. 1. Initially, the willingness to say or do almost anything to endear yourself to the one you’re attracted to may be effective. But over time it’s far more likely that your excessive dependency will make that put-upon individual experience you as burdensome. If you text them 10 times an hour, call them after they’ve gone to bed, or push them to spend more time with you than they’d want, they’ll probably feel more used than loved. But even though your bids for attention may be too much for them, they’re no more than what you feel you need to feel cared about in the relationship. Moreover, unless their attachment style is avoidantly disturbed (i.e., they were purposely raised by emotionally distant caregivers to be super self-reliant and independent), the problem isn’t theirs but your own. However unconscious, your goal may have been to flatter them into loving you. Eventually, though, your efforts are apt to leave them feeling flustered and frustrated, overwhelmed by the vast amount of loneliness-ameliorating togetherness you’re strenuously aiming to achieve. And how can that help but constitute a dire threat to their indispensable need for personal autonomy? In idealizing them, you’re also objectifying them. You’re compromising something critical to them by lessening their sense of relational equality. 2. “Smother love” reeks of negative connotations since being smothered is tantamount to being choked, suffocated, or locked in a stranglehold—hardly an experience anyone would find nurturing. Most of us would probably be disposed to call it something other than love—as a contrivance bordering on fulsome, scheming manipulation. Therapists, too, would generally concur that such love can’t reasonably be characterized as authentic. As opposed to obsequiously subordinating yourself to the one depended upon, here you’re subordinating their needs to your own. 3. If the receiver of this suspect loving feels trespassed upon, it can be inferred that they’re experiencing an irksome violation of their boundaries. Another way of accounting for their pained reaction is that they’re feeling disrespectfully “crowded” by you. From deep within, they’ll be distrustful and disapproving of your exaggerated admiration for them. And whether or not they conceptualize it as such, vicariously your anxiety about the connection will be felt by them. In fact, as the extraordinarily needful one in the relationship, you’ll be broadcasting it to them. They won’t feel loved for who they are but rather what they can do for you. Your insecurity and hyper-dependency will be veritably transparent to them. Here is where the distinction between neediness and love rears its repellent head. However often you profess your love and dedication, it won’t be seen as true caring but, surreptitiously, as controlling. And in too many ways that’s the exact opposite of caring. 4. Successful unions—unions that demonstrate mental, emotional, and physical intimacy—are marked by reciprocity. But the nature of this needfully impaired relationship is such that neither party can experience it as complementary. The one depended upon is prone to feeling preyed upon, whereas the dependent party is disposed to feel that their ostensible givingness isn’t being adequately returned. That’s a perfect recipe for disappointment—and as much for one side as the other. 5. As the neediness or clinginess, comes to feel never-ending, the too heavily depended-on party increasingly experiences the relationship as burning them out. Although their initial attraction to the needy individual may have made them willing to provide the reassurance requested of them, after a while that person’s dependencies come to feel insatiable. And they end up exasperated by the responsibilities which, unceremoniously, have been laid on them. Moreover, explicitly setting limits on what the dependent individual can expect from them probably won’t be heeded because the dependee’s needs are simply too weighty to be assuaged by anything short of the effort already made to appease them. And, as in the impossibility of appeasing a dictator (or would-be dictator), the dependee’s inability to internalize the positive messages received by the one depended-upon makes it exceedingly difficult for them to accept as adequate what their (hoped-for) savior has before willingly offered them. 6. From afar, the dependee might well be seen as the supplicant in the relationship, imploring the one depended upon to meet their past unmet needs. Yet there’s a certain demandingness about the needy individual. They can be aggressively critical of the one depended upon when that person fails to sufficiently furnish what they cannot provide for themselves. In these instances, they’re the disapproving ones and can make their now adversary feel selfish or guilty. Still, as mentioned earlier, because of the insatiability of their demands, the one depended upon can’t ever be successful in whatever conscientious endeavor they may make to pacify such neediness. The ultimate remedy for this unfortunate, even toxic, dependency is self-validation. And that’s a topic I’ll take up in my next post. Leon F. Seltzer, Ph.D.

The peers children associate with say a lot about their identity and security. The stability of your kids’ friends often reflects the stability of their own self-esteem. Every kid benefits from three important friendships in their circle. Your child will usually reflect the median of their five closest friends socially and emotionally. Elle is a longtime friend whom I’ve known since elementary school. On the surface, Elle seemed like any other girl, making average grades, and blending with the rest of her class. Upon closer examination, however, it became clear she needed more affirmation than anyone else I knew. She attracted friends who were also needy and often in trouble. They were socially awkward and weren’t sure how to talk about anything but themselves. She drew boyfriends who needed rescuing. Observing these male friends over the years, it was apparent Elle felt better about herself as she rescued them from their problems. She flitted from one activity and commitment to another, not sticking with anything for very long. It’s as though she was afraid of being found out as a fraud or a poser. Your Relationships Are Rarely Healthier Than Your Self-Esteem Herein lies the sobering truth about all of us. Our relationships reflect what we think about ourselves. They’re seldom healthier than our self-esteem. This means our relationships reflect how we feel about ourselves: Like attracts like. It also means the stability of those relationships tends to be about as stable as our self-esteem: Unstable attracts unstable. We migrate toward the people with whom we feel most comfortable—which can be good news and bad news. When Lacy’s mom and dad talked her into dating and marrying a solid, successful young man, things looked great at first. In time, they had three children, a nice home, and two new cars in the garage. Then, about eight years into the marriage, Lacy began exhibiting self- sabotaging behaviors, forming a drug habit, and hiding extramarital affairs. Her parenting grew volatile, swinging from lackadaisical to strict. It was as if Lacy was conveying: “I don’t deserve this life.” Within a year, Lacy divorced her husband, only to rebound into an unstable relationship with a man in prison, incarcerated for selling illegal drugs. She got pregnant, and the rest is history. Lacy began living below her potential, unstretched and stagnant. How could she do this? Our relationships will rarely be healthier than our self-esteem. Questions to Ask About Your Kids If you’re concerned your kids may reflect this dilemma, try asking yourself these questions: Are their friends insecure or fearful? Do they lie, cheat, or steal anything from anyone? Are they a rescuer who hangs around others who need help? Do they attract needy friends who make them feel better about themselves? Motivational speaker Jim Rohn says that we are the average of the five people with whom we spend the most time. This is based on the law of averages, a theory suggesting the result of any given situation will be the average of all outcomes. Consider this in light of your kid’s friends. 3 Ingredients That Boost Your Kid’s Self-Esteem Our generation of parents is consumed with our children’s self-esteem. While I admire this, too often we create a synthetic self-image for our kids, built on exaggerated praise and trophies. It frequently backfires, creating young adults with high arrogance and low self-esteem. As our two children grew up, I concluded their sense of identity was fed by three elements: Their achievement: When they accomplished something, it fed their self-image. Their affirmation: When we or others affirmed their conduct, it fed their self-image. Their association: Spending time with those who stretched them fed their self-image. While we can’t force any of these, parents, teachers, coaches, and youth workers can position their kids to enjoy these elements and create environments where they happen naturally. It must be a balance between organic and organized. We must be intentional and laissez-faire. Each of these elements must feel real, not artificial or contrived. How You Can Encourage Them My wife and I watched these realities firsthand when our kids grew up. We discovered a lot about how our kids viewed themselves by observing their friends. We attempted to play a natural and positive role in deepening their own sense of identity. Let me suggest a rule of thumb I tried to practice as they grew up: Encourage your kids to find at least one: Stretch friend: These are sharp, confident, and positive friends who stretch them. Safe friend: These are easy friends—peers whose influence is equal and comfortable. Support friend: These are friends whom your kids influence, mentor and inspire to grow. We usually live better lives and continue to grow when we spend time with those who are ahead of us in their growth, those who are next to us in our growth, and those who are behind us that we can help to grow. In the end, our circle of friends nudges us to stoop or to stretch to our potential, which eventually creates our reputation. And this creates a mold for our lives. James Clear said, "Your reputation is your most important asset. It precedes you before you walk into the room and lingers long after your presence is gone." Let’s guide this process for the next generation. Tim Elmore - Book -

Understanding pain and volatility. Individuals with borderline personality disorder are particularly sensitive to feeling shamed. Feelings of shame make people with BPD feel flawed and undesirable, raising fears of abandonment. Individuals with symptoms of BPD often respond to feeling shamed by lashing out at others. Most individuals with symptoms of borderline personality disorder (BPD) struggle with an underlying sense of self-loathing that makes them particularly vulnerable feeling flawed . The fear of being seen by others as flawed drives a strong fear of abandonment. Their propensity to be easily shamed makes it very difficult for them to take responsibility for undesirable outcomes. Efforts to resolve conflicts with individuals suffering from symptoms of BPD can be facilitated by approaches that minimize their experience of shame. For many with BPD, the sensitivity to being shamed is so high that they routinely hear others as slighting, defaming, humiliating, and exploiting them. This can take the form of paranoid thinking, where they feel targeted by others or groups. This may be associated with lashing out at others or shunning others, which are efforts to protect themselves from people they think are likely to expose their flaws. These reactions inhibit intimacy and cooperation. Following are some examples* of how individuals suffering from symptoms of BPD react to their sense of being shamed. Lila met her friend Sue, who has symptoms of BPD, for lunch. When they arrived at the restaurant, they were told that there would be a 45-minute wait for a table. They got onto the waiting list and had this conversation. Lila: Sue, did you make a reservation? Sue: How was I supposed to know this place would be mobbed? Lila: I never heard of this place. You picked the restaurant. Sue: So, I should have known a reservation was needed, and I am stupid for not making one. Lila: I didn’t say that. Sue: Next time you make the reservation. Or better yet, next time, go eat by yourself. Lila thought she was innocently asking Sue about the reservation. If Sue had said yes, she would have pointed this out to the maître d' in the hope of being seated sooner. Sue heard this as blame and criticism and immediately reacted defensively. Lila attempted to respond to Sue’s remark, but Sue then lashed out and threatened abandonment. Had Lila understood her friend’s sensitivity to shame, she could have started the conversation by suggesting a cooperative approach. It might have sounded like this: Lila: Sue, do you want to wait to be seated, or should we look for a less crowded place? If Sue had made a reservation, she would say so. For some individuals, any questions about performance, in this case, making a reservation, are seen as threatening with regard to shame. The sensitivity to being shamed can even be activated without direct contact. This is illustrated in the following*: Eric and Ken just returned from a cocktail party and had the following conversation. Ken suffers from symptoms of BPD. Eric: Wasn’t that a great party? Ken: Not for me. Eric: What do you mean? Ken: I can’t believe you talked about sports with our friends. Eric: What’s wrong with that? Ken: You know I don’t know anything about sports. I felt like an idiot. Eric: Nobody thought that. Ken: How do you know? I just stood there saying nothing. Maybe they think I am mute. Eric: You should have brought up something you were interested i Ken: Now you are blame-shifting. Forget it. Understanding that Eric is sensitive to feeling shamed in social situations, he might respond to Ken as follows: Eric: I am sorry you felt embarrassed. Next time we go to a party together, I will make sure to bring up some topics that I know you are interested in. The suggestions made in this post are meant to help people who have loved ones with symptoms of BPD minimize their experience of shame and, as a result, reduce conflict. It is a transactional solution. More permanent healing and growth require individuals with BPD to recognize their sensitivity to shame and their associated tendency to project shame into situations where it may not exist. Accepting this, individuals sensitive to change can ask others to clarify what they are saying before assuming they are being shamed. For example, Sue might have responded to Lila’s question about the reservation by saying: Sue: No, did you expect me to? If Ken accepts that he is sensitive to shame in social situations, he can prepare to bring up topics other than sports that will be of mutual interest to his friends rather than relying on others to ensure he does not feel shame. Daniel S. Lobel, Ph.D.

Yet it is at the core of successful human relationships. There are dire consequences in nature for being vulnerable. Yet vulnerability is essential for creating thriving relationships. Social anxiety results from the inability to tolerate the risk of rejection. Tolerating anxiety is the first step in reaching out to others. Humans want to feel safe. Feeling or being safe reflects profound shifts in your body’s chemistry, ushering in the capacity to “rest and digest.” Not only do you feel a deep sense of contentment, openness, and play, your body refuels and regenerates. Your safety needs are not met, however, if you don’t feel heard, validated, and nurtured; your body shifts to a fight-or-fight state. You may seek to achieve safety by using power and control or, further, by deploying anger , a last-ditch survival effort that, while being protective for you, is destructive to those around you. There is no reward for vulnerability for any species of life, from one-celled organisms to Homo sapiens. Consequences for being vulnerable are severe and often swift. It is never safe to be off-guard, and different species create ways to be safe in order regenerate. Dolphin sleep with one eye open. Many species form protective groups. Other creatures hide or camouflage. Many species simply have thousands of offspring so that a few will survive. When such strategies fail, organisms resort to whatever aggressive response they have available to them. The more strength and power, the better. Humans have language, which creates another level of issues around seeking safety. It enables us to possess abstract thinking, which allows us to engage in the arts, create coordinated societal actions, and have complex relationships with others. We rose to the top of the food chain because of our capacity to cooperate with each other. We have a strong evolutionary need for close connections and relationships: Being socially isolated or lonely has the same effect on health as smoking 15 cigarettes a day.1 Notice how much effort we put into seeing close friends and family during the holidays. We want to be with each other, and the closer the better. But one of the most perverse aspects of being human is that successful, thriving relationships require vulnerability and trust. These traits are the antithesis of feeling safe. “You hurt my feelings” and “you broke my heart” reflect the fact that emotional /mental pain is processed in a similar manner as physical pain.2 We don’t like pain in any form, yet we have to become vulnerable in order to have deep and satisfying relationships. It is a huge problem, and it is not playing out well for the human race. By definition, every interaction with another person requires taking a risk of being rejected or hurt. Even check-out at the grocery store involves trusting the person at the register to accurately document your purchases and help you with your bags. It's nice if they're in a good mood and are friendly, but what if they are having a bad day? Then there are deeper relationships—being part of a team, engaging in a project together, starting up any type of relationship, and living together. Being rejected at some level of interaction is not only common but also the rule. As you become more and more trusting, a tipping point of vulnerability may be reached, and one person will pull back or even reject the relationship. Your options At this point, your choices are to 1) quit taking risks associated with interacting with others, 2) engage but experience social anxiety, 3) use whatever power you possess to control others, 4) learn to be vulnerable. Since we don’t inherently possess the ability to feel vulnerable, the other strategies are more commonly utilized. Some form of anger is universal. Why? It keeps you safe. It protects you from both emotional and physical pain. Even if you don’t actually have the power to change the situation, you may feel like you do. Raw anxiety is intolerable and why we hold onto anger. Why let go of anger? You simply cannot heal or thrive when you remain angry. The essence of healing is normalizing your body’s neurochemical state to that of safety, which is profoundly restorative. If your whole system remains fired up, it can’t and won’t happen. Anger is destructive, as it is meant to be. It's your body’s last-ditch effort to escape threat. It is destructive in every direction, including self-destructive. It is a reason why many people completely neglect every aspect of their health. It is tantamount to slow suicide. Anger is abusive and destroys relationships. The key element of successful human interactions is awareness of your needs and others’ needs. How else can you constructively interact with those close to you? Anger completely blocks awareness. Anger destroys families. Human consciousness evolved through language and social interactions. The ability to cooperate took Homo sapiens to the top of the food chain. The need for human connection is deep. Unfortunately, close connections also provide the strongest emotional triggers. Why would you ever be unkind to someone you care for so much? Why is the incidence of domestic abuse so high? That may be the most disturbing paradox of human existence. Anger, as the manifestation of the fight mode of the survival response, affects all organ systems. The blood supply to your gut, bladder, and frontal lobes of your brain diminishes and is shunted to your heart, lungs, and skeletal muscles. You can’t think clearly, although it might feel like you can. It is critical to “take no action in a reaction. Interacting with others involves taking the risk of being rejected or even hurt. There are material risks, such as trusting a business partner who might run off with your money. What about when a partner or spouse takes off with another person? Simply reaching out to another person in friendship creates some level of anxiety. Train your brain You can use avoidance, suffer from chronic social anxiety, or resort to power and control to feel safe. The healthiest and most satisfying option is learning to be vulnerable and process rejection. In other words, being with anxiety. Being or feeling rejected is inherent to relationships, and unless you understand this, your world will become progressively smaller. Training yourself to lower your physiologic response to threat (anxiety) instead of fighting it allows you to navigate life more easily. It also matters that social connections are anti-inflammatory and lower your level of anxiety.3 Addressing social anxiety is a bi-directional process. You can nurture joy, more easily interact with others, create the life you desire, and feel safer. David Hanscom MD - Website - Resources - References Cigna US Loneliness Index. Cigna: 2018. Eisenberger N. “The neural bases of social pain: Evidence for shared representations with physical pain.” Psychosom Med (2012); 74: 126-135. Dantzer R, et al. Resilience and immunity. Brain, Behavior, and Immunity (2018); 74:28-42

It's more important than ever to use this terminology correctly. Representative Marjorie Taylor Greene hung a sign outside her Capitol office door that said “There are TWO genders: MALE & FEMALE. ‘Trust the Science!’” There are many reasons to question hanging such a sign but given that Rep. Taylor Greene invoked science in making her assertion, I thought it might be helpful to clarify by citing some actual science. Put simply, from a scientific standpoint, Rep. Taylor Greene’s statement is patently wrong. It perpetuates a common error by conflating gender with sex. Allow me to explain how psychologists scientifically operationalize these terms. According to the American Psychological Association (APA, 2012), sex is rooted in biology. A person’s sex is determined using observable biological criteria such as sex chromosomes, gonads, internal reproductive organs, and external genitalia (APA, 2012). Most people are classified as being either biologically male or female, although the term intersex is reserved for those with atypical combinations of biological features (APA, 2012). Gender is related to but distinctly different from sex; it is rooted in culture, not biology. The APA (2012) defines gender as “the attitudes, feelings, and behaviors that a given culture associates with a person’s biological sex” (p. 11). Gender conformity occurs when people abide by culturally derived gender roles (APA, 2012). Resisting gender roles (i.e., gender nonconformity) can have significant social consequences—pro and con, depending on circumstances. Gender identity refers to how one understands and experiences one’s own gender. It involves a person’s psychological sense of being male, female, or neither (APA, 2012). Those who identify as transgender feel that their gender identity doesn’t match their biological sex or the gender they were assigned at birth; in some cases they don’t feel they fit into into either the male or female gender categories (APA, 2012; Moleiro & Pinto, 2015). How people live out their gender identities in everyday life (in terms of how they dress, behave, and express themselves) constitutes their gender expression (APA, 2012; Drescher, 2014). “Male” and “female” are the most common gender identities in Western culture; they form a dualistic way of thinking about gender that often informs the identity options that people feel are available to them (Prentice & Carranza, 2002). Anyone, regardless of biological sex, can closely adhere to culturally-constructed notions of “maleness” or “femaleness” by dressing, talking, and taking interest in activities stereotypically associated with traditional male or female gender identities. However, many people think “outside the box” when it comes to gender, constructing identities for themselves that move beyond the male-female binary. For examples, explore lists of famous “gender benders” from Oxygen, Vogue, More, and The Cut (not to mention Mr. and Mrs. Potato Head, whose evolving gender identities made headlines this week). Whether society approves of these identities or not, the science on whether there are more than two genders is clear; there are as many possible gender identities as there are people psychologically forming identities. Rep. Taylor Greene’s insistence that there are just two genders merely reflects Western culture’s longstanding tradition of only recognizing “male” and “female” gender identities as “normal.” However, if we are to “trust the science” (as Rep. Taylor Greene’s recommends), then the first thing we need to do is stop mixing up biological sex and gender identity. The former may be constrained by biology, but the latter is only constrained by our imaginations. Jonathan D. Raskin, Ph.D., - Website - Book - References American Psychological Association. (2012). Guidelines for psychological practice with lesbian, gay, and bisexual clients. American Psychologist, 67(1), 10-42. Drescher, J. (2014). Treatment of lesbian, gay, bisexual, and transgender patients. In R. E. Hales, S. C. Yudofsky, & L. W. Roberts (Eds.), The American Psychiatric Publishing textbook of psychiatry (6th ed., pp. 1293-1318). American Psychiatric Publishing. Moleiro, C., & Pinto, N. (2015). Sexual orientation and gender identity: Review of concepts, controversies and their relation to psychopathology classification systems. Frontiers in Psychology, 6. Prentice, D. A., & Carranza, E. (2002). What women should be, shouldn't be, are allowed to be, and don't have to be: The contents of prescriptive gender stereotypes. Psychology of Women Quarterly, 26(4), 269-281.

A Personal Perspective: Knowing which one can help you flourish with bipolar. Are you a rocking chair or swivel chair? Play along with me. Imagine you’re a chair. But what kind of chair? You need to know because it determines what you can and cannot do. No one chair is better than the other. They’re just different, with different abilities. This rocking versus swivel metaphor has helped me to be gentle with myself and realize I’m not broken just because I can’t do certain things due to the bipolar disorder and anxiety I live with. Understanding which chair, I have allowed me to flourish despite, or maybe in spite of, my mental illnesses. The chair comparison was born out of my frustration when I first experienced the limits bipolar disorder, anxiety, and my propensity to psychosis placed upon me. Things I took for granted I could no longer. Such as staying up late a couple of nights in a row if I happen to, say be reading a great book, or binging on a Netflix series. Enjoying drinks with friends over dinner or having one in the evening while I make a meal. Forgoing my regular exercise for two or three weeks because I just don't feel like it. A consistent sleep routine, no alcohol (or keeping it to the minimum, which for me is around one drink per month if any at all), and consistent exercise (I’m a runner—well a jogger, let’s be honest) are essential to maintaining a stable mood and, as a result, a stable life. If I don’t adhere to these, I either do a nosedive into a murky quicksand of depression /anxiety combo or take the escalator up to a mania. When I faithfully follow them, I'm at my best, and I stay there for the most part. Any drawbacks of having to honor these pales in comparison to the benefits I reap. Back to the furniture: I needed to realize (and accept) whether I was a swivel office chair or a rocking chair. Why? Because if I tried to spin around while a rocking chair, I just exasperated myself and felt defeated. As a swivel chair, if I pushed back and forth in an attempt to rock, well, not only would it be fruitless, but I'd also likely hurt myself. Wheeled pedestals have a habit of toppling when trying to move in that way. I would never expect either kind of chair, or any other piece of furniture for that matter, to be something that it’s not. When I realized I was a rocking chair (OK—this isn’t when I’m in a psychosis), I knew what I could and couldn’t do. It meant I could stop fighting myself. When I finally understood that I wasn't a swivel chair, it meant I could celebrate my unique aptitudes and skills and manage my bipolar more easily. As someone who lives with mental health conditions, I have an acute empathy for others’ struggles. I have a stick-to-it-iveness to stay the healing course and to master things that are difficult. I’ve learned to be honest with myself and others. And I've learned to be vulnerable in healthy and safe ways. My nervous system is a delicate eco-system, which means I need to respect that I can’t stay up until all hours; I can’t let myself get overstimulated by large crowds; I need to pace myself and not take on too much. Early in my recovery, I blamed myself for being so "sensitive" and for not being able to push myself in a society that prizes work and productivity. But now I see it’s my constitution. It’s what I was born with. Like hazel eyes. Not bad or better. It just is. Once I embraced that, my life opened up and so did my self-compassion. Accepting my limits, paradoxically gave me my freedom. When you need something to hang onto in order to hang in there, I hope this lends a helping hand. Victoria Maxwell - Website -

Learn how this “Universal Rule” can instantly decrease anxiety. The stronger your emotion, the harder it is to think logically. Emotion can hijack your brain. Learn a new secret weapon in the fight to not let fear, anxiety, or worry take over your brain. The "Universal Rule" test helps you sort realistic fears from false alarms. Learn how. You learned how to create a fear vs. facts dialogue table in my past three blogs Listening to Worries Can Actually Make You Less Anxious, Practical Tips on Changing Anxious Thoughts, and How to Effectively Talk Back to Worries and Fears. Creating a dialogue table is a way to challenge anxiety -provoking thoughts and strengthen your thinking brain in its struggle with your emotional , reacting brain. Emotions make it hard to think The more your primitive, emotional, reacting brain is activated, the harder it is to activate and listen to your smarter, logical, thinking brain. A fear vs. facts dialogue table helps you to question the thoughts making you anxious, stressed, fearful, worried, or upset and replace them with more factual, logical, and helpful thoughts. Practice makes you better The more you write and review your dialogue tables, the more you believe and act using facts and logic. Creating and rereading the tables helps you access your thinking brain even while you are flooded with emotion. Fears vs. facts A fear vs. facts table has two columns and multiple rows. The left column is “Worries, Fears, Distressing Thoughts”; the right column is “Facts, Evidence, Logic, Perspective”. Write anxiety-triggering thoughts in the left column, one thought per row. Simply putting fears into writing may activate your thinking brain Some worries lose their power as soon as you see them in writing. You literally view those fears from a different perspective. You gain emotional distance. Read the three earlier blogs on how to create a fears vs. facts table. What if you think, “My thought is true”? When the anxiety-provoking thought seems true, pull out your new secret weapon: the “Universal Rule”. Test the thought’s credibility by restating it as a universally applicable rule or law that holds true for everyone. Realistic thoughts pass the test Take the thought, “I’m scared to walk on highways. Walking on highways is dangerous.” When you restate it as a "Universal Rule": “People agree that walking on highways is dangerous” the original thought passes the test. Here are some more examples: Fear: “I am embezzling at work. There’s going to be an audit. I am afraid I’ll be fired and prosecuted.” Restated as a Universal Rule: “Audits are likely to reveal embezzlement. Embezzlers are fired and prosecuted.” Fear: “Driving is dangerous because I have uncontrolled seizures.” Restated as a Universal Rule: “It is dangerous for anyone with uncontrolled seizures to drive.” Unrealistic thoughts flunk Some scary thoughts seem convincing but fall apart when restated as a “Universal Rule”. Here are some examples: Fear: “I made a mistake. My boss will think I can’t do my job and I’ll be fired.” Restated as a Universal Rule: “Everyone who makes a mistake is fired.” Restated, the original fear is pretty obviously not true. It’s good to minimize mistakes and learn from them, but everyone makes mistakes. What about these examples? Fear: “It is not safe for me to drive because panic will make me crash the car." Restated as a Universal Rule: “Everyone who has panic symptoms crashes.” Or “Panic symptoms make every driver crash.” Or “No one drives safely when scared.” Fear: “There’s turbulence! The plane is going to crash!” Restated as a Universal Rule: “Every plane that hit turbulence has crashed.” Or “No plane has landed safety after experiencing turbulence.” Or “Every flight that encounters turbulence crashes.” Fear: “The person I was dating broke up with me. No one will ever love me.” Restated as a Universal Rule: “Everyone who ever had a breakup is alone.” Or “No one has found love after a breakup.” Fear: “My parents do not accept my sexual orientation or gender identity. No one will accept me.” Restated as a Universal Rule: “Everyone thinks like my parents on gender issues.” Try it right now Write down an upsetting thought. It will only take a minute. Go ahead. Now, restate that thought as if it is universally true, as if it applies not just to you but to everyone. Notice what happens. Did the thought suddenly seem less credible? The next blog in this series discusses what to do when your fear is realistic. Thanks for reading and best wishes for a happier, less anxious life. Elizabeth McMahon, Ph.D., - Website - References For more information on Fears vs. Facts Dialogue Tables, see McMahon, E. (2019). Overcoming Anxiety and Panic interactive guide. San Francisco, CA: Hands-on-Guide.