Lessons from a chronic insomniac who finally learned how to sleep. Insomnia is aggravated, paradoxically, by trying too hard to fall asleep. Thus, experts recommend healthy sleep hygiene habits that replace obsessive thoughts about insomnia. When sleep hygiene isn't enough, a simple trick for distracting your brain from sleep anxieties could work. “Your biggest problem falling asleep,” my doctor observed, “is your anxiety about falling asleep.” I’d been struggling for years with insomnia, and my physician’s insight seemed right on target. Each night, when my head hit the pillow, I’d try to relax but obsessive thoughts would creep in. “What if I can’t sleep again? I’ll be a zombie tomorrow. I’ll get sick. Sleep deprivation could trigger yet another horrible bout of my recurring depression .”(1) How could anyone sleep with those anxieties buzzing around their brain? Recognizing this vicious-circle nature of insomnia, sleep experts advise insomniacs not to perseverate on their fears, but to stop trying to sleep, get out of bed (so the brain does not permanently link the bed with sleep problems), and put anxious thoughts aside by reading a book or engaging their brain in some other absorbing activity incompatible with obsessive thoughts. (2) Sleep experts also recommend keeping a regular schedule, not eating too late, filtering out blue light at night that tricks the brain into thinking it’s still daylight, cutting down on caffeine and alcohol, getting therapy for stress, engaging in regular meditation, and getting regular exercise (2,3,4). I more or less followed all of this advice and, being a neuroscientist familiar with what chemicals do to the brain, also avoided drugs and supplements such as melatonin and herbs. But I still routinely struggled to get to sleep and stay asleep. The really nasty part of having this kind of problem is that, the harder you try to solve it, the more power you give it, and thus the more the problem persists. Paradoxically, I sensed that the solution lay in not trying to solve my insomnia, in order to rob it of its power. So, I gave up the struggle and...drum roll... still suffered chronic sleep problems. The Resilience Center of Houston has licensed therapists to treat insomnia and other sleep-related issues. Nothing changes if nothing changes. Take the first step towards a better tomorrow. When I shared all this with my father shortly before his death, he revealed that he had also suffered chronic insomnia years before I was born, but had stumbled on to a simple trick that almost always worked for him. The life-changing discovery arose from his enduring interest in visual perception. Although he was a rocket scientist, Dad read every research article he could on visual psychophysics and physiology. One night at bedtime, after reading an article on phosphenes—the random blotches and tiny speckles of light you see when you close your eyes or in total darkness—he started paying close attention to his own phosphenes, relishing the idea that he was directly visualizing random, normal “resting” activity of individual neurons in his brain’s visual pathway. But, night after night, his attempts to carefully study his phosphenes were frustrated because he kept falling asleep before noting anything of interest. Then it hit him. After years of failing to overcome insomnia, he had finally found a “cure” in the tiny speckles of light produced by the spontaneous activity of his visual neurons. After discovering it, this simple trick had been getting him to sleep for over 50 years, because, he theorized, it gave his brain something to do other than obsessing about insomnia. “You can never tell your brain not to do something,” he observed, “because it will inevitably do exactly that thing in its attempt to avoid doing it." But focusing on phosphenes, which, unlike thoughts, never come and go but are ever-present, Dad reasoned he could actively do something incompatible with worrying, by informing his brain that he was doing it out of pure scientific curiosity, not fear of insomnia. Naturally, I tried the same trick the very night my dad revealed it and it worked that night, and almost every other night up to the present, but in a very different way than it did for my father. While I was “looking” at my phosphenes, I began to have waking visual hallucinations that perceptual psychologists call “hypnagogic images.” These images, which possess a clarity somewhere between images in a dream and real images seen with my open eyes, are quite normal and healthy, and experienced by most people just before they fall asleep (5). My hypnagogic images come in short flashes, but some people experience them as fragments of a visual narrative, or even “hear sounds” or “feel touch” accompanying the images. Hypnogogic images, for me, are three-dimensional objects like horses, fences, tables, landscapes, and…for some weird reason, fruits and vegetables. Over the years, I’ve refined the technique of summoning sleep-producing hypnagogic images without my brain noticing what I’m doing long enough to start obsessing about what I’m doing. The key to success, I’ve learned, is to say, “Now, see here brain, I’m not trying to fall asleep, but simply watching the light-speckled curtain of darkness in front of me, waiting for visual 'visitors' to poke through the curtain of darkness so I can greet them.” My brain has always been satisfied with that explanation, and, deprived of anything to worry about, quickly turns off, taking me along with it. I hope gazing at phosphenes or waiting for hypnagogic visitors from the darkness works for you too, in case you need fresh ideas for beating insomnia. But if these tricks for tricking your brain fail, keep looking for other techniques that might succeed for precisely the reason that they—like my nightly wait for hypnagogic images—do not try to succeed. Eric Haseltine, PhD - Website - Book References: 1 https://www.psychiatry.org/patients-families/sleep-disorders/what-are-s….; 2 https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes…; 3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6977539/; 4 https://www.sleepfoundation.org/sleep-hygiene; 5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10078162/

Fearing death is useless. It doesn't help and makes you feel worse. Fear of death comes from irrational thinking. Emotions don't come from situations. Not everyone fears death. Some people welcome death and act accordingly. Do you fear death? If so, you have thanatophobia. It's one of the most common fears people suffer from. Some fear the pain that may be associated with dying. The spiritual among us may have a fear of the unknown or the afterlife. Yet some have positive views of death, for example, in various places death has been referred to as "the last big adventure," "the happy dispatch," or "as a welcome as an insomniac long for sleep." Since individuals tend to have a self-preservation instinct it's natural to fear death. But is it necessary or sensible? It's unequivocally not necessary. Since your emotions are caused by your thinking about situations, not by the situations themselves, and you can learn to change your thinking, you can overcome your fear by identifying the thinking causing it, determining if your perspective is reasonable, then changing it if it's not. Great concern, extreme regret, and deep disappointment would be more functional. I cannot escape death, but at least I can escape the fear of it. — Epictetus In a roundabout way, death acceptance has a proven positive impact on one’s mental health as a whole. Accepting that the worst thing (death) will happen to you and all of your loved ones helps trivialize everyday anxieties. Compared to death, getting criticized or being treated unfairly fades in comparison. Here's a Three Minute Exercise (TME) to diligently think through and write out many, many times to overcome your fear of death: A. (Activating event) It's inevitable, I will die one day. B. (irrational Belief) I must never die. C. (undesirable emotional Consequences) Fear, anxiety, worry. D. (Disputing or questioning your irrational belief) What is the evidence, logic, data, or pragmatics supporting your notion that I must not die? No matter how much I want something does this mean I absolutely must have it? Can't I accept life, myself, and other people no how much I want it and don't get it? E. There are no empirics, logic, or pragmatics to prove I must not die. Although I passionately prefer not to die, a preference, no matter how heartfelt, passionate, or deeply believed never is a must or a law of the universe. I'm not special so there's no reason I should live forever. I definitely do not like being mortal, but I clearly can stand what I don't like. Rather than spend my life worrying about dying, I would be significantly better off by diligently working to achieve my short- and long-term goals and objectives. It's not the fact that I will die one day that makes be anxious , but rather it's my irrational must thinking about it that's my emotional problem and with much diligent F. I no longer fear death I just don't want to be there when it happens. You may also consider ways to avoid an early death. These include eating a healthy and moderate diet, exercising regularly, maintaining an active social life, get a good amount of sleep, and constructively dealing with and minimizing stress, depression , anger , and addictions. It's not the fact that I will die on Michael R. Edelstein, Ph.D., - Website - References Edelstein, M.R., & Steele,D. R. (2019). Three Minute Therapy, San Francisco, CA: Gallatin House.

How chronic overwhelm affects our partnered connection. Stress is very hard on sexual desire . We tend to get through tough times by putting one foot in front of the other, focusing on what has to happen to get through the day. From a physiological standpoint, stress can block arousal, as the arousal nerves are part of the parasympathetic branch of the central nervous system, which can’t be easily accessed when we’re stressed out. And when stress becomes chronic, it can have a significant impact on your experience of arousal and desire long-term. The weight of history in long-term relationships In long-term relationships, partners will often have taken on a lot of responsibilities together – like parenting, taking care of a home, financial planning, managing medical issues , caring for one another’s parents, and more. These significant stressors can leave you spending much of your time together in crisis-management mode. Parenthood, for instance, is a very common long-term stressor. It carries its fair share of joys and rewards, of course, but it also comes with multiple associated losses and adds a lot of complexity to people’s lives. Anything that requires one or both partners to make an enormous adjustment — and then keeps delivering an ever-evolving menu of stresses over a period of years — exhausts emotional and physical resources and, in turn, puts a lot of stress on relationships. A word about stressful circumstances Stressors come in all shapes and sizes, including daily annoyances, eras of challenge (such as raising a child, divorce , illness, pregnancy loss, job loss, or injury), and ongoing endangerments (like marginalization or threats to self/culture/personhood as a result of sociopolitical developments, natural disasters, and war). Of course, each stressor is unique, and each person experiences stress in their own way. Multiple axes of identity can overlap and create unique experiences of marginalization, each with its own particular stressors. (I’m drawing here on legal scholar Kimberlé Crenshaw’s work on intersectionality.) Nor do all stressors have clear beginnings and endings. Marginalization and discrimination aren’t likely to resolve any time soon, and intergenerational trauma , by definition, extends far beyond one lifetime. If your clients are experiencing extremely profound stresses or stress over long periods of time, I might start by asking them what place they want eroticism to have in their life, and why. Then I would listen carefully to their answers and support a conversation between partners about it. Not every client wants to experience more desire, and not every era is an era for expanding eroticism. And yet, many people find eroticism to be protective or healing in times of stress. Wherever your clients fall, a conversation that acknowledges the reality and complexity of their experience while including the topics of sex and sexuality will be an important start. Stress and desire discrepancy: where did the disconnect start? When I’m conceptualizing a case involving a desire discrepancy, I’m interested — for multiple reasons — in the role stress has played in the disconnect between partners. There are a whole lot of dimensions to consider: Stress is shaped by our sociopolitical realities. Stress affects the whole relationship ecosystem. Its impacts are an essential piece of the relationship's history. Stress can affect sex in a wide variety of ways, and partners are unique individuals with unique viewpoints. Often, each partner is having a totally different experience and has no understanding of the other’s viewpoint. Whatever difficulties you and your partner have with handling your differences, stress is likely to push those to the fore. Bouncing back from a period of stress doesn’t happen automatically. It takes some intentionality. Under a cascade of stressors, people often abandon important aspects of themselves or let go of things they enjoy, just to get through the current crisis. In time, being disconnected from yourself can mean having less to share with a partner. Stress tends to lead us to stress-relieving patterns of behavior. That can include some very poor decisions — think substance overuse and affairs, just to start. What happened to the juice? In my experience, one of the most common challenges relational therapists' reports is relationships that simply feel flat, where partners have turned into roommates over time. When you dig into that dynamic, it often emerges that significant stressors are a big part of the story. As partners contend with a crisis, they (understandably) become increasingly focused on what might go wrong. They lose their connection to their bodies, especially if they don’t have good strategies to help, like daily practices of accessing relaxation. Focusing on just getting through the day-to-day, they let go of parts of themselves that bring them joy. As a result, they have less to share with each other and less interest in life generally. They’re simply worn out and exhausted. Where is the juice when most of the time you feel like a dried-up husk? How are you supposed to experience desire, yearning, and pleasure when everything already feels like too much? Finding juiciness again Here are some practical ideas for contending with the impact of stress and increasing the experience of juiciness in your life and in your relationship: Cultivate the ability to access the parasympathetic nervous system. It’s possible to get better at accessing your “rest, relax, restore” nervous system, and building that skill can make a huge difference. One strategy can be developing a mindfulness practice that involves awareness of body sensation or trying out guided meditation with inspiring and relaxing imagery. When you’re able to access a parasympathetic state, a lot of things that may feel impossible now will start to seem more doable. It’s much easier to stretch when you’re able to relax. Identify the habits you created to get through ‘crisis mode,’ and figure out which are serving you and which are not. Are you really attending to one another when you’re together, or are you still on alert, thinking about what you need to do next or what might go wrong? Or are you in escape mode, scrolling on social media rather than braving a face-to-face conversation? Early attempts at being present with one another are likely to bring up a lot of vulnerability, so expect bumpy progress and be kind to yourself; celebrate all your successes, even if they feel small. Begin to imagine a more pleasurable life. If you were to write a great big giant list of fun things to do alone, what would be on it? What about a great big giant list of fun things to do with your partner? Try it out and push yourself to write more than 30 ideas for each list. Get silly and playful with it! Reawakening your curiosity and getting in touch with your interests will bring some juiciness back into your life and give you more to share with your partner. Martha Kauppi, LMFT, CST-S, - Website - Book -

Divorce after 50 or “gray divorce" is more common, bringing unique challenges. Untangling and dividing assets can be complicated and emotional later in life. There is a risk of feeling isolated at a stage of life when it is more difficult to rebuild social support. The stress of divorce and its many consequences can affect mental and physical health. Divorce after age 50 is often called “gray divorce.” As it has become more common, it brings unique challenges. Lynda and Jeff (not their real names) came to discuss Jeff’s decision to end the marriage. “I will always love her,” he says, “But I’m just not ‘in love’ with her anymore.” Lynda agrees that their marriage has been “stale” for at least five years, but she doesn’t want the divorce . Lynda believes Jeff is having a late mid-life crisis. She asks, “Why would you want to unravel everything we’ve built together?” After more than 25 years together, Lynda wants Jeff to have a realistic view of what divorce will mean. She says bitterly, “Jeff’s got rose-colored glasses. He’s looking for a new life and new wife.” 1. Finances Lynda and Jeff (a dentist) own a small dental practice, and Lynda handles the front office work. She states that she will no longer work there after the divorce. The practice will need an appraisal, and much of their personal expenses have historically been run through the business. They have some retirement savings and a vacation home that was inherited by Jeff, in addition to the family home. Since the children are adults, they agree that the home will need to be sold, or perhaps Jeff will buy Lynda out of the home. Lynda doesn’t want him to keep the family home, and Jeff doesn’t know if he can afford to keep it. Untangling their assets and dividing them will be complicated and emotional , and Lynda worries that she won’t have enough years ahead to recover financially. At 57, she wonders who will hire her if she has to earn money. Many couples have had retirement plans, and divorce can disrupt these, especially if one spouse is relying on the other's retirement benefits or if they were planning to retire together. Lynda had counted on the retirement funds Jeff had accumulated and said he had always reassured her that there was enough for her if he were to predecease her. For years, Jeff and Lynda had planned to travel around the country to national parks in an RV when they retired. He tells her in our meeting that he plans to retire in two years when he turns 65. Now he isn’t so sure he can promise her the financial security she had envisioned. He wants to make sure that he has enough money to retire and live comfortably. Lynda’s dream of travel seems to evaporate before her eyes. 2. Adult Children Jeff and Lynda’s two children have finished college and started careers. Their daughter is married, and their son is engaged to be married in a few months. Jeff says, “We’re looking forward to grandchildren in the next couple of years.” Lynda says she’s concerned that their children will struggle to cope with their parents' divorce since they had assumed their parents' marriage was stable. “They also know that I don’t want the divorce,” she says. Jeff is shocked that she has already spoken with them. I predict that without an amicable process, the children may worry about how the divorce will affect family gatherings and relationships with both parents. I recommend that they read and share a book to support their kids. 3. Social Disruptions Most couples develop close social networks over many years, and this is true for Jeff and Lynda. Jeff worries about what Lynda is telling their friends about his decision to divorce. He thinks his friendships will be broken as people will blame him for the divorce. Lynda fears that friends will abandon her because “No one wants to socialize with a third wheel!” They both risk feeling isolated and, at their stage of life, it is more difficult to rebuild a social support system. We talk about whether some friends might be able to remain connected to them both, but they agree this is not likely. 4. Health The stress of divorce and its many consequences can affect mental and physical health. Jeff reports that he’s recently developed high blood pressure, and Lynda has been depressed and anxious . Divorce is always stressful, but later in life, people are more vulnerable to long-term health effects. Divorce at any age can be emotionally taxing, but for older adults, it can be particularly challenging. In my experience, the feelings of grief , loss, and anxiety about the future are heightened in older adults. Adjusting to a new life after many years of marriage can feel overwhelming. As we discuss this, Lynda says, “I’m worried I will end up a bitter old woman like my mother.” 5. Living Arrangements and Lifestyle For most people, the family home is the biggest asset and often needs to be sold to settle the financial aspect of the divorce. This means that later in life people need to find smaller, more affordable housing. Lynda is tearful when she describes having to leave the garden she cultivated for the past 25 years. She thinks Jeff will be able to afford a nice home, even if he downsizes, but “I will probably end up in a tiny basement apartment.” The reality is that one’s lifestyle is often downsized after divorce, but Jeff and I caution Lynda about imagining the worst. 6. Estate Planning Divorce necessitates updating estate plans, wills, and beneficiary designations. Lynda raises the issue of Jeff’s new plan to retire and asks him to keep her as the beneficiary of his life insurance. Updating estate plans can be time-consuming and a source of conflict. However, failing to do so can lead to unintended consequences, such as assets passing to an ex-spouse instead of intended heirs. Lynda says she needs to find an attorney to help her protect herself. “If you retire, I don’t know how you’re gonna do it but you still need to pay my alimony,” she says angrily. 7. The Divorce Process Lynda and Jeff need information about the next steps. I describe their options: mediation, litigation, and collaborative divorce. We discuss how complex their divorce might be, especially at their stage of life, and when it comes to dividing assets accumulated over decades and navigating issues such as spousal support and retirement benefits. They agree to look into collaborative divorce so that each will have the legal and emotional support of a collaborative team. The challenges and complexities of gray divorce suggest that spouses need more support than spouses ending a short-term marriage earlier in life. Lynda and Jeff understand that they will need to plan carefully, seek support from friends and family, and continue to work with a therapist who specializes in divorce-related issues. Despite Lynda’s anger, they are motivated to divorce respect, to avoid court, and to avoid involving their children. They decide to interview several collaborative divorce lawyers to see if that process will be the best fit for them. And we decide to check in in a few months to see how the process is going. Ann Gold Buscho, Ph.D., - Website - Book -

To what extent is relationship science reflective of LGBTQ+ experiences? While same-sex marriage has been legal in some jurisdictions for two decades, relationships research continues to focus on mixed-sex couples. A review of 2,181 relationship science articles published since 2001 found that 85.8% excluded LGBTQ+ relationships. Without LGBTQ+ relationships research, it is hard to provide empirically supported advice to same-sex and gender-diverse relationships. In 2014, I attended the annual meeting of the Society for Personality and Social Psychology—one of the largest annual social psychology conferences. The conference covers a wide range of topics and one of the sub-areas is Close Relationships, which hosts a wonderful pre-conference each year leading up to the larger event. As I found myself strolling through the poster presentations for this section of the conference, I began to notice that most of them were reporting the results of research conducted with mixed-sex and presumably heterosexual couples. The pattern became so apparent that I decided to review each poster a bit more systematically and to ask the presenters some standard questions about the demographics of their samples. I was able to visit 58 of the 71 posters listed on the program for the Close Relationships section—there were quite a few posters missing due to a horrendous winter storm that made the annual trip to SPSP impossible for many. Of the posters reviewed, only 15.5% included LGBTQ participants and only one study specifically focused on LGBTQ relationships. Following the conference, I wrote an article for the Relationships Research Newsletter published by the International Association for Relationships Research discussing the "state of LGBTQ-inclusive research methods" in the field of relationship science. The following year, a somewhat more systematic approach to evaluating the inclusion of sexual minority couples in research was undertaken by Judith Andersen and Christopher Zou, who published their findings in the Health Science Journal. Their analysis focused on the inclusion of sexual minority couples in research relevant to relationships and health and they focused on publications indexed by Medline and PsycINFO between 2002-2012. Their results indicated that a striking 88.7% of the studies reviewed had excluded sexual minority couples from participating meaning that even fewer of the papers in their sample were inclusive than my snapshot of the posters presented during the 2014 Close Relationships Poster Session. Fast forward nearly another decade and the International Association for Relationship Research decided to launch two special issues of their flagship journals, Personal Relationships and the Journal of Social and Personal Relationships, dedicated to reviewing the last two decades of relationship science. Along with two other leading researchers in the area of LGBTQ+ relationships, I was invited to write a review focused on LGBTQ+ relationship science. The burning question in my mind was whether or not we would see a stark increase in inclusion as time progressed. After all, the two decades spanning 2002-2022 represent a time of significant advancements for LGBTQ+ civil rights, particularly those related to the legal recognition of same-sex relationships. What Is the State of LGBTQ Inclusion in Relationships Research Today? To answer this question, we gathered every single article published in Personal Relationships (PR) and the Journal of Social and Personal Relationships (JSPR) starting in 2002 until April 2021. This resulted in 2,181 articles; 1,392 articles from JPSR and 789 from PR. We used a variety of coding techniques, including automatic keyword coding and manual screening of articles, to identify which articles contained any information relevant to LGBTQ+ identities and relationships. Roughly 85.8% of these articles were excluded from further analysis as they did not contain any words relevant to sexual or gender minority identities or relationships. The remaining 329 articles were manually coded to identify how they handled issues related to sexual and gender identity. Some articles mentioned LGBTQ+ issues in their limitations section (n = 58), for example to state that future research should consider testing similar questions with a more inclusive and diverse sample. Another 42 articles explicitly stated that they excluded LGBTQ+ participants from their recruitment or analysis process, and while this may seem harsh, it still reflects a methodological improvement over the 1,852 articles that did not even provide adequate information to understand how the exclusion process took place. Some studies did include LGBTQ+ participants in their recruitment process and analyses, but often the sample sizes were small, meaning that no further efforts were taken to understand whether LGBTQ+ participants had unique experiences. Ultimately, of the 2,181 articles published in these two journals between 2002 and April 2021, 92 articles, or 4.2%, presented LGBTQ-relevant information that we considered capable of providing empirical evidence concerning the lives and experiences of sexual and gender minorities within the context of close relationships. Thus, with only 4.2% of the articles being LGBTQ-relevant, our review of two decades of relationship science research did not seem to suggest that great improvement was occurring over time. Has LGBTQ Inclusion Increased Over Time? However, when we broke our data down into smaller periods, we did see a slight indication of improvement over time for the general inclusion of LGBTQ+ participants in relationship science published in these two journals. For example, research published in Personal Relationships climbed from roughly 2% of articles being LGBTQ-relevant between 2002 and 2006 to a peak of just over 4% in 2012-2015, a rate that either slightly decreased or remained constant for the final five-year period, 2016-2021. The Journal of Social and Personal Relationships had a somewhat higher inclusion rate over time, with roughly 3.5% of articles in 2002-2006 being LGBTQ-relevant, peaking at nearly 6% between 2007-2011, and then settling back between 4% and 5% for the periods ranging from 2012-2015 and 2016-2021. Despite these slight differences, overall, there was no significant difference between the proportion of articles considered LGBTQ-relevant in each of the two journals reviewed. Additional Patterns of Inclusion and Exclusion Most of the research in the review that was deemed "LGBTQ-relevant" tended to explore the LGBTQ+ community as a whole, rather than presenting studies that specifically explored the experiences of one identity group or another (e.g., lesbian women vs. gay men). Only one of the 92 articles exclusively focused on the experiences of bisexual individuals and 54.3% of the LGBTQ-relevant articles did not include bisexuals in their sample at all. The overall body of research also had an androcentric slant, such that 17.4% of the articles focused exclusively on sexual minority men while only 9.8% focused exclusively on sexual minority women. Finally, although our interest was in exploring relationship science that was considered relevant to LGBTQ+ populations, a better descriptor would be LGBQ, as very few of the studies included transgender, non-binary, or gender-diverse relationship experiences. In total, 15 articles included transgender participants while only four included non-binary participants. LGBTQ+ Specific Journal Of course, this review focused on two of the leading relationship science journals and thus did not cover research published in other journals. Anecdotally, many researchers working in LGBTQ psychology and related areas note that when they try to publish in mainstream journals, reviewers often recommend that they send their LGBTQ-relevant research to more specialized, niche journals. Thus, there is likely more research on LGBTQ+ relationship experiences in journals such as Psychology & Sexuality, LGBT Health, Journal of Lesbian Studies, Journal of Homosexuality, and the APA Journal of Sexual Orientation and Gender Diversity. However, none of these journals specifically focus on relationship science and may not be widely read by other scholars studying relationships specifically. While one of the benefits of LGBTQ-inclusive research is that it helps us to better understand the experiences within this specific population, such research also benefits the wider population, as often LGBTQ-inclusive research suggests new and novel questions that help to shed light on relationship experiences that are relevant to all individuals, regardless of sexual or gender identity. Despite the indication that there is still a long way to go in terms of encouraging broad inclusion of LGBTQ+ experiences in mainstream relationship research, there were still many positive signs. The overall trajectory of inclusion appears to be increasing over time, conferences are beginning to include specific programming on how to increase the inclusivity of relationship research, and the editors of the special issues celebrating the past two decades of relationship science saw fit to include a review that was specific to LGBTQ+ relationship experiences. The review concluded by noting that we, the authors, were "looking forward to the next 20 years" of LGBTQ-inclusive relationship research, with a specific "focus on deciphering the minutiae of all the colorful intersection of identity that make up the true richness of human relationships." Karen Blair, Ph.D., - Website - References Pollitt, A. M., Blair, K. L., & Lannutti, P. J. (2022). A review of two decades of LGBTQ‐inclusive research in JSPR and PR. Personal Relationships. Andersen, J. P., & Zou, C. (2015). Exclusion of sexual minority couples from research. Health Science Journal, 9(6), 1. Blair, K. L., McKenna, O., & Holmberg, D. (2022). On guard: Public versus private affection-sharing experiences in same-sex, gender-diverse, and mixed-sex relationships. Journal of Social and Personal Relationships, 02654075221090678.

Techniques to help you and your loved one's de-stress when you need it most. Our stress response gets activated all the time, and it can make us feel and act in ways we would rather not. A strongly activated stress response flips the "thinking brain," and the "emotional brain" takes over. There are 10 key tools we can use to turn off the stress response in the moment and regain rationality. The tools can be useful for children or adults — and the more we practice, the better we get at using them. Our stress response systems get activated in small and big ways all the time. While this can be helpful, it can also make us feel and act in ways we would rather not — whether that’s losing our cool or feeling paralyzed by what’s ahead. Knowing that there are strategies at our disposal to actually help us turn off the biological stress response and regain rationality, balance, and cognitive flexibility can be empowering. These techniques can be helpful for any of us, from very young children to adults. Certain strategies are particularly useful for supporting a child or other loved one through an activated moment. When emotions take over: "Flipping your lid" Here's the hand model of the brain: The fingers, folded over the thumb, represent the prefrontal cortex — the upper or thinking part of the brain. The thumb represents the limbic system, including the amygdala or "emotional brain," which controls the freeze or fight-or-flight stress responses. A strongly activated stress response can make it so the "emotional brain" flips the "thinking brain" out of the way and takes over. Signs we’ve "flipped our lids" include freezing, "spacing out," or being irritable. Kids may ignore, cry, hit, or kick. We can bring our "thinking brains" back in control if we have the skills to manage the situation and calm the stress response. The more we practice, the better we get. Special notes on supporting children: Particularly after stressful events, children will often communicate their needs to us through their behaviors instead of words. They don't yet have the language or tools to tell us exactly what is going on. When a child is "acting out," there’s a good chance they’re feeling overwhelmed and stressed and don't yet have the skills to manage the situation or their stress response. Their behaviors give us clues about which skills kids may still need to learn, and then we can help them to do so. The brain processes information from the bottom up—from basic to more complex functions. This means that the regulatory (automatic functions such as heart rate) and relational parts of our brains are the first to process and respond to what we experience. To most effectively reach anyone who is stressed (child or adult), use neuroscientist Dr. Bruce Perry's 3 Rs framework, Regulate, Relate, Reason, to tap into brain functions in the order in which they are activated. A. Regulate: First, we have to regulate or calm our stress response (and/or your loved one's). B. Relate: Then, if supporting someone, relate to how they’re feeling. C. Reason: Once there’s safety and understanding, process what happened through reason. A. Regulate: Calm the stress response When possible, reassure yourself (and/or the person you’re supporting) that you are safe in the here and now. Use the techniques below to help return the stress response to baseline. 1. Grounding mindfulness practices Feel your feet on the floor, on a wall, or arm on a chair. Use your five senses:​ Notice 5 things you can see, 4 things you hear, 3 things you touch, 2 things you smell, 1 thing you taste. 2. Breathing techniques Slow, long exhalations decrease our heart rates and calm our stress responses. Try: 4-7-8 breathing Put your hand on your chest and abdomen to focus on breathing. Children can try belly breathing with Elmo or with Rosita 3. Sensory techniques Rhythmic, sensory activities soothe our stress systems: Drink water (sucking and swallowing is innately calming) Rock back and forth Listen to music Massage your hand or body Try tapping techniques: like patting your hands on thighs Cuddle or hug a loved one 4. Movement Moving our bodies helps release stress energy or rev up a system that may be depressed. Try: Walking or jogging Jumping jacks Dancing Stretching or yoga 5. Resourcing When you’re in a calm place, think of a person, place, thing, or memory that makes you feel calm, strong, or happy. Practice visualizing that person, place, thing, or memory. The more specific the sensory details, the better this works. Then, when you’re having a rough moment, you can connect with that resource, either in your mind or if possible, in real life. To help regulate a loved one, try these strategies: 6. Be the calm they need If you’re supporting a loved one through these skills, first, use the strategies below to reach a place of calm yourself. 7. Parallel activities Ever notice how kids seem more talkative in the backseat or when you’re walking side-by-side? Eye contact or face-to-face interactions can be particularly stressful when we are feeling activated. Consider positioning yourself to the side or lower than your loved one to decrease their activation. And consider parallel activities to calm the stress response, such as: Coloring or making art Playing with toys Washing dishes or cooking A drive or walk B. Relate: Connect If supporting someone, try these techniques to relate to their experiences, after they've regulated their stress response. These also work nicely solo — often with a journal or other tool. 8. “Connect, then redirect” Empathize with your loved one's situation, be curious, and ask questions to help them feel seen and heard. Knowing we are attuned to their emotional needs enables them to feel safer. Once they feel seen and heard, if needed, we can then redirect the conversation to next steps, like safety planning or practicing coping skills. If working on your own, hold space to validate however you’re feeling — and recall that feeling activated by a threat is natural. 9. “Name it to tame it” Give yourself space to figure out what you’re feeling now that your stress response is less activated: Maybe take a walk, write, or talk with a trusted other. Naming our emotions helps tap into how we’re really feeling, to feel more in control with those emotions, and to know how to proceed. If you’re supporting someone else, naming what you think you see can help — say something like, "You seem really frustrated or angry right now. Is that right?" This can work for all ages, toddlers to adults! C. Reason 10. Process and plan Once you’re feeling safe, regulated, and understood, you can use higher-order thinking to problem-solve and build longer-term skills to cope with stress now and in the future. Consider these questions: What were the triggers that led to the stress behaviors? What helped you feel better? What strengths could you draw on next time to cope? What supports do you need to feel safe? What skills might you learn to better cope with a similar experience next time? Devika Bhushan, M.D., - Website -

It might seem similar to social phobia at first but look again. Avoidant personality disorder is considered a common personality pathology but is often under-recognized. Avoidance is driven by exceedingly poor self-image, and sufferers are hypersensitive to possible criticism. AVPD can generate rich fantasies where sufferers attempt to live out their desired life via imagination. Those with AVPD often present for depression, anxiety, and substance abuse, which are common co-occurrences. Avoidant personality disorder (AvPD) isn’t as well-known as narcissistic or borderline personality disorder, but that doesn’t mean it’s uncommon. In fact, some researchers tell us that AvPD was the most frequently occurring personality disorder in three epidemiological studies. It was reported as between 5.1 and 55.4 percent prevalence in clinical settings (Sperry & Casteliero, 2022). While interpersonally avoidant characteristics occur in social phobia, autism , and schizoid and schizotypal personalities, the avoidant personality is a unique character that is frequently unrecognized. In fact, researchers Reich & Schatzburg (2021) noted, “AvPD is an important clinical issue because it is prevalent in the community and has high morbidity and high heritability. Its single factor seems to suggest evaluation and treatment should be straightforward, but despite this, it tends to be underdiagnosed and undertreated.” With this in mind, being aware of and able to recognize AvPD is the big first step. Readers may be wondering if AvPD is simply a more ingrained social phobia. It’s true that researchers and clinicians have debated for years whether these two conditions exist on a continuum (e.g., Turner et al., 1986; Reich, 2000; Sperry & Casteliero, 2022) but, regardless, it can’t be ignored that social phobia is more of a performance anxiety , while AvPD is much more of a pervasive interactive style and the way the person has “always been.” Further, those with AvPD tend to have greater functional impairment than social phobia, given the avoidance pattern is much greater (APA, 2022), and it often co-occurs with other personality disorders, including dependent and borderline, which are both significantly impairing in themselves. Three major red flags in avoidant personality disorder 1. Social avoidance in AvPD isn’t fueled only by fear of doing or saying something that could bring embarrassment or social scrutiny, like when someone is the center of attention for some reason or feeling like they don’t fit in. While this fear is present, the avoidant personality’s avoidance is generated by the core belief that “I’m so inept, undesirable, and stupid that others couldn’t possibly want to associate with me or take me seriously. My undesirable characteristics are irrepressible and easily detected, and therefore, I’ll always be seen as ‘less-than.’” In effect, it’s negative self-evaluation in comparison to others, a matter of self-esteem. This pattern isn’t something that seems to develop like a phobia. Rather, the person has “always been this way” and, since early on, has been experienced as uneasy and unusually shy or timid. 2. While avoidant, those with AvPD aren’t necessarily hermits. Instead, the handful of people they have let in have likely had to prove many times over that they are not judgmental and have made many gestures to the person that their company is desirable. Also, in terms of dating relationships , they might have a penchant for being attracted to someone they can feel superior to. People with AvPD I’ve worked with often complain about their partners’ inadequacies. Further, once in a relationship, despite the steady flow of complaints, the AvPD person hesitates to discontinue the relationship because a) they rely on having someone to devalue, b) there’s an assumption they’ll never find someone again, or at least someone that will accept them and is a safe target as needed, and c) there are also dependent and borderline personality characteristics at hand, both of which have a penchant for clinginess. 3. Someone with AvPD likely has a rich fantasy life involving idealized relationships and life accomplishments to obtain some sense of gratification . An acquaintance of mine with characteristics of AvPD once lamented their lack of risk-taking to capitalize on their photography skills, build their own business, and leave the area where they were raised. When asked to provide more details, they explained, “Oh, I’m no good at promoting myself or trying to fit in elsewhere. I’m just a dreamer.” In addition, the fantasies in AvPD probably involve resolving interpersonal conflicts. Many with AvPD seem to cast themselves in an assertive, or perhaps even heroic, light to compensate for their real-life deficits. Theodore Millon (2011) noted, “But fantasies also prove distressing in the long run because they point out the contrast between desire and objective reality.” Treatment implications Like people with untreated social phobias, those with AvPD are not only anxious but also tend to harbor significant depression and substance abuse issues (APA, 2022). It’s easy to see how interpersonal avoidance, from not having satisfying relationships and jobs to conflict resolution, can be depressing. Some have told me, “It’s like watching everyone else have a life.” Chemical dependency can arise as self-medication, and substances, especially alcohol, may not only take the edge off but facilitate socializing. It’s often this clinical cocktail, particularly the depression and substance abuse, that initially brings someone with AvPD to treatment, where it’s discovered that personality dynamics are driving the suffering. The good news is that AvPD can respond well to intervention (e.g., Beck & Freeman, 1990; Millon, 2011; Simonsen et al., 2022; Sperry & Casteliero, 2022). The therapist’s best asset may be patience, as successful treatment, provided the patients’ timidity, will likely begin with a particularly delicate rapport-building phase. This is no different from the AvPD’s need to carefully investigate colleagues, friends, etc., for signs of criticism before allowing any exposure. AvPD, unlike social phobia, which may improve within months with cognitive-behavioral interventions like exposure therapy (e.g., ADAA, 2021), will likely involve longer-term investment to ingrain more constructive ways of relating. Anthony D. Smith LMHC References American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Anxiety and Depression Association of America (2021). Clinical Practice Review for Social Anxiety Disorder. Millon, T. (2011). Disorders of personality (3rd ed.). Wiley. Reich, J. (2000). The relationship of social phobia to avoidant personality disorder: A proposal to reclassify avoidant personality disorder based on clinical empirical findings. European Psychiatry, 15(3), 151-159. Reich, J. & Schatzberg, A. (2021). Prevalence, factor structure, and heritability of avoidant personality disorder. The Journal of Nervous and Mental Disease, 209(10), 764-772. Simonsen, S., Popolo, R., Juul, S., Frandsen, F.W., Sørensen, P., & Dimaggio, G., (2022). Treating avoidant personality disorder with combined individual metacognitive interpersonal therapy and group mentalization-based treatment: A pilot study. The Journal of Nervous and Mental Disease, 210(3), 163-171. Sperry, L., & Catelliero, G. (2022). Avoidant personality disorder. In R.F. Feinstein (Ed.), Primer on Personality Disorders (pp. 545-564). Oxford. Turner, S., Beidel, D., Dancu, C., & Keyes, D. (1986). Psychopathology of social phobia and comparison to avoidant personality disorder. Journal of Abnormal Psychology, 95(4), 389–394.

With support, it is possible to grow after loss. Painful feelings about chronic illness dependence can adversely affect mental health. Acknowledging the guilt and shame of chronic illness dependence can help soften painful emotions. Communicating with caregivers about painful feelings surrounding dependence is essential. Chronic illness limits one’s ability to work, play, and thrive. Pain and fatigue can affect energy levels, cognitive sharpness, and physical mobility. Living with chronic illness involves grieving for the life one is expected to lead. This grief encompasses the experience of relying on others for care that, if one were not ill, one would be able to provide for oneself. Our culture prizes independence. It feels good to do things for ourselves. But it’s important to recognize that there are many areas in which we also normalize and approve of dependence. As a society, for example, we depend upon public entities. When our house is on fire, we call the fire department, rather than fight the fire by ourselves. When we have to drive in a snowstorm, we don’t grab a shovel; rather, we rely on city plows to keep the roads we share safe. Similarly, in family units, we share resources and labor. Grocery shopping and meal preparation typically are done for the family as a whole. Financial planning involves shared decision-making and pooling of money. There are many ways that we are not independent, and we look upon this as a positive. Chronic illness dependence differs from the examples cited above because it goes against what we believe to be “normal.” So, it’s not dependence per se that is frowned upon, its dependence that we believe to be socially unacceptable. Chronic illness dependence is correlated with depression , anxiety , withdrawal, and hopelessness (Williams, et al., 2016). Guilt about requiring assistance and shame of feeling like a burden to others are common emotional experiences cited by people living with chronic illness (Williams, et al., 2016). How can we work with the difficult feelings associated with chronic illness dependence? Acknowledgement of difficult feelings, strong communication with caregivers, and improving self-worth are three important ways to make dependence less fraught. Acknowledgement of painful feelings Guilt and shame are difficult to acknowledge, even to oneself. Anger , depression, and anxiety often mask guilt, shame, and loss. If you’re feeling angry, depressed, or anxious about dependence issues, see if you can dig underneath these emotional reactions and find the roots of guilt and shame. “I hate the needy, dependent person I have become due to my illness.” “I am a burden to my family; I ruined their lives when I became ill.” These are painful—and common—beliefs. It’s important to bring them into the light so that you can work with them. Ask yourself: Am I holding myself to a different standard than I hold others to? If my spouse, friend, sibling, child, etc., were in my shoes, what would I feel toward them? Am I blaming myself for a situation that I didn’t choose and that is beyond my control? Communication with caregivers Sharing your vulnerability with caregivers and being open to hearing their vulnerabilities can increase feelings of agency and power. Sharing how dependence makes you feel allows you to be seen and understood as a person, rather than as an object of care. Being curious about how your illness dependence affects your caregiver allows you to give them the gift of understanding as well (Catchpole & Garip, 2019). Illness dependence becomes a “we” issue to be faced together. Both the ill person and the caregiver are viewed as having needs, and the goal becomes how to meet those needs as generously as possible using problem-solving coping (Bigda-Peyton, 2019). If one person is meeting your caregiving needs, process with them how it would feel for both of you to spread out caregiving responsibilities. Are there other family members, friends, or social services that can step in? Decreasing dependence on one person can provide much-needed space for both the primary carer and the recipient of care. Improving self-worth When dependence increases, life changes. The roles once played are altered, shattering one’s sense of self-worth. Who am I if I can’t work, cook for my family, dress myself, go out, and socialize? Who am I with this illness? This painful question is necessary, but the hurt it calls up often causes people to turn away, rather than toward it. Who can you be with these new limitations? What can you do? How can you contribute? What can you offer? Stay tuned to these questions, looking for new ways to feel valuable. Grieving your old roles is important; so is finding a way to grow into new roles. Conclusion Chronic illness dependence is challenging, provoking feelings of loss and grief. Meeting this challenge with acknowledgment of painful feelings, communication with caregivers, and attention to self-worth can allow growth after loss. Katie Willard Virant, MSW, JD, LCSW, - Website - References Bigda-Peyton, F. (2019). Can't live with you, can't live without you: Working with a primitive, hostile, dependent couple. Modern Psychoanalysis, 43(2): 33-48. Catchpole, S. & Garip, G. (2019). Acceptance and identity change: An interpretive phenomenological analysis of carers' experiences in myalgic encephalopathy/chronic fatigue syndrome. Journal of Health Psychology, 26(5). Williams, A.M., Christopher, G. & Jenkinson, E. (2016). The psychological impact of dependency in adults with chronic fatigue syndrome/myalgic encephalomyelitis: A qualitative exploration. Journal of Health Psychology, 24(2): 1-12.

Improving your social interactions and self-assurance. By focusing on positivity and presence instead of self-doubt, one's feelings of shyness can be lessened. Start small and work up through exposure to different social situations to help improve confidence. Hypnotic techniques, including visualization, can help one remain calm during stressful social situations. Approximately half of people in the U.S. are considered to be shy (Burstein et al., 2011; Young et al., 2021). Shy people tend to have exaggerated low self-esteem and are more likely to present themselves in social situations as incompetent and inhibited rather than in a favorable light (Bober et al., 2021). Although they are related, it is important to distinguish shyness from social anxiety . While shyness is marked by discomfort that is short-lived, social anxiety takes on more debilitating symptoms and leads to fear and avoidance of social situations (Young et al., 2021). Shy people are typically less anxious in formal situations, such as speaking in public, but report similar anxiety as people with diagnosed social anxiety during informal social tasks, like conversations. Despite this, shy people function relatively unimpaired in social situations compared to people with social anxiety. Shyness can be thought of as part of the continuum of social anxiety (Heiser et al., 2009). Shyness can turn into social anxiety if a person becomes increasingly insecure about their behavior or if they begin engaging in behaviors such as social avoidance. Here are three personal experiences that demonstrate methods for overcoming shyness. Shifting Perspective Using Positive Talk As a recent college graduate (Mac Lancaster) who used to consider myself shy, I understand the feelings of social insecurity that can lead to timidity and even avoidance. During my junior year in college, I signed up for a summer study abroad experience in Athens, Greece. I decided then and there that I wanted to be less shy so I could get the absolute most out of the interpersonal interactions I knew I would face during my upcoming journey. Part of my shyness was feeling like what I had to say or how I presented myself was wrong, and the other person would notice. I reflected objectively and realized that I was the one thinking negatively about myself in situations, not others. I worked to catch distorted thoughts before they influenced my perception and replaced them with positive talk and affirmations. I hypothesized that if I presented myself securely, others would think of me as confident. Sure enough, appearing confident led me to have more consistently effective conversations that I felt good about during and after the fact. I recognized that confidence was a choice under my control, and I began conversing with the assumption that what I had to say was right (and if it wasn’t, the other person could simply inform me). I made it a point to look people in the eyes and focus on the presence that a conversation would naturally bring. Rather than self-doubting, I centered my view around the positive aspects of myself that I could bring to a conversation. I continued to surprise myself when I finally went to Greece, and my interactions with strangers and new friends were purely comprised of confidence. The more I stayed in the present moment with a positive view, the easier it became for me to be uninhibited by shyness. Practicing Confidence For me (Mary Kovic), shyness is more than just a feeling of bashfulness in a moment of casual conversation. It’s a procedure of emotions that overwhelmingly impact the way I interact with people. It’s the anxiety leading up to a group hangout. It’s the tension caused by unnerving lulls in the conversation when I’m unsure what to say. It’s the inevitable shame that comes after when I’m re-analyzing the scene, dissecting the social faux pas I made. Confidence is a skill much like any other. The more I practice, the stronger this skill becomes. And the only way to practice is to put myself in uncomfortable situations, knowing that I might experience these complicated emotions once more. The technique I utilized is known as exposure therapy. Exposure therapy is an effective form of cognitive behavioral therapy for people with social anxiety. This type of therapy works by repeatedly exposing a person to feared scenarios, leading to reduced anxiety as they become used to the scenario (Jefferson, 2001). One of the first steps of exposure therapy is thinking up a fear hierarchy, where the bottom of the hierarchy consists of situations that cause the least fear and then working up to the ones that cause the most fear. Using the fear hierarchy, people can work their way through building a tolerance to different levels of exposure until they no longer fear particular situations (Kemp et al., 2023). My goal was to approach the top situation of my fear hierarchy. So, I threw myself into one of the most uncomfortable conditions I could imagine: I went to a concert by myself. Going into this, I knew that it was going to be hard for me, but I still wanted to make an effort to overcome my shyness. When I was waiting in line outside of the venue, strangers stacked up and started combining and conversing with each other. I waited in that line for an hour, contemplating ways I could introduce myself to someone the same way I saw others doing so easily. Eventually, I managed to talk to a stranger beside me. I started by talking about the band we were about to see. Being the initiator of conversations has helped me become more confident because it allows me to lead and be more prepared. Practicing confidence doesn’t always mean throwing myself into the deep end. Starting small is how I developed the courage to tackle bigger feats like this concert. I made small talk with the waiter at dinner. I checked in with classmates before class started to see how their weekend was. Once I realized I could hone this skill, I came to enjoy the challenge of overcoming my shyness. The more successful I have become at doing this, the less anxiety I experienced leading up to interactions and the less time I spent feeling shame afterward. Overcoming shyness can get easier with the help of both time and practice. Using Hypnosis By entering a hypnotic state of inward focus, people are more susceptible to suggestions either from themselves or others. In the case of overcoming shyness, hypnotic techniques can be directed toward achieving greater control during situations that normally may cause distress. For example, you can visualize what it would look like to go into conversations with confidence. You can create a sense of realism by vividly picturing how you would like to flow through your social interactions with ease. When you imagine achieving a goal in your head, you create a mindset that will lead you to your desired result. In a way, such rehearsal in hypnosis is a form of exposure therapy in the imagination. Additionally, hypnosis can help you remain calm, which can ease the stress associated with engaging in social interactions. First, pick any physical sign—an anchoring gesture—that you can do with one hand (like a thumbs up or peace sign). Using visualization techniques with a method similar to that described above, you can imagine yourself in a calm and safe environment of your choosing. When you’re there, engage every one of your senses to make it feel more real. Experience what your setting looks, smells, sounds, tastes, and feels like while simultaneously relaxing your body (from head to toe or toe to head). Once you feel completely relaxed, make your anchoring gesture and tell yourself: “Whenever I use this sign, I can become this relaxed, even when I am not doing hypnosis.” Through engaging in a regular practice of hypnosis, your anchoring gesture will become a powerful harbinger of calmness and confidence. You can lessen or even avoid feelings of shyness altogether. Takeaway Overcoming shyness is a journey that involves dedication, patience, perseverance, and a desire to venture outside of your comfort zone. By engaging in positive talk, practicing confidence through social exposure, and using hypnosis, feelings of shyness can be diminished. Dealing with shyness can be thought of as a golden opportunity for personal growth, establishing vibrant social connections, and long-lasting self-confidence. Ran D. Anbar, M.D., FAAP, - Website - Book - References Arzt, N., Patel, M. (2023). Shyness Vs. Social Anxiety: Understanding the Difference. Bober, A., Gajewska, E., Czaprowska, A., Świątek, A. H., & Szcześniak, M. (2021). Impact of Shyness on Self-Esteem: The Mediating Effect of Self-Presentation. International Journal of Environmental Research and Public Health, 19(1), 230. Burstein, M., Ameli-Grillon, L., & Merikangas, K. R. (2011). Shyness versus social phobia in US youth. Pediatrics, 128(5), 917–925. Heiser, N. A., Turner, S. M., Beidel, D. C., & Roberson-Nay, R. (2009). Differentiating social phobia from shyness. Journal of Anxiety Disorders, 23(4), 469–476. Jefferson J. W. (2001). Social anxiety disorder: More than just a little shyness. Primary Care Companion to the Journal of Clinical Psychiatry, 3(1), 4–9. Kemp, J., Benito, K., Herren, J., Brown, Z., Frank, H. E., & Freeman, J. (2023). Exposure to exposure: A protocol for leveraging exposure principles during training to address therapist-level barriers to exposure implementation. Frontiers in Psychiatry, 14, 1096259. Young, C. M., Steers, M. N., Shank, F., Aris, A., & Ryan, P. (2021). Shyness and susceptibility to social influence: Stronger concordance between norms and drinking among shy individuals. Addictive Behaviors, 119, 106922.

There’s genuine love, and then there’s fraudulent, opportunistic neediness. Most narcissists, despite their cockiness and sense of entitlement, harbor major insecurities from childhood. Narcissists and their victims are much less contrasting than they’re complementary. Once their relationship becomes committed, major interpersonal issues, before hidden, come sharply into focus. “The desire of the man is for the woman, but the desire of the woman is for the desire of the man.” This classic quote from Madame de Staël (1766–1817) is certainly intriguing. But it requires qualification—its most notable exception being extremely narcissistic men or abusive males generally. It should be added, however, that narcissistic women can be love bombers as well, although, to date, no statistical comparisons of its relative prominence between genders exist, to my knowledge. But, at least indirectly, the literature I’ve explored suggests that it’s more common among men than women. Consonant with my own past experience as a psychologist, I’ve probably seen about twice as many men love bombers as women—despite, in many respects, they're betraying their underlying narcissism equally. For example, they’d mirror one another in unashamedly transgressing the other’s boundaries (as in, uninvited, actually reading the other’s diary) and, too, blaming their relationship problems on their partner’s selfishness or insensitivity. Even as they flagrantly victimized the “bombee,” they could self-righteously proclaim that they were the real victims. So, keeping in mind that either gender can love bomb, to avoid the awkwardness of constantly writing “he/she” or “she/he” in the descriptions below, I’ll regularly employ the male pronoun. Also, be aware that not all love bombers are narcissists, and not all narcissists are love bombers. Further, not all love bombers suffered serious psychic wounds during childhood. The Mutual Quest for Unconditional Love Many writers regard narcissists, despite their bravado, and bloated sense of entitlement, as harboring underlying insecurities from childhood. As a result, this argument goes, they’ve developed powerful tactics to conceal their anxiety and damaged self-image. Desperately needing what professionals typically designate as “narcissistic supply” to permeate an emptiness they’re rarely cognizant of, they’re attracted to others who will honor and validate their (defense-laden) superiority. So, what kind of person would be willing to ultimately degrade themselves to accept—or at least tolerate—such compensatory scheming behavior? Any such duo is paradoxical since the two individuals may be much less contrasting than complementary— the unexpressed motivation of one feeding into the other. For convenience, going forward, I’ll abbreviate the term “narcissist” to "N" and identify their target as "CV” for "cooperating victim." If the CV plays into the N’s over-the-top fantasies, it’s because these fantasies may reflect their own. Frequently, growing up, the woman also felt insecure in her family. And, like the N, many of the CVs had N parents too self-absorbed to enable them to feel adequately attended to, appreciated, or cared for. What, albeit unconsciously, CVs customarily long for is an intimate, loving relationship that will provide them with what was absent when they were younger and may have culminated in the scalding wound of mental and emotional abandonment . In consequence, the N’s overblown love bombing would seem to fit the bill for CVs perfectly, making them putty in the N’s treacherous hands. Never before has the CV basked in such extravagant, glorious homage, so flattered, praised, adored—even worshipped. Figuratively on his knees professing his ardor and humbly beseeching the CV to return it—lavishing expensive gifts on her or precipitously whisking her off to exotic islands—she’s compelled or rushed into returning these flamboyant demonstrations of affection. By such gestures swept off her feet, the CV loses her balance. Acquiescing to the stringent requirements of this unprecedented relationship (for, if only unaware, she’s determined the N to be “the one”), she strives to re-balance herself according to the N’s dictates. It’s essential to add that the N has also adjusted his balance to guarantee that the relationship will offer him the unconditional love and acceptance he, too, never experienced growing up. Here, we have the joint illusion—or collusion—of compatibility or spiritual kinship based much less on any shared identity than on pledges, promises, misleading words, and duplicitous deeds. Both the N and the CV must then act in ways that will preserve their sense of relational control. In his case, he asserts (or rather demands) what must happen in the CV’s life for him to be assured that he matters more to her than anyone or anything else. And, in the CV’s case, to assure herself that she’ll remain his genuine, undying true love, she willingly concedes to these demands—ironically, by “assertively” renouncing her assertiveness. Unable to feel whole or secure within herself, she feels obliged to derive the security available only from without. Although she’s likely to feel pressured, wanting to take things slower, feeling so highly valued (after all, that’s long been her heart’s deepest desire), she allows her boundaries to be trampled on—even violating them herself. For instance, capitulating to the N’s jealous nature, she defers to his efforts to isolate her from family and friends. As he makes plain to her, his insistence (presumably) is only for her to acknowledge the primacy and exclusivity of their super-special relationship. From Idealization to Devaluation: Rudely Knocking the Cooperating Victim Off Her Pedestal Although there were hints of problems to come during the N and CV’s surreal courtship, once their relationship enters its second, far more harmful stage—particularly to the CV—the until-then well-camouflaged threats to their common need for independence, autonomy, and self-respect now occupy center stage. The N becomes increasingly suspicious and distrustful that he’ll have to surrender his dominance and control if he’s forced to recognize his “mark” as now his equal. In attaining the CV’s commitment, which he so diligently sought earlier, he experiences (however abstrusely) mounting anxiety about merging with his no-longer-subordinate attachment object. Needing, therefore, to emotionally distinguish himself from his mate, he resorts to anger, contempt, and even hatred to uphold his cardinal sense of superiority. In turn, the CV, feeling downcast, deserted, and desperate to retrieve the intimate attachment and euphoric feelings of specialness now actively denied her, responds to the N in an obsequious manner sharply contrasting with his behavioral distancing. With her idyllic relationship vision so seriously undercut by the N’s insults and condescension, she tries ever harder to gratify his preferences—in the process, sadly compromising her self-esteem and integrity. But, regardless of how much she can admit it to herself, she also resents this gross betrayal of her love. After all, she’s not done anything she can understand that would account for his callous treatment of her. And when she protests his so-soured attitude, the N either adamantly gaslights her, making her doubt her eyes and ears, or offers her intermittent reinforcement to assure her willingness to stay—and stay one-down in the relationship. Demonstrating it in contrary ways, they share the same fear of abandonment. The N, as long as the CV remains a narcissistic supply, is afraid to lose her as a less-than, inferior emotional dependent. And the CV, yearning for the relationship to return to what it once was—or seemed—doesn’t want (exemplifying cognitive dissonance) to recognize that the wonderful feelings she’d once experienced were all a sham. She’ll minimize or rationalize her mistreatment, blaming herself (as the N has prompted her to do) for the torturous withdrawal of his kindness, generosity, respect, and devotion. In short, both the N and the CV are now gravely disappointed in one another, suffering anew from old, disturbing feelings of insecurity. Their shared desire to feel safe in a healing relationship—which explains their largely unconscious incentive to engage in the first place—has failed miserably. They’ve tried to accomplish through mutual dependency what ultimately can only be achieved inside themselves. Assuming that the N is at or near the pole of the N spectrum, the deadlock between them is unresolvable. And as so many counselors have pointed out, it’s best for the CV to escape from the trap she couldn’t help falling into. She may need to renew the supportive friendships she’d relinquished. And possibly undertake mental health counseling to gain—or get back—the confidence and courage to leave the relationship that’s so injured her sense of self. Here, I should reiterate that if it’s the woman who’s carried out the manipulative love bombing and her defenses are so extreme that she cannot empathize with her partner’s dilemma, then it’s the man who needs to extricate himself from this dysfunctional union. But, regardless of their gender, both of them must free themselves from the relationship imprisoning them. Otherwise, they’ll forfeit the opportunity to live a life as rewarding as, potentially, it can be—once they liberate their psyche from an abusiveness likely worse than anything they may have endured growing up. Leon F. Seltzer, Ph.D., References See A. Gionet, “The Love Bombing Survey,” Apr. 12, 2023.

Abuse thrives in stress and isolation; and is increased by a pandemic. Abuse is abysmal. It leaves multiple scars and acts as a contagion to others around and the generations that follow. It is not a worthy legacy one wants to inherit—or leave behind. And yet, it is pervasive. At least a quarter of all adults report being abused as children with 1 in 5 women and 1 in 13 men reporting they were sexually abused as children (WHO, 2017). Unfortunately, the environment that breeds abuse has been fueled by the isolation, stress, and economic impacts of the current pandemic. Abuse thrives in stress and the protection of isolation. People who abuse generally have poor control in managing their stress and can often view significant others, intimate family members, and pets as objects that need to be controlled. People who abuse typically employ an array of manipulative tactics along with threats, intimidation, and violence to elicit the desired response from those around them. People who resort to intimate partner violence (IPV) tend to view family members like pawns in a chess game who serve their will. While some abusers seduce their loved ones with a dance of apologies and kindness and promise never to do harm again, followed by steps of further abuse, other abusers will remain impassive and dose out a steady stream of complaints while still receiving loyal attention from their loved ones. Part of the problem of abuse is the loyalty of loved ones who endure abuse. Some suggest there is a conditioning of abuse victims who go through the emotional extremes with the abuser and then feel the mutual relief when the abuse subsides. This traumatic bonding experience can keep loved ones together. There may also be a survivor rationale that keeps one in an abusive relationship as there can be a heightened risk of escalated torture, stalking, and even death for those that have left their abuser. Another variable that has been suggested is that a victim of IPV often grew up in an abusive environment which created a type of set-point for how one defines and experiences love. In other words, abusive love feels normal. Overlaying all of this is the added danger of intoxication by alcohol and/or drugs which can cause increased violence and increased tolerance of it. Survivors of childhood abuse often have higher adverse childhood experiences (ACEs). Research has shown that children who have experienced maltreatment, malnourishment, neglect, and sustained high amounts of psychological abuse revealed long-term changes in their brain architecture, neural wiring, immune response, psychiatric health , and were more prone to addictions, lower life-spans and had higher rates of medical diseases (Zarse, Neff, Yoder, Hulvershorn, Chambers, & Chambers, 2019). The mitigating factor to these grim results is resilience. A lot has been written about resilience and the myriad of professions that help people heal would probably not exist if a remedy did not exist. The word remedy sounds simple, however, resilience is as complex as the conditions that create abuse. Resilience is not one thing—it is a combination of multiple observed in people who found a way out of their personal abyss. Polizzi and Perry (2020) compared the stress of COVID-19’s pandemic to resilience and post-traumatic growth found among survivors of the 9/11 terrorist attacks on the World Trade Center. They suggest activities that may be beneficial for abuse victims and trauma survivors who are concurrently dealing with the aggravated stress imposed by the pandemic. They cite the 3-C’s model (control, coherence, and connectedness) and recommend journaling, mindfulness, and practicing loving-kindness meditation (LKM). As I reflected on my own traumatic and abuse experiences in childhood and adulthood, I found these suggestions to mirror practices I undertook without realizing the resilience it was enhancing. My self-disclosure is simply offered as a way of empathizing. If someone who did not understand pain and abuse told me to meditate and practice loving kindness, I am not sure I would embrace the suggestion. In fact, I may have resisted it because I was being told what to do. (Maybe.) Instead, it was reading the Diary of Anne Frank when I was very young that profoundly changed how I lived and survived in the world. First, Anne Frank taught me to write a diary. Any pain I felt I suffered was addressed in my own writing. Knowing what Anne Frank suffered made any of my complaints seem small and petty. I did not see myself as a victim, ever. More important, Anne Frank taught me how to love and forgive. Her last entry expressed loving-kindness as people were seeking to capture her and her family: “I still believe, in spite of everything, that people are still good at heart.” Her words seared my heart and soul. There is an expression that "hurt people hurt people." While some people may show a callousness and an inability to have empathy for others, perhaps the greatest victims are the ones who harden their heart. They give up loving-kindness. In doing so, they miss out on feeling the depth of love, care, spirit, and resilience. They try to control others instead of harnessing the control from their heart—which seeks to love and not harm. In the war of abuse and disease, perhaps we can be comforted by another heroine, Mother Teresa, who had this version of the paradoxical commandments written on the wall of her home for the children of Calcutta: People are often unreasonable, irrational, and self-centered. Forgive them anyway. If you are kind, people may accuse you of selfish, ulterior motives. Be kind anyway. If you are successful, you will win some unfaithful friends and some genuine enemies. Succeed anyway. If you are honest and sincere people may deceive you. Be honest and sincere anyway. What you spend years creating, others could destroy overnight. Create anyway. If you find serenity and happiness, some may be jealous. Be happy anyway. The good you do today will often be forgotten. Do good anyway. Give the best you have, and it will never be enough. Give your best anyway. In the final analysis, it is between you and God. It was never between you and them anyway. (This version is credited to Mother Teresa.) Kimberly Key, Ph.D. - website - books References: Polizzi, C., Lynn, S. J., & Perry, A. (2020). Stress and Coping in the Time of Covid-19: Pathways to Resilience and Recovery. Clinical Neuropsychiatry, 17(2), 59–62. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.36131/CN20200204 Zarse, E.M., Neff, M.R., Yoder, R., Hulvershorn, L., Chambers, J.E., & Chambers, R.A. (2019). The adverse childhood experiences questionnaire: Two decades of research on childhood trauma as a primary cause of adult mental illness, addiction, and medical diseases. Cogent Medicine, 6(1). Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1080/2331205X.2019.1581447

Applying memory to enhance intimacy. By drawing on the potential of memory to work for us, we can nourish our relationships. Collective memories define a relationship, reminding us how much we mean to each other. Rehearsal of vivid, positive memories significantly correlates with higher marital satisfaction, especially with memories of laughter. Relationships thrive on appropriate remembering. Just as forgetting implies a lack of caring, remembering affirms that we care . Recalling past events spent together and remembering consequential events in our partner’s life shows that we value our relationship and our partner's concerns. But not all remembering sustains a relationship. Some kinds of persistent recall can weaken the connection between two people. This post focuses on the kinds of remembering that nourish a relationship. 1. Creating New Memories – Going Places Together Long-term relationships are enriched by creating new shared memories that build on the foundation of established memory. Adding mutual memories allows a relationship to grow. Memory is connected to and distinguished by place, so going to different places together forms vivid memories that endure. Travel encourages new memories, but it need not be extensive. Day trips, visits to unfamiliar neighborhoods in one’s town, or a break in geographic routine can provide distinctive place cues for new shared memories. 2. Defining Memories – Forming Collective Memories Evolution bequeathed to us the potential to remember consequential events for our entire lives. Early hominids with the capacity to form long-term memories of one’s family and mate had a greater chance of survival than hominids who had less ability to form these bonding memories. Just as personal episodic memories define individual selves, shared memories define a relationship, reminding us how much we mean to each other. Noteworthy long-term memories experienced by both partners are referred to as relationship-defining memories. In an extensive meta-analysis of couples, agreement on these relationship-defining memories was positively related to measures of relationship quality and negatively related to divorce . Recalling these shared memories also ensures that we are part of each other’s thoughts, and the more we are together in thought, the stronger the relationship. 3. Remembering Good Times and Laughter A substantial study of married couples showed that the rehearsal of vivid, positive, and emotionally intense memories significantly correlated with higher marital satisfaction. In particular, recalling events when we laughed hard with our partner increases reported relationship satisfaction more than any other type of happy event. This elevated relationship satisfaction connects directly to the research on laughter itself, which creates considerable physical and emotional benefits. When we recall a time of uncontrollable laughter with our partner, we bring back a primary memory of that uninhibited time, retrieving and reliving the sights, sounds, and joyful emotions. 4. Creative Reminiscing – and Living Forward Creative reminiscing uses shared memories as a springboard for plans and ideas for future activities. In this way, memories themselves become the present life we’re living, and we can build from them. 5. Finding Themes Particular interactional memories can coalesce into patterns, providing enduring knowledge about a relationship. It may take a while to detect these patterns, but they should be remembered once established. Possible themes include working together to overcome adversity, creating fun from challenging situations, and being surprised by unexpected romantic gestures. 6. Being Understanding With Forgetting We forget a lot, naturally. Everyday forgetting is usually not a moral failing or a personal slight. It’s simply forgetting. Every so often, however, this natural forgetting creates conflict. If our partner forgets we had a late work meeting or a dinner with friends, it’s best to acknowledge this forgetting and then put it aside and not consciously rehearse it. In general, everyday forgetting itself should be forgotten – even if it seems inconsiderate or uncaring. Notably, we are capable of remembering the gist of conversations but not the detail. Recalling specific words is not how our memory works. We should not be expected to remember what was said verbatim. 7. Helpful Forgetting Some forgetting can be beneficial to a relationship. Recalling an unresolved disagreement is necessary for successful conflict resolution later, but once resolved, we are better off putting the disagreement behind us and moving ahead. It also helps to forget the harshness of an argument or an interaction that was out of character and that our partner apologized for. Letting go of atypical irritations is beneficial. 8. Recognizing Individual Differences When remembering together, it’s necessary to keep in mind that we each have different strengths and weaknesses with memory. We should acknowledge our own distinctive ways of remembering, as well as those of our partner, and realize that ingrained patterns of remembering and forgetting shape what we remember. (For example, I can remember who starred in a movie 25 years ago, but I forget who gave me a gift from my last birthday.) Differences in memory and forgetting should not be taken personally or taken to heart. When we’re young children, we are taught the value of remembering, largely through interactions in the family. Our parents teach us the importance of memory by asking specific questions about past events, even before we care much about the past. In particular, gender-related differences have been identified in what children are typically asked to remember, which then influences what they remember later in adulthood. When this research was conducted, girls were asked more about friendships and emotions, and boys were asked about facts and activities. (Refer to the references below.) 9. Remembering Prospectively Prospective memory is remembering about a future action or event – buying a birthday present next month, taking medication before dinner, remembering to call someone at a particular time. Online calendars and scheduled reminders can tell us about meetings and appointments, but many informal daily events rely on prospective memory. In particular, we should strive to remember what we promised to do – in the most effective way possible (post-it notes, emailing ourselves, spending time rehearsing the promise). Prospective memory is also helpful with our partner’s important professional obligations and busy or difficult days. 10. Deciding to Reminisce Reminiscing can be useful early in relationships and in mature relationships. People who rehearse relationship-defining memories are usually younger than 30 or older than 70. In new relationships, remembering firsts can be fun and sustaining. Later, landmark events are helpful to review – trips together, weddings, births of children – and grandchildren. Between a relationship’s formative years and much later years, reminiscing should be called on judiciously to avoid using nostalgia to replace lived experience. (Reminiscing can have the disadvantage of implying that a relationship is mostly in the past.) We live our lives forward, but every so often, we can pause and reminisce with our relationship partner. Final Words Memory has multiple effects – suggesting, supporting, disturbing, validating, exacerbating, comforting, and guiding. We should not call on memory to dwell on isolated unpleasantness, uncharacteristically harsh words, occasional forgetting, or resolved arguments. Instead, memories should be used to plan, discuss new activities, note patterns of commitment in our relationships, and savor happy, funny times together. By drawing on the potential of memory to work for us, we can nourish our relationships. Robert N. Kraft, Ph.D. - website References: Davis, P. J. (1999). Gender differences in autobiographical memory for childhood emotional experiences. Journal of Personality and Social Psychology, 76(3), 498–510. https://doi.org/10.1037/0022-3514.76.3.498 Fivush, R., Haden, C., & Reese, E. (1995). Remembering, recounting, and reminiscing: The development of autobiographical memory in social context. In D. C. Rubin (Ed.), Remembering our past: Studies in autobiographical memory (pp. 341-359). New York: Cambridge University Press.