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

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

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

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

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

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

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

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

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