Reducing the risk of suicide involves a range of measures implemented over time. Self-harm and suicide are substantial public health problems, but are essentially impossible to predict in individual cases. Self-harm is a risk factor for suicide, but the proportion of people with suicidal thoughts who go on to complete suicide is less than 1 in 200. In an overall sense, good mental health care, communication with families, and good follow-up all likely help to reduce risk of suicide. Public education and measures to limit access to means of self-harm are also important and effective. Each year, more than 700,000 people die by suicide. Many more engage in deliberate self-harm. As a result, there have been extensive efforts to predict and prevent both. Key risk factors for non-fatal deliberate self-harm include female gender, younger age, poor social support, major life events, poverty, being unemployed, being divorced , mental illness, and previous deliberate self-harm. Key risk factors for suicide include male gender, poor social support, major life events, chronic painful illness, family history of suicide, mental illness, and previous deliberate self-harm. For both deliberate self-harm and suicide, the availability of means is significant (e.g. easy availability of tablets to take overdoses). Suicide is associated with major depression (long-term risk of suicide: 10-15 percent), bipolar affective disorder (10-20 percent), schizophrenia (10 percent), and alcohol dependence syndrome (15 percent). In addition, individuals who engage in deliberate self-harm have a 30-fold increased risk of completed suicide over the following four years. Predicting Suicide Despite these associations from the research, the majority of people with these risk factors will not die by suicide. This is because the increases in risk associated with these risk factors are small and, despite its tragedy and implications, suicide is (from a mathematical viewpoint) a statistically rare event. As a result, it is impossible to predict suicide at the level of the individual. There have been many studies of this, and all yield similar results. One classic study followed up almost 5,000 psychiatry inpatients after discharge, using a combination of known risk factors to try to predict suicide in this especially high-risk group. While this study succeeded in predicting 35 out of 67 subsequent suicides, their model also generated over 1,200 “false positives” (i.e. predicted suicide in over 1,200 individuals who did not die by suicide). That's because suicide is, statistically, a rare event, and rare events are either very difficult or impossible to predict. The risk factors for suicide (male gender, poor social support, etc.) are both very non-specific and very common in the population, so the vast majority of people with these risk factors will not die by suicide. This is true even for people who have thoughts of suicide, as the proportion of people with suicidal thoughts who go on to complete suicide is less than one in 200. This suggests that simple population screening for suicidal thoughts is unlikely to be either effective or efficient in identifying individuals at risk of suicide. Overall, then, it is impossible to predict suicide in any individual case. Bereaved families sometimes believe that there were signs they missed or that health professionals should have predicted the outcome in cases of suicide. Statistically, however, there is no way that anyone can predict suicide in an individual case. What Can Be Done? If the risk is impossible to predict accurately at the individual level, what can be done? Plenty. First, despite the impossibility of prediction in individual cases, careful, realistic clinical assessments and risk explorations are still very useful for guiding treatment and providing support to people who present with a suicidal crisis or mental illness—although it must be remembered that these assessments do not provide a basis for statistical prediction of precisely which individuals will engage in deliberate self-harm or suicide, and which individuals will not. In an overall sense, however, good mental health care, good communication with families , and good follow-up likely all help to reduce the risk of suicide. Good treatment of depression in primary care (by family doctors) is essential, as is the treatment of substance abuse (including alcohol) and management of specific mental disorders by specialist teams. In emotionally unstable personality disorder, psychological therapies can prove helpful, including adaptions of cognitive-behavior therapy (CBT) and dialectical-behavior therapy (DBT). DBT is somewhat similar to CBT and also involves group sessions, building skills such as mindfulness, and developing coping strategies other than deliberate self-harm for dealing with emotional instability. DBT is challenging but can be highly effective for reducing self-harm in certain conditions, including (but not limited to) emotionally unstable personality disorder. Public Health From a public health perspective, public education and measures to limit access to means of self-harm are important and effective. Regulations governing acetaminophen (paracetamol) sales are an excellent example as they greatly reduce harm resulting from overdose. Placing barriers at known suicide locations (e.g. certain bridges) is another effective method for deterring self-harm and suicide. Research shows that a great number of people who are deterred or delayed in this fashion will re-consider their suicidal thoughts and very many will not proceed to find other means of self-harm. Good primary care, good mental health care, and appropriate public health measures are, then, essential for addressing deliberate self-harm and suicide. These measures should be aimed at everyone, not just those with thoughts of deliberate self-harm or suicide. Often, there are no warning signs. Approaches rooted outside health services are also vital: reducing homelessness, reforming the criminal justice system, and improving access to social care. This matters to everyone. One in four people will develop a mental illness at some point in life. There is no “them.” There is only “us.” If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 contact the National Suicide Prevention Lifeline, 1-800-273-TALK. To find a therapist near you, see the Psychology Today Therapy Directory. Brendan Kelly, M.D., Ph.D., - Book - References Kelly, B. (2017) Mental Health in Ireland: The Complete Guide for Patients, Families, Health Care Professionals and Everyone Who Wants to Be Well. Dublin: Liffey Press. Pokorny AD. Prevention of suicide in psychiatric patients: report of a prospective study, in Maris RW, Berman AL, Matlsberger JT, Yufit RI, eds., Assessment and Prediction of Suicide. New York: Guilford Press, 1992 (pp. 105-29).

Research pinpoints the brain-damaging force of bullying. Bullying is seen as a moral issue, but a meta-analysis of research shows it's a medical issue. Bullying, along with child maltreatment, can do physical damage to important brain regions. The physical harm bullying does to the brain shows up in poor academic performance and mental illness. Two researchers have found that bullying damages a number of brain regions in children . The damage is such that victims fail to understand social cues, fail to think clearly, and fail to have a handle on their own behavior and emotions. It’s devastating. Researchers Iryna Palamarchuk and Tracy Vaillancourt conducted a meta-analysis of studies, including their own studies, on the impact of bullying victimization on the developing brains of children. Although they focused on the amygdala, fusiform gyrus, insula, striatum, and prefrontal cortex, they acknowledge that the negative effects of bullying are not limited to such areas of the brain. They explain that neurological interplay between the regions "contributes to the sensitivity toward facial expressions, poor cognitive reasoning, and distress that affect behavioral modulation and emotion regulation." In other words, when damage occurs to these brain regions, the victim may misinterpret or overreact to someone’s facial expressions. While a person may show surprise, the victim’s brain, harmed by bullying, may read the facial expression as angry or threatening. The brain regions malfunction. in a sense, because of bullying. Victims may also struggle to use their rational mind to problem-solve or make decisions. Their cognition, the ability to think through challenges and problems, is impaired by bullying. Furthermore, their distressed brain may struggle to self-regulate or modulate their conduct. Likewise, their bullied brain may struggle to manage emotional outbursts or withdrawals. What’s makes these injuries to the brain even more distressing is that they are invisible to the naked eye and thus most in society do not even know they have occurred. Victims know they are struggling, but few would be informed that it’s because a series of regions in their brain have been harmed. Most concerning: if we do not know the brain is hurt, we do not set in motion the care needed for the brain to repair and recover. This is tragic because in fact the brain is innately wired to heal with evidence-based interventions. How do children react who are victimized by bullying? One manifestation discussed by Palamarchuk and Vaillancourt focuses on the way in which brain responses that naturally protect the target are thrown out of whack by the repeat nature of most bullying. Withdrawal, for instance, is an effective way the brain responds to threat out in the world, but if bullying behavior happens repeatedly, this normally healthy brain response tilts into unhealthy territory. The way bullying harms brain regions can lead to “the development of mental health problems including anxiety , depression , psychosis, psychosomatic and eating disorders among bullied children.” Some children may develop emotional numbing, associated with further harm to the brain, seen in post-traumatic-stress disorder (PTSD) . It is well-established and frequently discussed in educational and parental circles that children targeted by bullying often see a drop in their grades. What is missing, however, is the brain science that informs us that poor academic performance is likely a result of “neurophysiological changes like the ones found in maltreated children.” What kind of physical brain changes do researchers document in maltreated and bullied brains? Children who are abused by adults or bullied by peers may show signs of “suppressed neurogenesis, stress-associated delayed myelination, as well as distorted apoptosis.” Scientists know that our brains produce new cells throughout our lifespan. When a brain is being abused or bullied, brain-imaging reveals, the birth of new brain cells, or neurogenesis, is compromised and in some cases halted. Scientists know that myelination is the way the brain creates efficient, rapid, superhighways of information transmission in the brain. Myelin is a fatty insulator that wraps around axons and allow the brain to wire-in skills and knowledge through repeated practice and dedication to achievement. Children who are being maltreated or bullied suffer from delays in the critical process of laying down the myelin that helps people capitalize on their talents. Moreover, among the bullied and abused, a normal process of apoptosis, or cell death, is “elevated.” The cycle of cell birth and cell death is put into a state of imbalance. The target’s brain struggles to birth new cells while at the same time an elevated number of cells are dying. As a result, targets suffer anxiety, depression, PTSD, poor academic performance and yet rarely know that their brain is unwell and needs help. Chances are very good that those who abuse and bully do not know that the way they act is causing damage to a child’s brain. It is time to educate everyone about the seriously harmful impact of bullying on the brain As Palamarchuk and Vaillancourt demonstrate in their own studies, and in the meta-analyses they undertake into extensive research being conducted internationally, child maltreatment and peer bullying harm regions of the brain in very serious and lasting ways. This knowledge needs to be shared with all adults who are in positions of trust and authority over children. Parents, teachers, coaches, doctors, social workers, mental health professionals need to use every opportunity to help children understand that the epidemic of mental illness in youth populations could be lessened if it were widely and known that all forms of child maltreatment and bullying do damage to regions in the brain. Physical bullying may visibly harm the brain, but far more insidious is emotional, psychological, social-relational, and cyberbullying, as the damage they do to the brain is unseen. Emotional neglect, ignoring, ostracizing also does deadly harm, but cannot be seen. Where the damage can be seen and documented is in brain imaging. The knowledge researchers have grained through noninvasive technology establishes that bullying can no longer be understood merely as a moral issue. It must be understood as a medical crisis as serious as catching a potentially fatal virus. There need to be public service announcements about the devastating invisible neurological scars bullying and child maltreatment leave on the brain. The damage can be seen on brain scans. Even more important, the damage can be repaired once acknowledged and identified. Jennifer Fraser, Ph.D. - website - books References: I. Palamarchuk & T. Vaillancourt. (2022). “Integrative Brain Dynamics in Childhood Bullying Victimization.” 2022 Frontiers in Integrative Neuroscience 16:1-24.

Your feelings just might save you from all that anxiety. Many OCD treatments focus exclusively on managing thoughts rather than on confronting feelings. Focusing on feelings can reduce anxiety and promote greater self-efficacy. Focusing on feelings may also help provide greater meaning and personal understanding of your OCD . Focusing on feelings can help you see the strengths so often hidden by your OCD anxiety. As someone with OCD, you are quick to use your mind to control your world. It’s likely the first place you go to make sense of your feelings and find safety. Yet as much as it tries to help, your overactive mind quickly runs away with itself, bringing on vicious spirals of worry, doubt, and fear. All that jumbles together to form anxiety. The OCD mind thinks it knows better than the feelings you carry in your own body. It tries to speak for your feelings but much gets lost in translation. As the old Italian expression goes: Traduttore, traditore. To translate is to betray. Your mind is quick to believe it is the best messenger, but it so often lacks the nuance of what your feelings can say in their own native tongue. To balance out this tendency, let's practice noticing and translating your feelings when your mind tries to speak for them. This can reduce your obsessional spirals and connect you more fully to your emotions and yourself. Burning Down the House If anxiety is the inferno, feelings are the sparks. It’s excellent preventive work to notice the feelings before they start a blaze. Anxiety moves fast and is difficult to extinguish when it’s a five-alarm fire. Happily, the feelings underneath are much easier to work with to keep your OCD from burning your metaphorical house down. In order to apply this to your own situation, let’s use the case of Adam to showcase how you can find your way to your feelings when your mind tries to keep you locked in your obsessions. How to Move From Anxiety to Feeling Adam had obsessive worries about his wife's health. He was consistently triggered with obsessive-compulsive anxiety when she ate junk food or large portions of fatty foods—or even worse, when she had too much to drink or occasionally smoked. What from the outside might look like anxiety and controlling behavior was an emotional mix Adam had largely avoided: fear, anger, and desire. Now it's your turn. What is the prominent obsession that is fueling your current OCD spiral? Like Adam, what triggers your anxiety the most? Step 1: Identify all the emotions within your anxiety. What are some of the feelings that may be within your anxiety (i.e. anger, fear, envy, sadness, or any other emotion you can identify)? If so, as Adam does above, say or write out any of the particulars about how you feel about the situation. Step 2: Identify past sources of your anxiety. It wasn't totally surprising that Adam had these obsessions. His mother was a lifelong smoker who had died young of emphysema despite so many begging her to quit. Adam could remember feeling an angry desire as a child to swat the cigarettes out of her hand, as well as the haunting nightmares he had about losing her. He had loved his mother very much and had much difficulty holding the ambivalence of such strong hateful and loving feelings. Are there any past sources of anxiety that provide further context so you can be more mindful and compassionate with your feelings? Step 3: Going for the easiest available feelings first. Which feeling should you focus on in the mix? Sometimes, it's easiest to go to the least dangerous feelings like desire, love, or even fear. Adam could talk very openly about how much he cared for and loved spending time with his wife and how much he wanted to live to old age with her. He could also easily talk about his fears of losing her. Anger is an emotion that OCD therapists often have to model as something OK to explore, noting that it doesn't negate the love or the fear, and also won't destroy the person that is so loved. Adam allowed himself little room to feel anger out of concern that it wasn't fair or would hurt his wife or mother. Why add any more negativity to the mix? By focusing on each of these component feelings that led to the bigger anxiety, we could better tame Adam's OCD. Identifying, processing, and organizing Adam’s feelings were enormously helpful. Why? Up until this exercise, Adam hadn’t noticed how much he had been avoiding his feelings and focusing almost exclusively on his thoughts. It wasn’t his fault; that’s how most OCD treatments are currently structured. Having a practical and concrete tool to help him sort through his feelings greatly improved his feelings of self-efficacy, providing him with a much better alternative to the ways his anxiety attempted to maintain control. For most people, it is a strange thing to ask them to totally ignore the signals that are coming from inside and trust that they have no inherent meaning or purpose. The exercise provided a more personal and coherent sense of meaning to his particular obsessions and compulsions. It answered the questions as to why these issues were troubling him so much. Adam came away from this exercise feeling that he had a strength instead of a problem. As a result of tracking his quite nuanced emotional experience, he felt proud of the richness with which he viewed himself and his relationships. What Are the Feelings Underlying Your OCD Anxiety? The emotional theme of nearly every form of OCD (harm OCD, contamination OCD, relationship OCD, etc.) is the loss of something or somebody important and precious to you. The rest of the feelings inside your OCD can run the range, and we'll focus on a few. Let’s locate the desire first. What do you most wish to maintain and keep in the situation or relationship that is triggering your OCD? Notice how it might connect to other important relationships/issues from the past, as Adam did with the connection of his fears about his wife and his early childhood fears of losing his mother. What are the specific fears you have about losing the other person or thing and, by extension, a part of yourself? Notice how it connects to important values and attributes you want to carry inside yourself. Is there any anger that you have a hard time giving yourself permission to express to yourself or others? Acknowledge that you are entitled to your feelings. Notice why it angers you that this person or situation makes you upset, even if you feel positive about them/it in other ways as well. Notice whether untangling these feelings allows you to feel more connected to yourself. You might feel a little less chaos in your head or less tension in your neck, shoulders, or throughout your body. Notice how different that feels from being taken over by the anxiety fueling your obsessions and compulsions. Good! That’s the new creative way to approach your OCD to get to the core emotions so you can feel better, calmer, and more powerful. Michael Alcee, Ph.D. - website - publications

Knowing what works can keep it from turning into a flood. People with BPD are known to have difficulties regulating their emotions, creating more stress in their lives. New research based tests one approach's ability to predict distress over a one-year period. Poor coping strategies, especially ones that are inflexible, can create a cascade that escalates over time. A key feature of borderline personality disorder (BPD) is emotional dysregulation. People with this disorder have tremendous difficulty controlling their emotions, particularly when they are under stress. Their lack of emotional control can further contribute to stress by creating strife in relationships with others as well as generalized difficulties in navigating life’s obligations. You may know someone with BPD and can attest to this problematic reverberation between symptoms and poor outcomes. This individual may lash out at a supervisor who they believe is treating them unfairly, only ensuring that they lose the very position that they’re trying to keep. In what is referred to as the “stress generation effect,” people with BPD actually make their lives more miserable over time and as a result, find themselves under constant pressure due to financial problems or loss of valued close relationships. Emotional Cascades in Borderline Personality Disorder According to Howard University’s Kapil Chauhan and colleagues (2023), BPD can be understood within the larger Alternate Model for Personality Disorders (AMPD) in the diagnostic system of DSM-5 as reflecting not only emotional dysregulation, but also lability (fluctuations between highs and lows), anxiety over the loss of relationships (separation anxiety), risk-taking, and constantly elevated levels of depression , hostility, and impulsivity. Within the AMPD, personality disorders are viewed as longstanding adaptive disturbances that are distinguished from each other according to a set of underlying dimensions. BPD, in this system, reflects a particular pattern of elevations along these dimensions. Additionally, however, BPD can be “cross-walked” diagnostically by linking it to the traditional DSM-5 system currently in use that is based on categorical demarcations between disorders. All of this may sound very technical to you, and of perhaps no more than academic interest, but the implications of moving from the categorical to the dimensional approach in diagnosing personality disorders are actually very significant. To put people’s personalities into bins based on whether they possess “X” number of symptoms could lead not only to inaccurate diagnoses but also failures in treatment. Returning to the Howard U. research team’s investigation, its basic premise was that people with BPD not only experience emotional dysregulation, but that they also engage in a harmful tendency to ruminate over their out-of-control feelings. In what is called the Emotional Cascade Hypothesis, as the authors describe it, “individuals with BPD respond to negative affect with rumination, which further intensifies distress.” As the cascade progresses, these individuals may become self-injurious and suicidal, “because of more consistent associations with relief” (p. 2). Testing the Emotional Cascade Over Time Using a one-year longitudinal design, Chauhan and his collaborators tested the ability of the AMPD-BPD diagnosis to predict distress, rumination, and suicidal thinking. Their model rested on the assumption that one of the chief reasons that emotional cascades develop is due to an inability of people with BPD to use effective coping skills. The trajectory the authors proposed would be reflected in their data led from AMPD-BPD symptoms through to poor coping and ultimately higher distress scores as the year progressed. The online sample of 107 individuals (from an original pool of 700) ranged from 18 to 57 years old (average age 31 years; 51 percent identified as women). They completed measures of personality disorder, symptoms of depression, anxiety , and stress, a rumination measure, and a coping checklist. Of the initial sample, approximately one-third dropped out over the course of the study, leading to a final sample of 67 tested at 9 months and 72 at one year. Looking in more detail at the coping checklist, it was derived from a theoretical model used in treatment known as Dialectical Behavior Therapy (DBT). The coping-related skills that DBT teaches include mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. People who are unable to use these skills, according to the Howard U. researchers, should experience an increase both in rumination and distress. Additionally, poor coping in this model would be reflected in a tendency to stick to one coping strategy (i.e. an ineffective one) rather than show flexibility in the way they adapted to stressful situations. Consistent with the Howard U. researcher team’s predictions, dysfunctional coping at the 9-month point had the strongest effect on rumination at the one-year testing point. Additionally, looking at the AMPD-BPD diagnosis itself, later outcomes were more strongly predicted by anxiousness, depressivity, emotional lability, and separation insecurity. However, impulsivity, risk-taking, and hostility had negligible effects on outcomes, suggesting that these dimensions are less important from a diagnostic standpoint. Turning Down the Emotional Cascade Knowing now that people with certain BPD traits make their lives much worse by their poor use of coping skills should be of value in understanding how potentially to keep the cascade of emotions to manageable proportions. Interventions based on DBT are known to be highly effective in treating people with this disorder, and the Howard U. study’s findings are essentially a time-lapse approach to seeing how poor coping in people who are untreated can make their lives so much worse. Even for people without BPD, though, there can be value in learning from the Chauhan et al. study. Perhaps someone has made you angry by criticizing you in a way that seems unjust. Maybe you parked in a spot you shouldn’t have in a crowded store lot. The owner comes out to chastise you and although in the grand scheme of things it shouldn’t bother you, it does and you mull over it for days. Knowing how rumination can create a cascade of negative emotions, you could practice your own functional coping and put it all behind you. To sum up, an emotional cascade doesn’t have to turn into a flood if you are aware of the strategies needed to restore your own equilibrium. For people with BPD, these skills can make all the difference in helping them to keep their emotions more manageable as they navigate life’s many challenges. Susan Krauss Whitbourne, Ph.D. - website References: Chauhan, K., Donahue, J., & Thompson, R. (2023). The predictive validity of the dsm‐5 alternative model for borderline personality disorder: Associations with coping strategies, general distress, rumination, and suicidal ideation across one year. Personality and Mental Health. doi:10.1002/pmh.1580

Your OCD may stem from a false need for certainty. What can you do about it? There are two types of OCD : Moral and existential, both of which stem from a felt need for certainty expressed as a demand. The felt need not to do bad things is deceptive; human actions are never certain by any reasonable definition of the latter term. Overcoming this bogus felt need means (cognitively and behaviorally) embracing possibility, not certainty. OCD Thinking There are, in general, two types of obsessions that can occur in obsessive-compulsive disorder: Moral Existential In moral obsessions, the person imagines herself doing something she thinks would be extremely (morally) bad and ruminates about it. In existential obsessions, the person imagines something bad happening to himself or a loved one, for example, getting sick and dying, and ruminates about it (Cohen, 2021). While this post examines the thought process embedded in moral obsessions, the logic in existential obsessions is similar. In both cases, the genesis of the obsession is a demand for certainty. For example, suppose you think: I must be certain that I would not stab my partner with this steak knife. But I am imagining myself doing it and it almost feels like I’m going to really do it! It’s possible I’m going to really do it! But what kind of monster would do such a horrible thing! I can’t stop thinking about it until I can be certain I wouldn’t do it! The above set of premises displays the emotional reasoning involved in moral obsessions. This reasoning chain produces and sustains the intense anxiety experienced by the person with a moral obsession. Notice that the process is generated by a demand for certainty (Premise 1). Here, the term “must” express a felt need for certainty. The term “certain” entails both knowledge and impossibility (Chisholm, 1957, p. 19). That is, in Premise 1 you are demanding that you know that you would not do such a thing and that it is impossible for you to be mistaken. This is an extremely strong sense of knowledge that many contemporary philosophers would argue is vacuous and is satisfied only by truisms like “All triangles are three-sided.” In Premise 2, you imagine yourself doing this very act and even feeling an urge to do it. In Premise 3, from the very fact that you imagine yourself doing it and it feels so real, you conclude that there’s a real possibility you might stab your partner with the steak knife. Clearly, this premise conflicts with Premise 1, which demands that it is impossible that you would do such a thing. Given the latter possibility, in Premise 4, you then damn yourself by calling yourself a “monster.” Such damning language thus reinforces a lack of self-respect, which feeds a vicious cycle of rumination . Consequently, in Premise 5 you conclude that you can’t stop yourself from ruminating about this demoralizing thought until you can somehow be certain you wouldn’t do it. However, every time you imagine yourself doing it, you only reinforce your lack of certainty (if you can imagine it, then it’s not logically impossible). You torment yourself in a vicious ruminative cycle ad nauseam with no way out. There is indeed no way out so long as you hang on to inconsistent premises—1 and 3. On the one hand, in Premise I, you demand certainty. But in Premise 3 you make clear that you don’t have certainty. This is because you're performing the action in question is not impossible. The Meaning of Impossibility But let’s look even deeper at this curious logic. What does it mean to say that something is impossible? One sense of impossibility is physical impossibility. This means contrary to the laws of physics. For example, it appears to be physically impossible for life to exist without a water source. It is not impossible in this sense for you to stab your partner with a steak knife, however. This is because humans do not uncommonly do such regrettable things. That’s exactly why there are criminal laws that proscribe them. Another sense of impossibility is logical impossibility. This means logically contradictory or inconsistent. For example, it is impossible in this sense to draw a triangle that has four sides. You could not even imagine doing such a thing because triangles, by definition, only have three sides. However, stabbing your spouse with a steak knife is not impossible in this sense because you can easily imagine yourself doing it; and that’s exactly what you have done in the present scenario—imagine yourself doing it. As demonstrated here, you have painted yourself into the proverbial corner by demanding that something be impossible that is not so, in either the physical or logical sense. For each time you imagine doing this act, you reaffirm its possibility, which then contradicts the demand that you be certain you wouldn’t do it—that is, that it be impossible that you would do it. Your only rational way out is to give up your demand for certainty. It is plainly self-defeating to cling to a demand that you cannot possibly satisfy. What, then, does it take to give up this unrealistic demand? Getting Practical In Cognitive-Behavioral Intervention for Self-Defeating Thoughts (Cohen, 2021), I discuss the construction of a cognitive-behavioral plan to overcome this demand and gain freedom from self-oppression. You need to learn to accept possibility rather than certainty as a condition of living in the everyday world. If you wish, you could redefine the latter term as "certain for practical purposes." Indeed, humans make decisions every day by accepting conditions that are not certain, but we merely assume that they will stand the test of time. For example, it is not certain that the earth will support life in the near future (there is no contradiction in the earth ceasing to support life), but you still make future plans. With much less assurance that something won’t go awry, you drive or take public transportation, cross busy intersections, live in proximity to nuclear power plants, or other sources of potential harm. You assume that most people with whom you have social commerce (from your babysitter to your physician) are not rapists, murderers, or psychopaths even though, no matter how carefully you check them out, you cannot be certain of this. These are things, that for practical purposes, you simply assume are probable enough to act on. You don’t need certainty to live as though you have it; and once you live as though you have it (and here comes the behaviorally therapeutic upside of doing so), you won’t even feel the need to obsess about not having it. This means pushing yourself to go about your life without checking and rechecking your thinking ad nauseam. It means not locking up the knife or throwing it away but instead using it to cut steak. It means giving up any other meaningless ritual you have concocted to remediate your anxiety (for example, humming to drown out your thoughts). This means accepting that it is not impossible (logically or physically) for you to do bad things, even very bad things. You are flesh and blood and like all other contingent creatures in the universe are subject to an infinite range of possibilities—some bad and some very wonderful. This means embracing possibility, not certainty, as an inescapable part of life on earth. Elliot D. Cohen, Ph.D., - Website References Cohen, E.D. (2021). Cognitive behavioral interventions for self-defeating thoughts: Helping clients to overcome the tyranny of 'I Can't'. London: Routledge. Chisholm, R.M. (1957). Perceiving: A philosophical study. Ithaca: Cornell U. Press.

Rules for ensuring success when combining households. A blended family is a unit that includes parents and their stepchildren. Joining family members enhances the social support network. Despite the benefits, navigating the creation of a blended family can sometimes present a challenge. A blended family is a unit that includes parents and their stepchildren. Joining members of more than one family can increase the number of people available in members’ social support networks and lead to expanded opportunities to form strong and loving connections. However, navigating the creation of a blended family can sometimes present a challenge. For example, psychologist, Anne Malec, who authored Marriage in Modern Life: Why It Works, When It Works, notes that stepchildren may often experience tension between wanting their parents to be happy but feeling upset or disloyal to their other parent. No matter what the growing pains may be, there is likely to be an adjustment period . Take for example hypothetical couple Shawna and Ray, who recently got married. Shawna has two sons, aged 20 and 17 from a previous marriage, and Ray has a 7-year-old-son and 5-year-old daughter from his previous relationship. They purchased a house big enough for them and the kids but are encountering many challenges. Shawna’s sons are adults and view themselves as such. As a result, they don’t want to join the rest of the family for dinners or game nights, and they feel that since they are in college, they don’t have anything in common with Ray’s children. Ray’s children had been living in another state with their biological mother until recently, so even though they have known about Shawna for a long time, they are adapting to being around her for extended periods of time and living with her. They often ignore her requests and rules, not viewing her as a parental authority figure. Shawna and Ray, in trying to get their family to come together as one, are feeling exhausted and overwhelmed, which has resulted in them getting angry with one another over small things that never used to come between them. Below are some helpful suggestions for blending families: 1. Move Slowly and at Your Own Pace While Shawna and Ray have been together for a while, their four children are just getting used to living together under one roof. They are also just getting accustomed to having another parental figure as a part of their daily lives. Shawna and Ray, because of their desire to create a happy and cohesive family, may have instituted too many rules and changes too quickly. While they were well-intentioned, trying to have a family dinner, family game night, etc., as well as giving the children new house rules, roles, and responsibilities, may have been too much all at once. Instead, allow the children to get acclimated to the new family and family environment, slowly introducing new things one by one. 2. Be Present and Be Active Remember to show your partner’s children that you care about them and understand how big of an adjustment blending your families is. Be sure that you are there, answer any questions they have, and address their fears/ anxiety . Don’t make any assumptions; let them know that you are available and that you are able and willing to talk to them and engage with them. Opening the lines of communication between you and your stepchildren will establish trust between you and ensure that you are all on the same team. To do this, Shawna and Ray could each have a separate conversation with their stepchildren to let them know that they are there for them, without going in with a specific agenda. 3. Be Open and Honest with Your Partner It is important for you and your partner to discuss parenting roles and responsibilities, as well as your parenting styles. While you may have had these discussions when dating, now that you are all under one roof, responsibilities and stressors have changed. So, it is imperative to have another conversation/series of conversations. For example, what role do each of you want/feel comfortable with in terms of creating and implementing rules for your partner’s children? How important is it for your children and your partner’s children to be friends? Having a clear understanding about where each of you stand on parenting issues is important. A united front will communicate to your children the importance of creating a new blended family unit. By following these steps, you not only ease the stress on the family members, but on yourself. This is a big transition, so remember to practice self-compassion, as change can be slow, but rewarding. Marisa T. Cohen, Ph.D - Website - Book References Malec, A. B. (2015). Marriage in modern life: Why it works, when it works. Advantage Media Group.

A partner's low emotional intelligence can impact your sense of self. A robustly and rigidly defensive partner may lack the emotional capacity to relate in healthy ways. Narcissistic partners rarely say things like "What I did was insensitive, and I apologize," or "I would be mad too." The constant absence of six sentiments may indicate a partner has narcissistic tendencies. Their lack of empathy, insight, and ability to self-reflect, be accountable, and partner with you instead of taking control may be evidence of low emotional intelligence. An explanation of how these deficiencies impact you may help you evaluate the emotional safety of the relationship. 1. "I hurt your feelings, and that is not okay." Often, a narcissist is annoyed and indignant when their partner communicates a feeling that they do not appreciate. This may be most evident when the partner attempts to address an issue with the narcissist, which involves the narcissist doing or saying something hurtful. Instead of conveying empathy, as in the statement above, they tend to dodge accountability and either shame the partner, dismiss the partner or withdraw their affection to punish the partner passively aggressively. Owning a hurtful action in the moment is rare for narcissists because they are typically robustly defensive and resist “looking in the mirror.” However, after several days or weeks pass, the narcissist may try to take responsibility for their selfish act but eventually minimize or subtly justify the transgression. In place of authentic and heartfelt introspection during the course of the interaction, it can take days and weeks for the narcissist to grasp an understanding of their emotional mistreatment, and even then, they may not grasp the negative impact their actions had on you. 2. "You have every right to be upset." In a relationship, a narcissist often has difficulties honoring your feelings when they feel differently than you; thus, they lack empathy. Empathy requires a person to access the deep and uncomfortable emotions that allow them to momentarily resonate with a partner’s emotional discomfort in order to truly understand. This allows the partner to feel less alone in their predicament and connected to a loved one who gets it. Feeling understood and close to someone in emotional distress is usually comforting and can speed up the healing process. A narcissist may be too fragile to put themselves in another person’s shoes because it is difficult and taxes a waning sense of self. Providing empathy requires a person have “broad emotional shoulders.” A narcissist usually has low emotional intelligence and thus prefers to be sympathetic because they escape the brief hardship empathy requires. Instead, they would rather to be the hero. Sympathizing allows them to emotionally distance themselves from the pain by pitying you. Next, they usually take a position of authority and tell you how to fix the problem or offer to swoop in and “save the day.” Either way, they use your most painful moments as an opportunity to fluff up their ego. 3. "I’m glad you told me that bothered you–I’ll try to be more considerate." Addressing an issue with a narcissist frequently leads to an epic battle. Their refusal to consider your perspective if it differs can be maddening. Frustrated and agitated, you may waste a lot of time and energy attempting to get the narcissist to understand where you are coming from. Unfortunately, their inability to perspective-take in the context of an interpersonal relationship often prevents them from owning even small missteps in the relationship. In addition, the narcissist may unfairly frame your attempt to address an issue with them as “aggressive” or “antagonistic.” They may immediately position themselves as the victim in the interaction and you as the “abusive party.” They often convince you and many others that you are unfairly persecuting them. In addition, a narcissist may take this as an opportunity to project their tendencies onto you. Using deflection and then projection, they ignore your viewpoint and accuse you of doing what they actually did. For example, when you confront them about a lie they told you, they twist the narrative and call you a “liar.” Due to their extreme defensiveness, they are typically unable to self-reflect, so it is unlikely that they will graciously accept the feedback and use it for permanent growth and change. 4. "What I did was insensitive–I apologize." Narcissists usually have a distorted self-image. They see themselves as innocent, at all times, and thus are rarely able to take responsibility for an insensitive or inconsiderate action or comment. Instead, they accuse you of being “picky, harsh, overly critical, or impossible to please.” They tend to excuse their selfish or disrespectful behavior as justified in response to your “unfair criticisms.” The unwavering denial that they have done something wrong prevents them from authentically admitting fault in a relationship . The exception, of course, is when you are fed up and ready to end things. At this point the narcissist may issue a general apology for past behaviors, however, they often minimize and justify their wrongdoings. The evidence of their insincerity is the continual repetition of hurtful behavior in the future. They lack genuine empathy, remorse, and insight, so the apology is simply lip service in order to get out of “hot water.” This type of partner rarely apologizes when it matters the most. 5. "I would be mad too." One of the telltale signs of narcissism is a lack of empathy. A narcissist shames and dismisses you for identifying a feeling that they do not care to hear. The expectation is that you feel the same way about the relationship as they do. If you are mad, they react angrily in response to your anger. If you dare to express a feeling that is incongruent with how they feel, they may passive-aggressively punish you by withdrawing their love and affection. In order to avoid being emotionally abandoned, you may find yourself censoring your feelings because you are afraid that you will be rejected. A series of these micro-abandonments may cause you to shut down essential aspects of who you are. Moreover, when a loved one strips you of your basic human right to feel what you feel, it can be dehumanizing. When you are treated as less than human, it may induce anger and pain. These experiences can be traumatizing. Desperate to be heard, respected, and understood, and deeply disappointed when you are not, may result in feelings of loneliness and shame. 6. "How can I help?" More often than not, a narcissist truly believes they know best. Unable to perspective take, they firmly believe there is one right way, and it is their way. Because of this unilateral and egocentric viewpoint, they tend to tell their partner what to do–a lot. Because the narcissist believes they know everything, they demand that you follow their advice. Also, narcissists tend to enjoy being the hero, so they like to save and rescue. In place of following your lead about how they can best support you, they may take over and grab control. You may be grateful for the help, but it may also strip you of your own self-efficacy and create dependence on the narcissist. A loss of confidence in your own competence may follow. Alternatively, a partner who asks for guidance on how to support you best may be someone who has faith in your ability to solve problems. Taking responsibility for hurtful behavior in the moment is rare for a narcissist because they lack the ability to introspect. Offering empathy is also uncommon for them, as they prefer to use your hardship as an opportunity to fuel their ego by either being the “expert” or by playing the “hero.” In addition, considering your feedback is almost impossible for a narcissist due to their immediate and hefty defensiveness. An apology may only be issued when their back is against the wall, and taking over in place of asking you what you need may also be a sign. For these reasons, a narcissistic partner may fail to respond in ways that preserve the closeness in a relationship. Erin Leonard, Ph.D. - website

Discovering a spouse’s porn use can be a challenge and an emotional opportunity. The discovery of porn in a committed relationship can be a crisis of exposure and trust. Using certain guidelines, a couple can address the meaning of porn use in terms of mutual trust and desire. If the porn use is excessive, professional help can be a valuable asset for repair. Porn is defined as the depiction of erotic behavior intended to cause sexual excitement and accessed through adult and sexually oriented online sites, DVDs, chat rooms, etc. The use of porn may be a passing curiosity, a source of sexual stimulation, or excessive and problematic to many aspects of a person's life. For partners who are married or in committed relationships , the secret continual use of pornography is complicated, as it can ultimately impact both partners and pose a risk to their relationship. Discovering Your Partner’s Secret Use When a partner walks in on the other viewing porn that is quickly shut off or discovers charges for porn on a credit card, there is often an initial shock followed by a mix of feelings including anger, distrust, rejection, and betrayal. Some partners feel hit in the gut. “How could he do this?" Some become frightened, “Who is she talking to?” Some are afraid to say anything and collude with the silence that surrounds the secret. For others, the feelings spill out in anger. “If you want that, you don’t want me.” “Is this why you act like I am invisible?” Whether or not there is protest, many partners take the other’s secret use of porn as an indictment of their inadequacy—a feeling that disqualifies their desire and in a vicious cycle often results in less intimacy and often the partner’s continued use of porn. Whether they are comfortable or not with porn, many partners experience the “cover-up” of porn use as a rupture of trust and an assault to mutual desire. Sometimes the preface to learning about a male partner’s use of porn is his avoidance of sex because of difficulty with arousal or sustaining an erection with a real partner. Having the Secret Exposed Given the denial that fuels the secret use of pornography, it is not surprising that many partners will at first negate the other’s confrontation of their secret—even in the face of the evidence. “How dare you check my computer!” “I knew you would be too uptight to understand.” “ I am having problems—that’s the reason.” Whether or not initially denied, many partners who value their relationship, feel guilt, shame, and lowered self-esteem when their secret is exposed. Essentially, both partners are in crisis. What Do You Do in the Face of the Discovery of Porn Use? Like any challenge, a couple that believes they have a relationship worth saving or improving can repair the breach of sexual secrets. To do so, both partners need the courage to address the meaning, use, and impact of porn with openness and mutual consideration of their sexual connection. It happens, for example, that a period in which one partner stops being interested in sex or both lose sight of their sexual bond, may be the impetus for one of the partners (usually the male) to turn to porn as a sexual outlet. The real issue was not discussed or resolved. Couple Guidelines 1. Talking so the other will listen—listening so the other will talk. Whether your partner is very upset and apologetic about their porn use or quiet and avoidant, try to calmly talk and listen together. Rather than judging or condemning, try to be curious. The expectation that partners who feel betrayed, judged, and angry can just talk this out in one sitting is unrealistic, but you can start anywhere. Consider reflecting on the state of your relationship: Was it intimate and fulfilling? Consider sharing (even writing) your answers to questions like: Do we both want a sexual relationship? What do we each think about porn? Why is it being used? How does using it affect our sexual and intimate relating? 2. Access Information Information often helps move people from a state of helplessness and confusion to a feeling of control. Understanding more about the reason for, the types, and the use of pornography may offer a blueprint for collaboration and repair. It’s worth knowing that: The American Psychological Association considers the compelling use of porn that disrupts a person’s functioning and relationships to be in the category of sexual pathology or maladaptive sexual behaviors. Not everyone viewing porn uses it to excess or has a problem with it. Research does show that when men regularly used porn, they tended to report lower levels of sexual intimacy in their real-life relationships. When women used porn, intimacy increased. Consistent with this, in a study of newlyweds followed for three years, there was a negative reciprocal relationship for men between relationship adjustment, sexual satisfaction, and porn use. For men, the more porn use, the more negative relationship adjustment and more sexual dissatisfaction. Women’s porn use did not result in negative relationship adjustment or decreased sexual satisfaction. Researchers hypothesize that the male’s porn use is more disruptive to the relationship than the female’s use because his use is driven by solitary stimulation. Her use is more often with the expectation of viewing porn that involves couples and is related back to sex with her partner. In his book, Your Brain on Porn, Gary Wilson addresses the physical difficulty many men eventually face when the use of porn has become so linked to arousal that it interferes with the ability to be aroused by a partner. He underscores that what makes porn so compelling is that It offers the brain and body nonstop novelty and taps into the dopamine reward system. Over time, it can make the ability to be aroused or to sustain an erection with a partner very difficult. In clinical work, I have found that when a man can share this problem with a spouse, she feels less rejected and more eager to work together to rekindle the bond. Often partners can seek information individually and as a couple for overall help with their sexual relating. There is also information and online help for the impact of excessive porn use. 3. Develop and Try Couple Solutions For something to change in the life of an individual and the relationship he/she shares, there has to be a plan. For many partners, healing from the rupture of discovering porn use may invite seeing and desiring each other in a new way. Mutuality is key. No one wants to dread having sex with their partner, or feel they are competing with a computer screen. Checking in with each other on what is working can be a wonderful insider connection. Talking and texting more, being affectionate, adding humor, dropping expectations, finding paths of unexpected reconnection are valuable steps to romantic renewal. For some couples, the joint agreement to occasionally use porn alone or together might be possible and enjoyable. For other couples reigniting their relationship may be all that they need and want. Change happens in steps—a commitment to reconnect with love rather than a magical expectation of bliss is a first step. When a relationship has been disrupted, the way back to each other is a new way forward. Suzanne B. Phillips, Psy.D., ABPP - website - book

Addressing both biomedical and social psychological factors can help. Masculine norms and stigma may play a role in both the occurrence of concussions and their undertreatment. On some college campuses, concussions are more common among women and nonathletes than among men or athletes. Knowledge and preparedness can help prevent concussions and ensure prompt medical attention when they occur. When you think about the major problems affecting college students, what comes to mind? You may think of physical health hazards associated with alcohol, other drugs, and sex. And there are threats to psychological health including academic stress, interpersonal conflict, and being away from family and home. These are without doubt important dimensions of college life. If you have come across mild traumatic brain injuries , or mTBIs—commonly known as concussions—as a problem on campuses, it was most likely in connection with college sports, pranks, or rough-housing among male students. You would not be alone in placing mTBIs low on your list, though, especially for nonathletes and women. Underreported, Undertreated, and Understudied An mTBI is a form of brain injury resulting from a sudden blow that causes damage to the brain. A person with an mTBI may lose consciousness briefly and experience symptoms including headache; dizziness; blurred vision; ringing in the ears; changes in sleep, behavior, or mood; and difficulty with memory, concentration, or thinking. More severe TBIs have the potential to cause more severe and longer-lasting symptoms, but mTBIs are both more common and more likely to go undetected and untreated. Psychological approaches to the problem of mTBIs are informed by health behavior theories. These can guide the design of psychoeducational programs aimed at preventing TBIs and promoting treatment-seeking when they occur. Barriers to prevention and prompt treatment include beliefs about vulnerability to TBIs, their perceived severity, and the cost-benefit analysis of health-care seeking. Vulnerability, severity, and treatment-related beliefs are relevant to a wide range of health threats. Unlike most of those, TBI prevention and treatment-seeking also may be influenced by masculinity beliefs and stigma. These factors play a role in health problems like TBI that have features that involve social identity. There are no definitive national data on TBIs in the general college population, but studies of individual institutions suggest they represent a large and growing problem. Although athletics play a role, some studies find that most TBIs are not sports-related. Other major causes are bicycle and automobile accidents, falls, self-harm, and assault. Some data suggest a higher incidence among women compared with men, whether or not they are athletes. Women also may be more likely to experience long-lasting effects of TBI as a result of several biomedical factors. There is evidence that college students who express greater conformity to norms placing a higher value on self-reliance and winning indicate that they would be less willing to report symptoms of a possible TBI. This has been observed both among athletes and nonathletes, and among both male and female students. These are sometimes referred to as masculine norms because they involve a desire to manifest agency, a trait-like behavior pattern emphasizing a sense of control and independence. Masculine norms are a salient feature of male gender-role expectations but are present in women as well as men. Stigma Among athletes, the operation of masculinity norms may be augmented by the threat of being stigmatized—that is, experiencing diminished positive regard in the eyes of teammates and coaches. For college students in general, fear of potential academic consequences may also play a role. A TBI also may be stigmatizing if attributed to carelessness or lack of impulse control. Just as TBI is not high on the lists of major health hazards on college campuses, it does not rise to the top when it comes to health conditions that are stigmatizing. Mental health and behavioral problems such as depression and alcohol and other substance use disorders, are more often discussed as stigmatizing conditions, as are physical health problems that are sexually transmitted or involve bodily systems and functions that can be a source of embarrassment. Processes involved in stigmatization are complex and variable. In the case of TBI, they may involve attributions of the injury to psychological attributes such as personality, the view that the person was responsible for its occurrence, and the belief that symptoms reports represent malingering or at least exaggeration of their severity. Prevention, Recognition, and Timely Treatment Campus resources for preventing TBIs and identifying them when they occur include coaches, campus safety personnel and police, disability services, psychological services, health centers, and academic assistance centers. Additional resources may be present nearby in the community and university-affiliated clinics. Staff members should be familiarized with the signs and symptoms of TBI, including indicators such as pain, nausea, and dizziness, as well as more subtle cues such as evidence of impaired executive functioning. Medical treatment should be sought for anyone who loses consciousness, even just for moments, for any reason, especially if they suffered a blow to the head and experienced the symptoms of TBI outlined above. Horses and Zebras There is an expression used in medical school saying that, when you hear hoof beats, think horses, not zebras, an admonition to consider the most likely diagnosis. Clearly, there are other possible causes of apparent TBI symptoms that may be more likely than a TBI depending on the circumstances. Nonetheless, a TBI might be responsible and should be among the causes that are considered. And this is true regardless of the affected person's gender or sports participation. Richard Contrada, Ph.D., References Barnwell, P. V., Ingate, M. R., Sagar, A., & Contrada, R. J. (2023). College students’ perceptions of concussion: Illness beliefs and masculinity norms predict stigma and willingness to seek treatment. Journal of American College Health, 1–16. Breck J, Bohr A, Poddar S, McQueen MB, Casault T. Characteristics and incidence of concussion among a US collegiate undergraduate population. JAMA Netw Open. 2019;2(12):e1 917626–e1917626. doi:10.1001/jamanetworkopen.2019.17626. Tanabe KO, Hayden ME, Rege S, Simmons J, Holstege CP. Risk factors associated with concussions in a college student population. Ann Epidemiol. 2021;62:77–83. doi:10.1016/j.annepidem.2021.06.009. Kroshus E, Baugh CM, Stein CJ, Austin SB, Calzo JP. Concussion reporting, sex, and conformity to traditional gender norms in young adults. J Adolesc. 2017;54:110–119. doi:10.1016/j.adolescence.2016.11.002.

Comparing yourself to others rarely makes your life better. Social comparison is a normal part of being human. The effect of social comparison is mediated by self-esteem and perceived control. The internet has arguably made social comparison more extreme and toxic. There are steps you can take to reduce how much you compare yourself with others. We humans are comparison creatures. We are constantly measuring ourselves against other people. This attribute may have evolved as a means of helping us fit into the social hierarchy of the cultures we inhabited. Regardless of the reasons, social comparison plays a significant role in how we view and evaluate ourselves, and how we interact with our world. What is Social Comparison? The noted psychologist Leon Festinger defined social comparison as “the processes by which individuals evaluate their own abilities, opinions, attitudes, feelings, physical features, accomplishments, or any other self-aspects in relation to other individuals and/or groups.” Other researchers propose that the impact of social comparison depends on two factors: 1) how closely the comparison is connected to people’s self-esteem, and 2) how much perceived control people feel they have related to their status in relation to the person or people they are comparing themselves to. For those with high self-esteem or high perceived control, downward comparison, namely, comparing yourself to those less fortunate, tends to bolster self-esteem and improve mood states, while for those with low self-esteem or low perceived control, downward comparison reduced their self-evaluations and produced diminished mood states. Conversely, for those with high self-esteem or high perceived control, upward comparison—that is, comparing yourself to those more fortunate—provided encouragement and hope. For those with low self-esteem or low perceived control, upward comparison decreased subjective well-being and lead to more negative mood states. Then and Now It used to be that our primary reference of comparison was our local communities, primarily neighbors and co-workers. Because we tend to congregate around those similar to ourselves in terms of educational level, work income, and shared interests, the range of differences when we compared ourselves to others was fairly small. Yes, through magazines, newspapers, television, movies, radio, and other media, we experienced glimpses of other potential comparison groups, but they tended to be viewed at a distance, as separate from us, so they were less impressionable on us. As such, the impact that those comparisons had on our self-identities, self-esteem, and place in our above-mentioned social hierarchies was relatively minimal. Unfortunately, with the emergence of the internet, our points of comparison have expanded exponentially because we can now compare ourselves to literally anyone in the world. Thus, we are now exposed to groups that are drastically different from us in terms of wealth, status, power, celebrity, and physical appearance. What had in previous generations been a small gap in our comparisons has become a yawning chasm of differences, in which those differences feel so large and unattainable. Comparison is Often Toxic This new level of comparison has immense implications for many aspects of our psychological and emotional lives. Before the internet, there seemed to be far fewer people to compare ourselves to because there were, in fact, far fewer in our immediate vicinities and in our visual fields. But when so many people that are easily discoverable on the internet seem to be so successful, famous, influential, and beautiful, given our proclivities to compare, it is difficult to not have it influence how we view ourselves. Sadly, these stark comparisons usually result in our feeling inadequate and “less than.” Even if we compare downward (to those less fortunate than we are), it usually only provides a temporary salve to low self-esteem and feelings of inadequacy. These toxic comparisons also erode our emotional lives. When we feel lacking, we experience an array of unpleasant and unhealthy emotions that make happiness and contentment difficult to experience. We feel jealousy and envy for what others have and what we lack. We feel frustration and helplessness for our inability to have what they have. We can even feel bitterness, resentment, and anger at others (but really at ourselves) for the unfairness of it all. We can feel shame, guilt, and humiliation for believing that there is something wrong with us compared to others. And we can feel hurt, sadness, and even despair in realizing that we will never have all of those wonderful things that we think so many people in the world have (in reality, “those people” are a very small number). Again, even if we compare downward, the schadenfreude that we might experience and feelings of superiority from measuring ourselves to those less fortunate can’t easily be considered a healthy emotion. Stop Comparing It’s one thing to realize that you compare yourself to others. It’s another thing to recognize that social comparison is often corrosive to you in so many ways psychologically and emotionally. It’s an entirely other thing to stop yourself from comparing yourself to others. Yet it is possible, and it is worth the effort for your mental health and well-being. Here are some steps you can take to reduce the amount of comparing you do to others. Accept that social comparison is a normal part of being human (but that doesn’t mean you should keep doing it). Recognize when you are comparing (“Here I go again!”). Acknowledge why you are comparing (you may feel threatened by some aspect of another person, for example, accomplishments, relationships, intelligence, appearance). Understand how comparing makes you feel (probably bad!). Acknowledge that continuing to compare will only hurt you. Ask yourself whether you have high or low self-esteem and perceived control to better understand how social comparison affects you. Realize that we tend to compare our lesser qualities with others’ best qualities (not apples to apples), so you put yourself in a no-win situation. Put your comparisons in context, meaning put those lesser perceptions you have of yourself and those more admirable perceptions of others into a broader picture of who you and they really are in toto. Recognize that you only see the outside of a person and have little knowledge of who they are inside (they may appear happy on the outside but may be miserable on the inside). Accept your humanity (we are all imperfect beings, who still deserve love, respect, and appreciation). Focus on your strengths (you may be “lesser” than others in some ways, yet “more” than others in other ways). Focus on your goals and how to achieve them (remind yourself who you want to be). Limit social media (it tends to make comparison more noxious). If you do compare, use comparison as motivation (“If they can be that way, so can I!”). Shift your focus onto who you want to be and what you want to accomplish. Jim Taylor, Ph.D. - Website - Book -

The call for a more gender-sensitive understanding of autism. During Thanksgiving dinner, Beth's aunt asked her how she was enjoying college. This seemingly innocent question triggered Beth's discomfort and prompted her to abruptly exit the room. Beth is frequently misunderstood by her family, who have labeled her as "difficult," "angry," and “aloof." Her relatives have gossiped that Beth’s parents should have taught her to be more socially appropriate. No one, including Beth’s parents, ever asked the question: “Might Beth be on the spectrum?” Why? Well, she never looked like her cis-gender male cousin who, at 6 years old, was throwing temper tantrums, getting in trouble at school, and knew the number of floors in every major skyscraper in the world. Diagnostic Criteria for Autism: Gender Specificity The diagnostic criteria for autism spectrum disorder (ASD) were initially based largely on male presentations. Women like Beth may have non-male-specific manifestations of ASD. For instance, women may demonstrate fewer stereotypical behaviors and have strengths in social motivation, executive function, and intelligence. These variations complicate timely diagnosis, leaving individuals without essential support and interventions vital to their well-being. In response to this disparity, the Autism Center of Excellence (ACE) Network is actively working on a gender-sensitive tool for ASD assessment, aiming to bridge the diagnostic gap and ensure timely and appropriate support. Autism Spectrum Disorder (ASD) can present differently in men and women, though it’s crucial to recognize that these are general trends and may not apply to every individual. 1. Social Differences Men: Often display more noticeable social difficulties, such as challenges in forming friendships, understanding social cues, and engaging in reciprocal social interactions. Women: May develop coping mechanisms that allow them to camouflage or mask their social difficulties. They might mimic social behaviors, which can make it less apparent that they are experiencing challenges in social situations. 2. Communication Differences Men: May exhibit more pronounced language and communication difficulties. For example, they may have delayed language development or struggle with maintaining conversations. Women: Can be more verbally fluent and may develop compensatory strategies, such as memorizing social scripts, to navigate social interactions. This might make their communication difficulties less noticeable. 3. Interests and Activities Men: Often show intense and narrow interests, focusing on specific topics or activities to the exclusion of others. Women: May have more varied interests and may be able to blend in more easily with neurotypical peers by adopting interests that are more socially acceptable. 4. Sensory Sensitivities Men and Women: Both genders may experience sensory sensitivities, such as hypersensitivity or hyposensitivity to sensory stimuli like lights, sounds, or textures. 5. Diagnosis and Recognition Men: Tend to be diagnosed with ASD more frequently, possibly because their symptoms are often more overt and align with traditional diagnostic criteria. Women: May be underdiagnosed or diagnosed later in life due to differences in the manifestation of symptoms and a greater ability to mask difficulties. The Impact of Undiagnosed ASD: A Link to Depression The silent epidemic of undiagnosed women with ASD exposes them to a heightened risk of depression. Without a timely diagnosis, individuals like Beth may struggle to understand and navigate the challenges they face, leading to persistent feelings of isolation, anxiety, and frustration. The absence of appropriate interventions and support further exacerbates these struggles, compounding the emotional toll on undiagnosed individuals. Psychologists have a responsibility beyond awareness: to challenge stereotypes and advocate for gender-sensitive diagnostic tools. Understanding the intricacies of ASD in women contributes to a more inclusive environment, paving the way for a brighter future for those navigating the intricate landscape of neurodiversity. Cara Gardenswartz, Ph.D. - Website -

Letting go of your work-life is formidable. Take time to let it sink in. Retirement can pack an emotional and existential wallop. Take a break before redirecting yourself. Letting go of a lifetime of work is a great opportunity to practice what the Sufis call “sacred drift.” Retirement may be the end of work, but not of evolving. Ask, “In how many ways can I continue to evolve?” Whenever I visited my father at the factory he owned in New York, he would usher me into the back office—which was his fathers before him—and motion toward a green vinyl couch in the corner. He would then position himself across the room, in a high-backed leather chair beneath a shield and two crossed swords, at a mahogany desk big enough to play a couple of rounds of golf on. He would lean his elbows on the desk, fist in palm, and look at me over his bifocals—a posture I took to be one of intimidation, or, perhaps, camouflage. On one particular visit, I invited him to come out from behind the desk and sit with me on the green vinyl couch. Long pause. Then he rose and walked slowly around the desk, keeping his fingers on it the whole time, breaking contact only at the last possible moment, before crossing that moat between us. When he finally sat next to me, I thought I saw on his face a look of pride mixed with sheepishness. This is one of the memories that came to me recently as I began deliberating about retirement, or rewirement, or call it what you will. A desk is emblematic of work-life, and stepping out from behind it—whether momentarily or permanently—is an act of vulnerability. And courage. It’s re-positioning yourself in relation to the world, to others, and to your own sense of power. In fact, any role you inhabit is, in part, motivated by the desire for power, and we don’t generally like letting go of power, as human history demonstrates with brutal and protracted eloquence. The readiness or willingness to even consider letting it go by relinquishing our work-life is sometimes fueled by nothing more than a hunch that there are other involvements equally worthy of our energies as the contributions we’ve made through our work, equally compelling and valuable, if not moreso: the building (or re-building) of relationships and community, the enjoyment of the natural world, the exploration of the spiritual life, the calls of elderhood, or the making of some peace with yourself that has so far eluded you. At the end of his life, psychologist Abraham Maslow changed his famous hierarchy of needs pyramid, at the bottom of which was always food-clothing-and-shelter and at the top of which was “self-actualization”—which he replaced with “self-transcendence.” He realized that self-actualization is still about the self-seeking its own potential, still about tinkering with the ego, whereas transcendence is a decentralizing of self, an extending of awareness and frame of reference beyond your own borders. Self-actualization isn't the be-all and end-all, but a transitional goal, and retiring its agendas isn’t just about pocketing a gold watch, moving to Florida, and playing golf, not that there’s anything inherently wrong with any of those things. But retirement may confront you in the most profound and often rattling ways with who you are, how you operate in the world , and how attached you are to your mental models. Or more to the point, who you are now, and what parts of you want airtime in the time remaining. And this won’t unfold at the flick of a switch. A lifetime of working—certainly of striving to attain the mythic summit of your potential—generates a tremendous momentum that doesn’t end just because work ends. It’s a bit like a head-on collision. The car stops, but the passenger doesn’t. The books I’ve been reading lately about retirement certainly speak of the challenges of losing a sense of identity, purpose, and power, but they instruct me to get busy again as soon as possible, filling up my calendar with new sources of these commodities, filling up the presumed holes in my sense of meaning and contribution left by the cessation of my work-life. Short shrift is given to the hard human work of making peace with the emotional and existential wallop of it (at least for many people) and the need to unabashedly face ourselves inside that vacuum. Because there is the backside of ambition, the downside of upward mobility, the brute existential fact of getting old and fading from view, and the imperative of learning to manage losses and endings. There is the truth that if your sense of value is pegged to visible achievement and external validation, you’ll be freaked out at the prospect of retirement. To say nothing of the anxiety about whether you can even afford to retire. But it’s critical to understand that even if you identify hugely with your work, have loved it, and will miss its benedictions, it isn’t your identity any more than the tip of an iceberg is an iceberg. Letting go of a career isn’t letting go of your true work in the world, not if you have what people call "a mission statement for your life." Let’s say your deepest calling, your soul’s work, if you will, is to model and educate (literally draw out) passion and self-expression in yourself and others—say as a teacher, life-coach, or performer. This isn’t something you retire from any more than you can retire from your personality. Such a mission is big enough to encompass a lifetime’s worth of activity in a multitude of arenas, not just a career, and certainly not just a job. (A good primer on crafting a mission statement is a book called The Path, by Laurie Beth Jones.) Early in the conversation with myself about retirement, while still stoned on self-actualization, I signed up for a weekend retreat on “designing your life.” But months later, on the morning it began, I woke up feeling deflated. “I don’t want to design my life. I want to listen to it.” The word retirement comes from the old French retirer, meaning "to go off into seclusion"—which is precisely what makes the prospect of retirement unnerving, but precisely what I sense needs to happen before I start scripting my retirement and spread-sheeting my future. That is, I need a break, a pitstop. Time to reflect and engage in what the Sufis call “sacred drift.” Time to let my soul catch up with my new circumstances, to celebrate my contributions, perhaps even do some griefwork around letting them go. “What is your karmic assignment right now?” the author John Kabat-Zinn asked the audience at a conference I recently attended called Wisdom 2.0. “And if it’s not-knowing, that may be the most powerful assignment of all.” Indeed, my impulse at this juncture is to not be impulsive, not just hop from one train to another, but step off the track altogether for a little while. Motion isn’t necessarily progressing any more than noise is necessarily music, and before I jump to problem-solving, I want to consider that retirement isn’t a problem to solve but a passage to navigate, and that I’m certainly not going to retire from evolving, or continuing the work of becoming myself, if not transcending myself. In fact, rather than focusing on what my next iteration is going to look like, what new roles I can invent for myself, perhaps the better question is, “In how many ways can I practice evolving?” Or, “In how many ways can I express my mission statement?” During this not-knowing period that I’ve been allowing myself for the past six months or so, this eddying-out from the current, I’ve been feeling the hunger to create a retirement ritual for myself, a rite of passage to commemorate the relinquishment of the work-life I’ve known for almost 50 years. And then, a few weeks ago—the universe and its mysterious ways being what they are—a ritual found me. An unplanned and perfectly fitting retirement ritual. My desk—and what’s more iconic of work-life than a desk? —broke apart in attempting to move it. The desk on which I’d written all of my books, hundreds of articles and blog posts, and from which I’d orchestrated my entire freelance and speaking careers. It was a most literal break with tradition, and a more appropriate observance I can’t imagine. Gregg Levoy - Website -