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A Personal Perspective: You may not realize what's holding you back. Internal and external forces can sabotage the best of intentions. These forces include primitive instincts, emotional baggage, family dynamics, popular culture, habits, inertia, and fear. Identifying, understanding, and mitigating these forces are essential to improving your life. Changing your life is difficult, very difficult, despite what all of those self-help gurus say. If it weren’t so hard, almost everyone would be the people they want to be and live the lives they want to live. Too often, people blame themselves for their inability to change their lives for the better, seeing weakness and personal shortcomings as the reasons for their inability to have lives filled with meaning, satisfaction, or joy. Adding insult to injury, people are often criticized by others for lacking willpower, determination, persistence, and perseverance. Yet, these judgments are often unfair because they don’t take into account other internal and external forces that act as anchors to positive life change. The reality is that it is far more difficult to change than people think. In fact, so many forces conspire to keep us just the way we are, even if it is not the way we want it to be. First, our evolutionary instincts are focused on survival, maintaining homeostasis, and staying comfortable. These primitive drives worked very well on the Serengeti 250,000 years ago but don’t work so well in our efforts at evolving as people in 2023, so we can do more than just survive every day. Second, our emotional baggage (e.g., low self-esteem, perfectionism, fear of failure, need for control, need to please) helped protect us from pain as children but now keeps pulling us down the bad road of stagnancy and unhappiness. These deeply ingrained needs compel us to act in ways that served a purpose when we were younger but now prevent us from changing the course of our lives. Third, family dynamics can keep us stuck where we are. Most family dynamics (e.g., attitudes, beliefs, relationships, communication styles, hierarchies) get established early in our lives in ways that best meet the needs of those dominant in a family, and that enable a family to function. Family members expect those dynamics to remain intact. Pressure from parents, children, and siblings who are invested in who we are and don’t want us to grow out of fear that the existing family dynamic will be get disrupted or, even worse, they will lose us. Fourth, our popular culture exerts an outsized influence on us, most powerfully these days, through the many platforms found on the internet, most notably social media. Through persuasive technology, our popular culture does everything it can to control us, including our attitudes, beliefs, interests, attention, decisions, and behaviors. It wants us to conform to who it wants us to be rather than who we want to be, all in the name of accumulating more Benjamins (i.e., to make more money) with a reckless disregard for what is best for us. Fifth, we humans are creatures of habit (also for evolutionary reasons). There are three things we don’t like: unfamiliarity, unpredictability, and lack of control because on the Serengeti 250,000 years ago, if we experienced those three states, death was likely close behind. So, we establish habits, routines, and patterns that we rely on to feel safe and comfortable. By engaging in these habits over and over again, even if they aren’t healthy, they become so deeply ingrained in our psyches and neural structures that retraining our attitudes, beliefs, and behaviors and rewiring our brains can seem like an insurmountable hurdle. Sixth, for similar evolutionary reasons, we humans are also inert creatures. Think of us as asteroids hurtling through space. Unless a powerful force is exerted on the asteroid that is in our lives, we will continue on that same trajectory forever. Because of the size of our asteroid, the speed it is traveling, and the momentum it’s carrying, it takes a huge and persistent force to move our lives from its current inertial path. Lastly, despite our desire and determination at a conscious level to change our lives for the better, fear can hold us back from putting that drive into action. Due to evolution, fear is our most elemental force because it catalyzes immediate and powerful physiological and psychological changes that increase our chances of survival. Again, fear worked well on the Serengeti 250,000 years ago but doesn’t work very well today. What we fear most when we consider making significant changes to our lives is the unknown. We might not be happy, but our lives are familiar, predictable, and, as a result, perversely comfortable, and, except in extreme cases, we have learned to manage the difficulties we face. Your life may not be great now, but if you make a big change, there’s no way to tell what might happen. Again, due to evolution, we tend to focus on the bad things that might happen, so we choose, usually against our best interests, to maintain the status quo in our lives, however unsatisfying it is. As the saying goes, “Better the devil you know than the devil, you don’t know.” I apologize if I’m painting a rather discouraging picture of what it takes to change our lives for the better. But all of our best intentions and efforts will go for naught if we don’t recognize and confront the formidable, persistent, and mostly unconscious forces that can prevent us from taking the first step, much less completing our journey of positive life change (think walking into a gale-force wind). As you contemplate the kind of person you want to be and the type of life you want to lead, it is essential that you identify, understand, and mitigate these forces in your life until you’ve broken free of their “gravitational pull” and can pursue your most dearly held hopes, dreams, and goals with confidence, courage, and vigor, and without doubt, worry, or fear. Jim Taylor, Ph.D. - website - books

In the digital world, a computer screen doesn't inhibit psychotherapy. A study found digital therapy to be as effective as in-person therapy. It can also cut costs and reduce waiting times. Many people value the convenience of online therapy. A massive study, involving more than 27,500 people here in the U.K., has found that talking to your therapist online is just as helpful as seeing someone face-to-face. Not only that, but it also cuts costs and reduces waiting lists. The study, which was mainly an economic evaluation of service provision, also looked at waiting times and the clinical effectiveness of therapy for patients presenting mainly with anxiety and depression. The data was taken from the NHS Talking Therapies (NHS TT) program, which was formerly known as Improving Access to Psychological Therapies (IAPT). 1 The study found that online therapy (either therapist-delivered or via modules) also brought down costs and decreased waiting times for patients. “The actual cost of mental health care doesn’t come from treating these conditions but from not treating them,” said study co-author Ana Catarino, director of clinical science at ieso Digital Health. Catarino and her team compared ieso’s internet-delivered CBT (which has a therapist working one-to-one with patients via text chat) with therapy offered by the NHS (which involved a variety of therapeutic modalities and delivery methods). The study found that online therapy was more cost-effective than other forms of care because the patients that were offered the therapist-delivered CBT programme got treatment faster. This meant that their quality of life improved faster too. “The longer patients wait, the more likely they are to see their problems become more severe and to have a poorer response as a result of that wait,” said Catarino. The study itself does not surprise me at all, as the results are the same for private therapists as it is for the NHS and other platforms. I’ve been offering online therapy as an option (both for rational emotive behavior therapy, or REBT, and hypnotherapy) since the early days of Skype. I went totally online during the pandemic and now, three years later, my practice is roughly 50% face-to-face and 50% online. I’ve even found that people who say they would prefer to see me face-to-face often very quickly revert to virtual, as they favor the convenience of it. But convenience isn’t the only factor in people’s decisions to see their therapist digitally. Ease of use with and confidence in video calling via smartphones and tablets has also influenced people’s decisions, as has saved money (i.e., no travel costs are involved). Also, many of my clients often find that it is easier to fit a video call into their work/life schedule than it is to make a trip to my actual clinic. Most other therapists I know offer both face-to-face and online therapy as a regular part of their practice and several are pointedly online only (as this also fits better with their own work/life balancing acts). Seeing a private therapist online means you get to see the person you are talking to (as opposed to text and chat box or module-delivered therapy) plus, as the client, you are not restricted by your area, your region, or even your country. This gives you even greater choice in finding the best-fit therapist (in terms of both rapport and modality) than ever before. With technologies such as Zoom and Skype, the world (and the therapists within it) is indeed the mollusc of your choice. I have seen (and continue to see) people not only nationwide, but also across Europe and, occasionally, (where time zones allow) in South Africa, North America, and Australia. “Virtual care won’t be right for every person,” said Catarino. But its effectiveness, accessibility, and convenience cannot be ignored. COVID revolutionized the way people accessed mental health support. I also see people online as part of my work for The Priory Hospital. It wasn’t an option before the pandemic, but now it’s a service the brand actively promotes. Not only is digital therapy the right choice for a growing number of people, but it is also here to stay. Daniel Fryer M.Sc., MBSCH - website - media References 1: https://www.nature.com/articles/s44220-023-00106-z

People can be sexually abused in childhood without realizing it. People often have misconceptions about what childhood sexual abuse (CSA) actually is. Subtle forms of CSA, such as nudity or disrobing, are often overlooked. It is important to connect CSA with problems like alcohol and drug abuse and self-destructive or self-sabotaging behavior. As a psychotherapist with nearly 40 years of experience, I am always saddened by how many people were sexually abused in childhood or adolescence without realizing it. Many people don’t label what happened to them as abuse. Others minimized what happened to them and told themselves it was no big deal. Still, others blame themselves or tell themselves they asked for it. The sad truth is that unless we acknowledge a problem, we can’t heal it. For example, many suffer from symptoms including alcohol and drug abuse, eating disorders, self-destructive behavior, self-sabotaging behavior, sexual aversion, sexual dysfunction, and repeated sexual victimization without making the connection between what happened to them as children and the problems they currently suffer. For this reason, I believe it is important to be open to the possibility that the trauma of childhood sexual abuse may have caused your current issues. Even though child sexual abuse is being talked about today more than ever before, many people are still misinformed as to what child sexual abuse actually is. Many think of childhood sexual abuse as an adult having intercourse with a child. But childhood sexual abuse is not limited to intercourse. In fact, most sexual abuse of a child does not involve intercourse. Others don’t realize they were sexually abused because they were an adolescent who was older than 13 years old when the act or acts occurred. But sexual abuse includes an adult having sexual contact with an adolescent. Defining Child Sexual Abuse Let’s begin by defining child sexual abuse. Child sexual abuse includes any contact between an adult and a child or an older child and a younger child for the purposes of sexual stimulation of either the child or the adult or older child, and that results in sexual gratification for the older person. This can range from non-touching offenses, such as exhibitionism and child pornography, to fondling, penetration, incest, and child prostitution. A child does not have to be touched to be molested. Many people think of childhood sexual abuse as an adult molesting a child. But childhood sexual abuse also includes an older child molesting a younger child. By definition, an older child needs to be two years or older than the younger child, but even an age difference of one year can have tremendous power implications. For example, an older brother is almost always seen as an authority figure, especially if he is left “in charge” when their parents are away. The younger sibling tends to go along with what the older sibling wants to do out of fear or out of a need to please. There are also cases where the older sister is the aggressor, although this does not happen as often. In cases of sibling incest, the greater the age difference, the greater the betrayal of trust, and the more violent the incest tends to be. What constitutes child sexual abuse? Below is a comprehensive list of the various forms of childhood sexual abuse, taken from my most recent book, Freedom at Last: Healing the Shame of Childhood Sexual Abuse. Child sexual abuse can include any of the following: Genital exposure. Kissing. Fondling. Masturbation. Fellatio. Cunnilingus. Digital (finger) penetration of the anus or rectal opening. Penile penetration of the anus or rectal opening. Digital (finger) penetration of the vagina. “Dry intercourse.” (A slang term describing an interaction in which the adult rubs his penis against the child’s genital-rectal area or inner thighs or buttocks.) Penile penetration of the vagina. Pornography. Nude photography. More Subtle Forms of Childhood Sexual Abuse Even if someone wasn't sexually abused in any of the above-mentioned ways, there is still a possibility that they may have been a victim of child sexual abuse and may be suffering from damaging after-effects. Below is a description of the lesser-known, more hidden forms of sexual abuse. These forms of abuse can be just as shaming and damaging as the more obvious, overt forms. Subtle forms of sexual abuse can include any of the following. Keep in mind that it is the intention of the adult or older child while engaging in these activities that determine whether the act is sexually abusive. Nudity. The adult or older child parades around the house in front of the child. Disrobing. The adult or older child disrobes in front of the child, generally when the child and the older person are alone. Observation of the child. The adult or older child surreptitiously or overtly watches the child undress, bathe, excrete, or urinate. Inappropriate comments. The adult or older child makes inappropriate comments about the child’s body. This can include making comments about the child’s developing body (e.g., comments about the size of a boy’s penis or the size of a girl’s breasts). It can also include asking a teenager to share intimate details about her or his dating life. Even back rubs or tickling, in rare cases, can have a sexual aspect to them if the person doing it has a sexual agenda. Emotional incest. Emotionally incestuous parents turn to their child to satisfy needs that should be satisfied by other adults–namely: intimacy, companionship, romantic stimulation, advice, problem-solving, ego fulfillment, and/or emotional release. Parents who have been divorced or widowed sometimes attempt to replace the lost spouse with their own child. Emotional incest also occurs when a parent “romanticizes” the relationship between herself and her child, treats the child as if he or she were her intimate partner, or when a parent is seductive with a child. This can also include a parent “confiding” in a child about his or her adult sexual relationships and sharing intimate sexual details with a child or adolescent. Approach behavior. Any indirect or direct sexual suggestion an adult or older child makes toward a child. This can include sexual looks, innuendos, or suggestive gestures. Even if the older person never engaged in touching or took any overt sexual activity, the child picks up the sexual feelings that are projected. Hopefully, the above lists have helped further educate people on what constitutes sexual child abuse. Survivors may be surprised to discover that behaviors they thought were normal can actually be considered abusive and can cause considerable damage to a child’s psyche, in addition to causing great shame in a child. It can be painful and disorienting to come to the realization that you were, in fact, sexually abused, but please, believe me, it is better to know than to remain in the dark. When we are unaware of what has happened, we are extremely vulnerable to being manipulated or re-victimized and surprised and even damaged by our own behavior. When someone knows what happened to them, it may be easier to connect the dots between the abuse they experienced and their current problems. If someone learns that what happened to them is considered sexual abuse, they can reach out for help. Individual and/or group therapy can help heal the shame, pain, sense of betrayal, feelings of powerlessness, and feelings of anger felt due to the victimization. RAINN (the Rape, Abuse and Incest National Network) offers a free 24-hour crisis line (1-800-656-4673). Beverly Engel L.M.F.T. - website - books References: Engel, Beverly. (2022) Freedom at Last: Healing the Shame of Childhood Sexual Abuse. New York: NY: Prometheus Books.

“In time we hate that which we often fear.”—Antony and Cleopatra Some people have a phobia of Halloween or the ghouls and goblins associated with it. People with phobias, anxiety disorders, and substance abuse problems are most likely to suffer from abnormal fears. Phobias not only stimulate fear, but can also provoke hatred of the detested object. A phobia, as you may know, is defined as an abnormal or irrational fear. Phobias can emerge from negative personal experiences, or they can occur without any identifiable cause. But did you know that phobias can be induced by exposure to toxic groups or individuals? By the end of this post, it will be obvious to you how that can happen. What determines whether a fear qualifies as a phobia? The determining factors are the intensity of one’s reaction to the feared object and one’s capacity for coping with that fear. In short, does exposure to the feared object provoke a panic attack, psychotic break, or other debilitating response? For example, I’m afraid of spiders. If I see a spider, I kill it. That’s not a phobia. But did you hear about the man who burned his house down trying to kill a spider? That sounds like a phobia to me. Some people have a phobia of Halloween or the ghouls and goblins we associate with it. For them, October 31 is not pretend-scary but really terrifying. People with an extreme fear of Halloween “hate that which they often fear,” as Shakespeare observed. Phobias stimulate not just fear, but can also provoke hatred of the detested object, as shown below. Samhainophobia Fear of Halloween is Samhainophobia. Samhain was a Celtic festival celebrated at the end of October in the pre-Christian era. Celts believed the seasonal change that brings on longer nights and shorter days creates a pathway between the physical and spiritual worlds. Fairies and dead relatives might cross over into our world during Samhain. Celebrants dressed up as beasts or monsters to ward off spirits. Samhain eventually morphed into All Hallows Eve (Halloween) with the advent of Christianity and became further embellished with trick-or-treating, jack-o-lantern carving, and other familiar rituals. Wiccaphobia As you might deduce from the name, “wiccaphobia” refers to the fear of witches and witchcraft. If you have seen the movie Jesus Camp, which documents intense Christian fundamentalist indoctrination of young children, you may recall that the woman leading one of the sessions states that Harry Potter is a warlock and that warlocks are enemies of God. She goes on to tell her young audience that if Harry Potter had lived in Biblical times, he would have been put to death. While the Jesus Camp lady’s intended purpose was to discourage Christian youth from reading or watching Harry Potter, her toxic approach risks inducing chronic phobias of witches, warlocks, and witchcraft in her young audience. The above example shows how phobias can be induced by others. There is no shortage of preachers pushing the idea that witches and witchcraft are the handiwork of a very real and malevolent Satan. For example, see John Hagee: Schools Teach “Principles of Witchcraft” and "Pat Robertson claims feminism causes women to practice witchcraft." Exposure to such harangues, especially if one already believes in demonic powers, can induce a phobic response. Phasmophobia People who are profoundly afraid of ghosts suffer from phasmophobia. Most people with this phobia probably believe that ghosts exist, and such a belief would undoubtedly fuel their fear. Children are more prone to believe in and fear “actual” ghosts than adults. But it’s not necessary to be a child or to actually believe in ghosts to suffer from phasmophobia. Many people who would otherwise be immune to this fear might succumb to it if stranded near a graveyard after midnight. Demonophobia If some churches and ministers can foment fear of witches, imagine what they can do with demons, devils, and the Prince of Darkness himself. Ardent faith, Biblical literalism, and ministerial hysterics can combine to produce an extreme fear of the demonic in receptive believers. What effect do you suppose Hell House has on impressionable young minds? Of course, one could also acquire this phobia from a dogmatic friend or relative, or from books or movies that portray demonic activity. It’s also possible for this or any phobia to arise without any obvious cause. People with other phobias, anxiety disorders, and substance abuse problems are most likely to suffer from the above abnormal fears. And exposure to toxic influences can elicit or heighten phobias in vulnerable individuals. “To overcome fear is the beginning of wisdom.”—Bertrand Russell Dale Hartley MBA, Ph.D. - website

How to recognize an anxious-preoccupied attachment style. Recognizing the signs of an anxious attachment style is important for greater relationship satisfaction. Anxiously attached partners may seem excessively clingy, desperate, or over-invested in a relationship. Partners of anxiously attached people may feel smothered, tested, or exhausted. An estimated one in five adults has an anxious–preoccupied attachment style. Persons with this attachment style seek to feel closely connected with and reliant upon their partners. While these are healthy values, anxiously attached persons can experience their longings as so compelling that it overwhelms logic or their ability to control their feelings. In addition, anxiously attached persons may sacrifice healthy self-reliance and self-love in their pursuit of closeness. This can complicate intimate relationships. Being in a relationship with an anxious–preoccupied partner may feel exciting and engaging but can also feel stifling or unstable. Such feelings tend to be felt most acutely by someone with an avoidant attachment style, which is on the opposite end of the spectrum from anxious attachment. Anxious-preoccupied attachment—termed “anxious” for short—can range from mild to severe. It can vary from relationship to relationship and change over time. The following are seven tendencies of anxious attachment in relationships: 1. Anxiously attached partners seek repeated reassurance. Anxiously attached partners may view their self-worth, safety, and identity as flowing from the relationship rather than from within themselves. They worry that they care about the relationship more than their partner does. As a result, they can become preoccupied—thus, the "anxious-preoccupied" descriptor—and seek repeated reassurances that their partner loves them and won’t leave them. In their search for reassurance, people with anxious attachment styles may: Bombard their partner with texts or voicemails if the partner doesn't respond quickly Become nervous or upset if a partner seems distant, critical, or unhappy Try to "read between the lines" of their partner's comments or actions Repeatedly solicit compliments and acknowledgments The effect of an anxiously attached partner’s need for reassurance is this: Their partner may feel overwhelmed by excessive or unreasonable demands. 2. Anxiously attached partners crave closeness but have difficulty trusting it. Whereas an avoidantly attached person thinks “I can only depend on myself,” anxiously attached people think “I am not OK by myself.” Anxiously attached partners struggle with feelings they are unable to regulate or soothe. But looking outside themselves to solve feelings within is not sustainable. Anxiously attached partners may: Worry that intimacy isn’t real or won’t last. Find it hard to relax even when things are going well in the relationship. Become more anxious when times are good, for fear that the good times will end. Be on the lookout for signs their partner is growing tired of them. The effect of an anxiously attached partner’s difficulty trusting is this: Their partner may try to help the anxiously attached partner trust more, but over time come to feel that their efforts will never be enough. 3. Anxiously attached partners can unwittingly sabotage a relationship. People with anxious attachment fear they won't be OK without their partner. As a result, they may unconsciously deal with fears of their partner pulling away by pre-emptively pushing the partner away by: Being jealous or possessive Testing their partner’s love or loyalty Complaining or nitpicking Engaging in stalking or harassment Becoming despondent or argumentative when their partner wants solo activities or alone time The effect of an anxiously attached partner’s possessiveness is this: Their partner feels mistrusted. 4. Anxiously attached people seek to be perfect for their partners. Many anxiously attached partners feel they will be loved only if they are on their best behavior. They may worry that if their partner sees their deepest and most vulnerable parts, the partner will be turned off and reject them. Or they may believe they will be loved for what they do for their partner, not for who they are. Anxiously attached partners often feel that they alone must keep the relationship from falling apart. They work overtime at catering to their partner, yet silently resent their partner's failure to do as much as they are. In focusing so intently on their partners, anxiously attached people neglect their own needs. They may: Engage in people-pleasing behavior Have loose boundaries Try to be indispensable to their partner Accept unhealthy treatment Hesitate to ask for what they need directly The effect of an anxiously attached partner’s need to appear as perfect is this: Their partner may assume that their partner is happy and fulfilled, then feel blindsided by complaints seemingly out of nowhere. 5. Anxiously attached partners live in emotional turmoil. Unlike avoidantly attached people, who tend not to feel their emotions as acutely, anxiously attached partners feel awash with feelings of loneliness, emptiness, or lack of safety. They tend to: Live in terror of abandonment or rejection Experience frequent or dramatic emotional ups and downs Create drama The effect of an anxiously attached partner’s emotionality is this: Their partner feels smothered or exhausted. 6. Anxiously attached partners feel one-down in a relationship. Persons with an anxious attachment style may worry that there is something defective about them that drives people away. They struggle with feeling unlovable, powerless, alone, and undesirable. They may project these feelings onto their partner, misconstruing innocent actions as signs their partner doesn't care for them or is planning to leave. The effect of an anxiously attached partner’s one-down stance is this: Their partner can come to feel responsible for, and burdened by, their partner’s unhappiness. 7. Anxiously attached partners overinvest in the relationship. Persons with an anxious attachment style may enter a relationship feeling that they have finally found their much-desired intimate connection. As a result, they may: Seek to quickly deepen a relationship Frequently ask their partner how the relationship is going Idealize their partner or relationship Fixate on the relationship so that it becomes their main focus of time and attention The effect of an anxiously attached partner’s overinvestment is this: Their partner feels saddled with responsibilities they didn’t choose and cannot fulfill. Dan Neuharth, Ph.D., MFT - website References: Ainsworth, Mary D. S. (1978). Patterns of attachment: A psychological study of the strange situation. Lawrence Erlbaum. Bowlby, John. (1988). A secure base: Parent-child attachment and healthy human development. Basic Books. Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511–524. https://doi.org/10.1037/0022-3514.52.3.511 Levine, A. and Heller, R. (2010). Attached: The new science of adult attachment and how it can help you find and keep love. Tarcher/Penguin.

Framing it as a disease hinders recovery, so why keep doing it? Popular presentations of depression can promote, or hinder, treatment outcomes. The medical model of depression is linked to increased stigma. A new study shows that framing depression as an adaptation might improve treatment outcomes. Since the 1970s, psychiatrists have often depicted mental disorders as diseases. We’ve all heard the expressions: “Depression is like diabetes.” “Schizophrenia is like cancer.” Many thought that the disease metaphor would reduce the stigma surrounding mental illness. That’s because it doesn’t see depression or delusions as moral failures or character defects. It sees them as due to chemical imbalances. But does the disease metaphor actually help people with mental illnesses? A growing body of evidence suggests that framing mental illness as a disease doesn’t so much alleviate stigma, but replace one stigma for another. While the disease metaphor can reduce blame, it can also increase the perception that people with disorders are dangerous and can’t be cured. People who accept biological explanations tend to have lowered expectations about their ability to get better. An alternative paradigm sees depression as nature’s evolved “signal” that not everything is well with my relationships or plans. It’s designed to push us to reflect on our lives and make the necessary changes. Framing Depression as an Adaptation A groundbreaking new study, recently published in Social Science and Medicine, provides evidence that the purpose paradigm might actually promote healing. It was led by Hans Schroder, a Clinical Assistant Professor of Psychiatry and clinical psychologist at the University of Michigan. Schroder has long thought that depression could be evolution’s signal that something in one’s life needs attention. The question he poses here is how that framing impacts recovery. He and his collaborators recruited over 800 participants with experience with depression and divided them into two groups. Each group watched an informational video and then completed a series of self-evaluations. The first group watched a series of videos of a clinician presenting depression as a “disease like any other,” somewhat like cancer or diabetes. The second group watched a series of videos of a clinician presenting depression as a signal that serves an adaptive function. It’s your mind’s way of telling you that “something in life needs more attention.” Schroder’s work was inspired in part by the concept of mindset—that our expectations and attitudes have a profound influence on mental health. 3 Measures of Well-Being Schroder and his team found that people in the second group made greater strides on three measures: “offset efficacy,” “depression adaptability,” and “self-stigma.” First, people exposed to the design framework felt less helpless about their depression (“offset efficacy”). They believed that their personal efforts were crucial to healing. Second, people presented with the design framework felt that their depression had a useful function, for example, that it leads to new insights (“depression adaptability”). Third, the design framework led people to feel less stigma about their condition (“self-stigma”). For example, they were less likely to think they needed to hide their depression from others. Schroder and his collaborators point out that one reason the study is so important is because of the sheer dominance of biological explanations of mental illness in the public sphere. For example, 90 percent of licensed social workers surveyed in a recent study often use the “chemical imbalance” metaphor of depression with their clients. And nearly half of all YouTube videos about depression present biological causes, rather than environmental or social ones. The authors point to the role of pharmaceutical advertising, public health campaigns, and technological innovations in explaining how disease framings became so widespread. In light of this new research, the question of whether to keep using the disease metaphor has become a profound moral problem. If framing depression as a dysfunction or disorder can obstruct recovery, what justification is there for continuing to use it? Justin Garson, Ph.D. - website - books

How can we set boundaries without the fear of future regrets or guilt? Setting boundaries with parents with BPD/NPD is challenging as they can be controlling. One factor often looms largest: The fear of regret. With newfound freedom, we can start looking ahead to new possibilities. Setting boundaries with parents suffering from personality disorders such as borderline personality disorder (BPD) or narcissistic personality disorder (NPD) can be a challenging process for many, especially when they act in emotionally immature, needy, or controlling ways. No matter how much you read or how much therapy you had, you may still feel helpless in the face of their constant need for your attention and approval. Perhaps your parent with BPD/NPD always wants validation and demands your presence without considering your needs. When you try to establish boundaries, they may guilt trip you, manipulate your emotions, and make you feel responsible for their feelings. It's especially difficult when they give you brief moments of warmth, empathy, or the promise of a real connection. It's tempting to keep trying, hoping that this time will be different. However, like quicksand, this glimmer of hope quickly turns into a treacherous game. It becomes an addictive cycle, much like playing a slot machine. You may feel compelled to keep trying for deep conversations and share your life with your parent with personality disorders. Yet, no matter how hard you try, your efforts are met with a stone wall. What stops you from stepping away from parents with BPD or NPD? Perhaps it is the emotional blackmail, the long-held sense of responsibility instilled in you from birth, fear of societal judgment, and the pressure to compensate for your siblings who might have left. But two factors often loom the largest: guilt and the fear of regret. What if you regret not doing more to care for them, and it becomes too late? What if you feel guilty for hurting their feelings? What if when they pass away, overwhelming guilt and endless regret haunt you for the rest of your life? Conscious or not, these questions might haunt you and stop you from walking away. Fear of Regrets When You Set Boundaries Rather than letting our fears take hold and stopping us from taking productive actions, let's confront these fears head-on and explore them with intelligence and reason. What exactly do you fear? What's the worst-case scenario? You might find yourself saying, "I'm afraid of missing out on the only chance to have a relationship with my parents." But pause for a moment and consider the truth behind this "relationship." Have you genuinely felt deep connections, or is it a residue of societal expectations about what a parent–child relationship should be? Was it just a story you've been told like you had a "happy childhood" because you were materially provided for? As you dig deeper into this investigation, you might realize that there might be little substance behind the facade of a "normal" parent–child relationship with a parent with BPD or NPD. Despite your desires and numerous attempts to establish a genuine connection, your parents' psychological limitations might have made it impossible. If you can be brutally honest with yourself, you might uncover a truth that resonates: the idea of a genuine and meaningful parent–child bond has always been just that—an idea. It's like a fantasy that has persisted, with your inner child desperately holding onto the idealized image of a nurturing parent and refusing to let go. When you find yourself stuck in a never-ending cycle of pointless efforts, it's important to face the one tough thing you might have been avoiding: grieving for what you never had. Grieving What Was Not There You might be wondering, "What do you mean by grieving what I never had? Haven't I already experienced enough sadness and grief in my life?" In psychoanalysis, there's a theory that suggests depression can be a form of denial—a refusal to grieve fully. When you find yourself trapped in persistent, low-grade depression, you unconsciously numb your emotions and withdraw from meaningful engagement with the world. It is a way of defending against the darker truth with your parent with BPD or NPD; like a shield, it masks you from feeling the pain of unmet desires and shattered dreams. But this shield comes at a high cost. You end up sacrificing joy, authenticity, motivation, spontaneity, and vitality in life. Perhaps, to move on is to understand the difference between passive reactivity and genuine mourning. Simply getting caught in a cycle of longing and disappointment, triggered by everyday events and interactions with your parents (when they once again break promises, dismiss you, gaslight you…) isn't true mourning. But it is not your fault to keep hoping things with your parent will be different. From fairy tales to ancient folklore, the yearning for ideal parents, nurturing love, and unwavering guidance runs deep in our DNA. As a child, you caught glimpses of what could have been, fueling your persistent longing for a different reality. Unfortunately, when you have parents with BPD or NPD, your childhood becomes a constant oscillation between harsh reality and sweet fantasy. You catch glimpses of the Fairy Godmother, but all you have is the Wicked Witch. Authentic grieving requires courage; it might mean giving yourself permission to weep, scream, write, draw, or express your inner turmoil in any way that helps release pent-up emotions. By releasing the weight of unfulfilled expectations, you open up new possibilities for a different future. Knowing That You Have Done Your Best When you can come to reconcile with the reality of who your parents are, including their true limitations, you will come to a profound realization: You've truly done your best. There's nothing more you could have done. Setting boundaries with them isn't just justified; it's the only viable option. By now, you've learned enough from past experiences that firm boundaries and safe distance are necessary for both your own well-being and theirs. They may or may not understand this, and they may or may not protest against it, but that is irrelevant. Most importantly, you understand that the enmeshed and dysfunctional dynamic doesn't serve either of you, and you choose to do what's right. Even if they don't admit it, they might know deep down that their constant need to control your life is toxic. They feel guilty about it, but their emotional immaturity or fragility traps them in old patterns. When you gather the strength to set boundaries with parents who are trapped in their disorders, you embark on a courageous journey of untangling the intricate web that binds both of you. In other words, it is not a cruel act; it's an act of profound honor and integrity. Reflecting on Your Values Instead of focusing on what might be lost, perhaps you can reflect on what you can gain. For example, how might you be honoring yourself and your values? Here are some examples: Personal growth. How can establishing boundaries contribute to mutual growth and understanding? Honesty. Reflect on times you sacrificed your own true values just to protect their feelings. Is that what it means to live honestly? Authenticity. Do you really want to spend the rest of your life perpetuating the illusion of a picture-perfect family rather than admitting that human relationships can be imperfect and complex? Realism. Assess what is realistically possible in your relationship with your parents. You might have to grieve the parents you do not have and come to see them for who they really are, not keep re-traumatizing yourself with disappointment. Harmony. What might create the most harmony for everyone involved? "More contact," as they might childishly wish for, is not always the best. There might be an optimal "sweet spot" you need to find when it comes to the amount of contact. See if you can find that optimal distance while avoiding enmeshment and discord. Asking Different Questions Instead of asking, "What if I regret it?" here are some equally valid questions to ask yourself: "What if I end up regretting sacrificing my own happiness and well-being just to keep my parents happy?" "What if I get stuck in the same old generational trauma instead of breaking free and stopping it from affecting my (potential) future family and me?" "What if, when I'm older, I realize it's too late to discover who I truly am beyond who they want me to be?" "What if I could have leveled up my career, found my soulmate, and enjoyed my freedom if I had just freed myself of their unreasonable demands?" "Will I regret all the compromises I've made when I see how much damage they've done to my self-worth, identity, and ability to connect with people?” Setting Boundaries With Parents With BPD/NPD: An Honourable Act It is certainly not your fault that you hope to have parents who will love and understand you unconditionally. But the painful reality is that not all parents are capable of fulfilling those expectations, and sometimes we need to be the bigger person and do the hard thing by setting firm boundaries with them. Setting boundaries with your parents doesn't make you cruel or defiant; it is a sign that you value yourself and want to live life honestly rather than hiding in the shadow of their dysfunction. As you go through this process, you'll realize that your personality and psychological limitations do not diminish who you are and how much you deserve to be loved. With newfound freedom, you can start looking ahead to a world of possibilities. The wounds may still be there, but they no longer define who you are. Your scars become powerful symbols of resilience, showcasing your ability to rise above adversity. The most important thing to remember is the love you've been searching for, and it resides within you. Ultimately, you are your best parent and have the power to nurture and care for yourself. Imi Lo - website References: Bartsch, D. R., Roberts, R. M., Davies, M., & Proeve, M. (2015). Borderline personality disorder and parenting: Clinician perspectives. Advances in Mental Health, 13(2), 113–126. Clewell, T. (2004). Mourning beyond melancholia: Freud's psychoanalysis of loss. Journal of the American Psychoanalytic Association, 52(1), 43–67. Fonagy, P. (2001). Attachment Theory and Psychoanalysis. Other Press, LLC. Pedder, J. R. (1982). Failure to mourn, and melancholia. The British Journal of Psychiatry, 141(4), 329–337.

A Personal Perspective: Behavioral activation was a game changer for me. These tips have helped me improve my mental health; maybe they'll resonate with you. 1. Recognizing the Warning Signs I've been feeling pretty darn good on the whole. But today and yesterday, I woke up feeling sluggish with a little pull or tug of ‘uugggghhh’. I’ve learned this may be a sign my mood and mental state are shifting. It also means I need some self-care. Paying attention to the first signs of fatigue, apathy, and overall ‘uuggghhh-ness’ (as I like to call it) is the first step towards regaining my well-being. 2. The Power of Exercise Exercise has consistently proven to be an invaluable tool in managing my mental health. Yet, as is the nature of ‘uggghhh-ness’, it's hard to get past its inertia to start exercising. However, what I find, and today was no exception, the simple act of getting out my running togs and putting them on sparked a little excitement and motivation. Just a glimmer. Then once I was out the door and in nature, it felt good to be moving and I felt a little better about myself. My low mood didn’t vanish, but it was shaken up a bit. 3. The Behavioral Activation Technique What I’ve done today is an example of one of the strategies I employ when I’m feeling low: behavioral activation. This approach involves engaging in activities that can bring about a positive change in my mood. By actively participating in a task that’s important to me, I can counter the overwhelming inertia that depression often imposes. It doesn’t guarantee that I will feel better, but it helps to prevent me from spiraling down any further. Today, the two important items I ticked off were exercising and accomplishing a personal goal (which was going for a run). These accomplishments serve as powerful reminders that “I can do hard things” (as Glennon Doyle has popularized the phrase). I direct my life, not depression. 4. Small Accomplishments and Self-Efficacy Engaging in physical activity offers more than just the immediate benefits to our bodies. There's an undeniable sense of accomplishment and self-efficacy that accompanies completing a task, no matter how small. You know that little dopamine hit you can get by ticking off one of your to-do’s? Making my bed, taking a shower, just putting on my sneakers and tying them up, or the most courageous one of all sometimes, reaching out and calling a friend, all of which take enormous energy when you’re severely depressed, can contribute to a sense of progress. That progress moves me along my journey out of depression and anxiety and into wellness. 5. The Impact of Simple Achievements Regardless of whether I’ve exercised for two minutes or 20, focusing on achieving even one small, simple task can make a remarkable difference. It's easy to overlook the significance of seemingly mundane achievements. Yet, for myself and others living with mental health challenges, these small victories hold a lot of value. When I’ve accomplished something, it boosts my self-esteem and self-confidence and reinforces the belief that I’m capable of overcoming obstacles. Remember, it's not about the size of the accomplishment; it's about the positive impact it has on well-being. Nurturing self-efficacy can play an essential step in improving mental health, decreasing depressive symptoms, and reducing anxiety. Remember: Pay attention to warning signs, embrace the power of exercise, and celebrate even the smallest victories. We’re in this together and together we can find hope, resilience, and strength in our journey toward better mental well-being. Victoria Maxwell - website - books

Identifying your triggers is important for overcoming panic attacks. A panic attack can be particularly frightening when you don't know what caused it. You can identify your unique triggers (body sensations, thoughts, and feelings) by examining patterns with your panic attacks. Knowing your triggers can help you come up with strategies to overcome panic attacks. You are sitting at home, watching a suspenseful movie. Out of the blue, your heart starts pounding. You feel like you can't breathe, your face gets hot, and your fingers start tingling. You've had these sensations before, and your mind goes back to a familiar thought: I'm having a heart attack, and I'm dying! However, you are still alive, and you are reading this article. It turns out it was another panic attack. Panic attacks can be frightening, especially when they are unexpected. Suppose you have a panic attack before a test or before giving a speech or when you see police lights flashing in the car behind you. It still can be scary and extremely uncomfortable. However, the fear can reach epic proportions when the attacks seemingly come from nowhere. Knowing more about your triggers can help defuse some of your anxiety during a panic attack and ultimately lead to overcoming them. The fight-or-flight response The fight-or-flight response is your body's reaction to danger. Having a powerful anxiety response can be helpful. If you were crossing the street, and a motorcycle came barreling towards you, you would need to have a quick reaction to get out of the way. However, some people are prone to having an extreme stress response in situations that don't warrant it. When there is no outside stressor, people try to figure out the reason for their intense body sensations. They often think there is something physically (or mentally) wrong with them. Why do people have panic attacks? Biological and genetic factors make more people more prone to experiencing repeated panic attacks. Here are some other risk factors: Sensations: High anxiety sensitivity: Research has shown that people with recurring panic attacks tend to have high anxiety sensitivity (fear of anxiety sensations). They pay too much attention to their bodies to ensure everything is OK. It's normal to experience changes in body sensations throughout the day, and most people don't notice them. However, those with high anxiety sensitivity can misinterpret harmless body symptoms as dangerous and set off a panic attack. Thoughts: Beliefs about the risk of physical and mental problems: Some people think they are at significant risk of physical or mental issues. For example, maybe they had a history of physical illness in childhood or lost a loved one to a heart attack. Or perhaps they have a relative with schizophrenia and worry that they might develop the disorder at some point. Or maybe they fainted and then became fearful of fainting. Thus, someone feeling vulnerable in these ways might misinterpret anxiety or panic symptoms as a sign of having a heart attack, "going crazy," or fainting. People with these types of fears also tend to have high levels of anxiety sensitivity. Situations: Fear of situations where previous attacks occurred: For those with recurring panic attacks, certain situations become associated with panic attacks. For example, someone might have been driving on the freeway on the way to a job interview, got anxious, and then had a panic attack. As a result, they might associate freeway driving with panic attacks and worry about losing control of the car and causing an accident. This fear might cause them to avoid driving on the freeway altogether. How to identify your triggers: Think about your first panic attack. Where were you? What was going on? What stressful things were going on in your life? What symptoms did you have? What interpretation did you make about the attack—did you think you were dying, losing control, going "crazy," about to faint? Think about more recent panic attacks and apply those same questions above as your first panic attack. Notice if there are any patterns. Also, note any situations you are currently avoiding for fear of having another panic attack. Now, write down specific triggers in terms of sensations, anxiety-producing thoughts, and situations. Here are some examples: Whenever I notice my heart beating fast or hear about someone having a heart attack, I think I'm going to have a heart attack. When I can't concentrate on something, I worry that I'm losing my mind, which causes me to panic. When I am in a situation where I feel like I cannot escape, like in the dentist's chair or a crowd, it causes me to have a panic attack. Put your knowledge of triggers to use. Now that you have identified your triggers, here's how to use this information: Sensations: If you notice uncomfortable body sensations, even if they seemingly come from out of nowhere, remind yourself that it is normal for this to occur. Also, tell yourself that you are likely to be hyper-aware of body sensations because you are vulnerable to panic attacks. You can also refer to a previous post I wrote for additional steps to reduce body awareness. Thoughts: Remind yourself of other times you have panicked, and your feared outcome didn't occur. For example, if you fear dying during an attack, ask yourself how many times you have had that thought and how many times you actually died. Panic attacks are not dangerous, even though they feel that way. If you have a health concern that you are worried about (e.g., heart attacks), talk to your doctor about it to alleviate your concerns. Situations: If you are going into a situation that you associate with panic attacks, remind yourself in advance that you might get anxious and possibly panic. However, all panic attacks are temporary and not dangerous, and you will be OK. If you are tempted to avoid a situation that you associate with panic attacks, try to resist the urge. Avoidance only makes situations scarier. Coach yourself through the situation by telling yourself that panic attacks are not dangerous and every panic attack will end. In sum, panic attacks feel scary and uncontrollable. However, the more you learn about your specific triggers, the more you will feel in control, which is an important step in conquering panic attacks. Bonnie Zucker, Ph.D. - website - publications References Norton, P.J., & Sears Edwards, K. (2017). Anxiety sensitivity or interceptive sensitivity: An analysis of feared bodily sensations. European Journal of Psychological Assessment, 33(1), 30-37. Ohst, B., Tuschen-Caffier, B. (2020) Are Catastrophic Misinterpretations of Bodily Sensations Typical for Patients with Panic Disorder? An Experimental Study of Patients with Panic Disorder or Other Anxiety Disorders and Healthy Controls. Cognitive Therapy Research, 44(6), 1106–1115. Van Diest, I. (2019) Interoception, conditioning, and fear: The panic threesome. Psychophysiology, 56(8), 1-27.

Personal Perspective: Lessons from my ADHD son's attempts at a driver's license. Factors such as distractions and overthinking can become safety concerns regarding teen drivers with ADHD. Teens with ADHD may need more time to obtain a driver's license. Implementing safe driving strategies can decrease reckless driving in ADHD teens. I recently viewed a webinar about teen drivers with ADHD, which gave me the idea to write about my son’s experience getting his driver's license. Like any parent of a teen anxious to get behind the wheel, I was nervous about my ADHD son starting to drive. This is not surprising when the data on teen drivers with ADHD is so bleak, with studies reporting an increased risk of accidents, more fines and points on drivers’ licenses, speeding, and impaired driving. My son understands his ADHD, with all its limitations. He would often make fun of himself, teasing about how he would probably drive the car into a ditch. So, how did my son’s experience passing the driver’s test go? It was a bit of a bumpy road (please forgive the pun). It may take ADHD teens longer to get their driver's license. In our state, a teen can get a learner's permit at 15 years and 9 months, and a license at 16 years and 6 months. My son took the required driver’s education class and passed the written exam right on schedule. I had been through the experience of teaching someone to drive with my older son, but was nervous my ADHD son, with his inattention and risky behaviors, would be a more dangerous driver. To my surprise, my son was more careful and attentive than his older brother when learning to drive. He navigated narrow streets with ease, had better spatial awareness (I didn’t feel the need to grab the steering wheel to avoid hitting the mailboxes lining the road), and was careful on the highway. I began to think he would have no problem passing the road test to get his driver’s license. After my son met all the requirements, I scheduled his road test with the Motor Vehicle Association. At the time of his test, COVID restrictions were still in effect, so the instructor did not get in the car with my son, and the test was conducted on a closed course with limited space for maneuvering the vehicle, as opposed to having him drive through the local neighborhood. When it was my son’s turn, I wished him good luck and got out of the car. I watched him perform one task after the other, and then I saw him get out of the car before the end of the course. I knew he failed. On the ride home, I consoled my son, listing the names of all his friends who didn’t get their licenses on the first try. In the coming weeks, we spent time working on the task he failed, and I found out his driving instructor never gave him crucial information about the road test which would have made it easier for him to perform the required maneuvers. True to his inflexible ADHD brain, he was driving for the test the exact way she had him driving during their sessions, which were not conducted on a cramped closed course. With the new information in hand, I felt confident my son would pass the driver’s test the next time around. So, he went back a second, and third, time and left without a driver’s license (he failed a different task each time). You can imagine how discouraged my son was at this point. This would be hard to take for a teen without ADHD, never mind someone who has little confidence in their ability and constant negative self-talk. How my ADHD son passed his driver’s test My son was a hurdler on the high school track team. One day, he was explaining to me that in order to be faster, he had to stop overthinking how to go over the hurdle (what leg was leading, how many steps he was taking between hurdles), since it was slowing his pace down right before jumping. Those with ADHD are notorious for being overthinkers, anxiously worrying about the details and the worst possible outcomes. I looked at my son and told him to stop thinking about it so much, he knew what to do, and to just go over the hurdle. Eventually, his speed improved. After listening to his story, I realized my son was doing the exact same thing when he was taking the driver’s test—overthinking. A few days shy of his 17th birthday, my son was going to attempt to pass his driver’s test for the fourth time. This time we went to a different Motor Vehicle location, in the morning instead of after school (his ADHD symptoms are worse in the afternoon after focusing all day in school). A smiling older man came out to greet my son, and even joked with him a bit, contrary to the business-like demeanor of his previous evaluators. I could see my son relaxing. When it was time for me to get out of the car, I reminded him about overthinking the hurdles and told him to forget about the test and to “just drive the car." Although I was trying to be positive for my son, I couldn’t bear to watch the test this time around. When I saw the instructor walking over to me, I simply asked if my son had failed. With that same smile, he said my son was an excellent driver. Finally! Tips for helping teens with ADHD be safe drivers Russell Barkley, Ph.D. and Daniel Cox, Ph.D. designed The ADHD Safe Driving Program, a step-by-step approach to help teens to develop safe driving habits. Some strategies to help your ADHD teen be a safe driver can include: Practicing often when your teen is learning to drive. Restrict driving to local locations like school or a job. Limit distractions like cellphone use, music, and number of passengers in the car. Use an app to monitor your teen’s driving. We used one that would alert us if our sons were in an accident, driving recklessly, or using their cellphones while driving. Make sure your teen has plenty of time to get where he/she is going (those with ADHD are time-blind and can end up rushing). My son was late for school one morning and, trying to make it on time, passed a stopped school bus loading children, resulting in a $250 fine. Know your child. Are they mature enough for a driver’s license? Do you feel comfortable with their driving skills? My son had to drive well and with confidence in several environments (e.g., weather, city traffic, highway, narrow streets, long drives) before he was allowed to take the driver’s test. Consider treating your teen for their ADHD; those who are treated for their ADHD are safer drivers than teens not on medication. Kristin Wilcox, Ph.D. - website - book

What do you know about attachment styles in an intimate relationship? Couples don't need identical attachment styles to function successfully in a relationship, but knowing how it impacts the relationship can help. Even with two securely attached people, the need for communication and problem-solving is crucial for a healthy relationship. Differing attachment styles may require extra intention and effort to work through problem areas. When we enter an intimate relationship, whether we have a complementary attachment style to our love interest is not on the radar in the least, but ultimately it is the factor that influences relationships the most. Couples do not need to have an identical attachment style to function successfully in a relationship but having an awareness of the ways one’s style can impact the relationship increases the odds of satisfaction and longevity. Attachment develops as a result of nature and nurture. It begins in utero and is influenced by maternal experiences and genetics. It is then impacted during early childhood in the ways caregivers respond to our cries in infancy, how our needs are met, and the way we are treated. Throughout our lives, relationships with family, friends, and others play into our attachment style, reinforcing or correcting our innate understanding of how other humans respond to us. Through this collection of experiences and genetic wiring, our attachment style is borne. Attachment styles are classified as secure, avoidant, anxious, or disorganized. How Couples’ Attachment Styles Impact the Relationship Two people with secure attachment are likely to have a greater sense of stability in their relationship. Not to say that the relationship will be perfect or without strife, but the baseline ability to trust the process of human relationships is a good indicator for success. Even with two securely attached people, the need for communication and problem-solving is crucial for a healthy relationship. For couples in which one (or both) people have anxious, avoidant, or disorganized attachment, communication can be difficult. Communication Issues Attachment style can impact the way couples communicate, and often it is as much about what is unspoken as what is said aloud. People who struggle with anxious or avoidant attachment styles may read too much into non-verbal communication or make assumptions about their partner’s intent or feelings based on underlying beliefs about themselves. Someone who has an avoidant attachment style may struggle with confrontation and this can result in resentments and perpetuated miscommunication between couples. Problems With Trust Trust is a primary challenge for people with insecure attachment styles. It may not even be obvious that the underlying issue is trust-related, but it manifests in murky ways like not fully investing in a relationship or keeping emotional distance for self-protection. More obvious ways trust is affected are through jealousy, insecurity about a partner’s dedication, and feeling preoccupied by self-doubt. Insecure attachment can even contribute to infidelity, as there can be a sense of relationship futility, boredom, and challenges with getting one’s needs met. Positive Outcomes for Differing Attachment Styles in Relationships Differing attachment styles in a relationship does not mean imminent doom, it just requires extra intention and effort to work through the problem areas. Sometimes couples who have attachment differences can experience personal growth because of their work in a relationship, and this can mean greater couple satisfaction and a healthier sense of self-worth. While no one should enter a relationship with the expectation of healing personal pain, (a setup for failure), sometimes it can become a joint effort and a happy side effect if two people are committed to mutual growth. Healing Old Wounds Couples who begin to explore the way their attachment styles affect their relationship may find that it helps reframe a lot of past life events, including prior relationships and lessons learned in childhood. When individuals are doing their own attachment work within a safe, loving relationship it can offer a lot of healing. The work is two parts; one’s own journey toward exploring self-worth and having a safe place to practice healthy attachment behaviors within a committed relationship. Learning to Trust One of the most beautiful aspects of couples growing together and doing attachment work is the mutual trust that can be built. Learning how to communicate and get one’s needs met effectively, gaining a greater understanding of how attachment directs relationship behaviors, and finding workarounds can disrupt insecure attachment and offer new, healthier experiences. Even though our innate attachment style is hard-wired, we can make informed decisions about thoughts, feelings, and behaviors that can shape the quality of our relationships with ourselves and others. Couples who have differing attachment styles may find that the best is yet to come when they are open to exploring attachment together. Teyhou Smyth, Ph.D., LMFT - website - articles

Recent findings may lead to a way to prevent nightmares. Nightmares are remembered intensely and often reappear on subsequent nights. Animal studies support a role for bottom-up mechanisms involving the brainstem, especially those controlling the autonomic nervous system. A recent study confirmed that frequent nightmares were associated with emotional dysregulation and altered autonomic activity. Subjects who reported more nightmares exhibited enhanced heart rates during all sleep stages and significantly reduced parasympathetic activity. The mechanisms involved in the origin of dreams remain one of the great unknowns in science. Dreams are typically viewed as fascinating, but largely irrelevant, mental epiphenomena of the sleeping brain with questionable functional relevance. Despite the many dreams people experience each night, most are lost into oblivion. But not all. Nightmares are remembered intensely and often reappear on subsequent nights. Nightmares are vivid, distressing dreams that usually cause the sleeper to awaken abruptly with a clear recall of the details. Fortunately, only a small percentage of the general population experience weekly nightmares. Psychologists believe that nightmares may be an indicator of psychopathological processes given that they are more common in psychiatric populations. Children , who have more REM sleep each night than adults , report a greater frequency of nightmares, while the elderly , who have far less REM sleep each night than adults, report nightmares much less often. Overall, females report more nightmares than males. Studies suggest that dreaming relies on multiple generators within the brain. Dreams are primarily visual; thus, it was once assumed that higher perceptual cortical systems play a critical role in dream generation. However, congenitally blind people report visual dreams. Thus, dreams must be originating from non-cortical structures. Decades of animal studies strongly support a role for bottom-up mechanisms involving brainstem structures, especially those involved in controlling the autonomic nervous system. Nightmares are a characteristic symptom of PTSD . However, most people have idiopathic nightmares that are not related to a specific traumatic experience. Nightmares are reported more often by heavy smokers, people with type 2 diabetes mellitus, anxiety disorder , and constipation. The sleep of people with chronic nightmares is fragmented due to frequent awakenings and short periods of intense arousal that are associated with intensified cardiac activity that indicate activation of the sympathetic nervous system and attenuation of the parasympathetic nervous system. A recent study investigated whether nightmares are caused by an altered autonomic regulation. Ordinarily, the sympathetic and parasympathetic systems are in a perfect Yin-Yang balance: as one increases in activity, the other decreases equally and symmetrically. This recent study monitored the parasympathetic nervous system activity during nightmares as well as while the subjects were awake and performing emotionally challenging tasks. The investigators hypothesized that the parasympathetic nervous system was less active during nightmares and while performing an emotionally challenging task. The study confirmed that frequent nightmares were associated with emotional dysregulation and altered autonomic activity. Subjects who reported more nightmares exhibited enhanced heart rates during all sleep stages, as well as during the daytime, and significantly reduced parasympathetic activity. The increased heart rate during slow wave sleep is surprising given that this sleep period is usually dominated by the parasympathetic system. The authors concluded that nightmares that are not directly caused by trauma are most likely induced by dysregulation of the parasympathetic nervous system. The dysregulation may be due to dysfunction of limbic structures, such as the hypothalamus (which might explain the prevalence in females due to hormone fluctuation) or the amygdala, that are known to directly control activity of the autonomic nervous system. It is important to understand the cause of increased occurrence of nightmares since their frequency is linearly and statistically significantly associated with higher risk of cognitive decline amongst middle-aged adults, and higher risk of dementia amongst older adults. Gary L. Wenk, Ph.D. - website - book References: Tomacsek V et al (2023) Altered parasympathetic activity during sleep and emotionally arousing wakefulness in frequent nightmare recallers. European Archives of Psychiatry and Clinical Neuroscience. https://doi.org/10.1007/s00406-023-01573-2 Wenk GL (2017) The Brain: What Everyone Needs To Know. Oxford University Press.