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The truth about repairing complicated relationships. - There is a problem with hoping another person will change: People tend not to, at least not for long. - Many people focus on others to remove any accountability from themselves. - When we accept others, it doesn't mean we are okay with everything they do and say. Some of our family relationships feel secure and satisfying; those are the relationships we are comfortable being ourselves in. On the other hand, certain family relationships can feel so difficult and stressful that we wonder if that person should even be in our life. Many of us hope that the family member or members who emotionally trigger us will change, keeping us in the relationship until the next emotionally triggering event happens. Maybe your father will finally appreciate all you do, your sister will complain less, or your aunt will stop telling you what to do. Perhaps you've set boundaries, expressed your feelings about behaviors you don't like, or even pushed yourself to be more accommodating. However, if you've managed a problematic relationship long enough, you have probably started to notice the other person never really changes—not for long at least. There is an issue with thinking, pushing, or hoping the other person will change to improve our relationships. When we focus on the other person changing so our relationship can improve, we don't see what we are blind to—understanding how we might contribute to the problems; what we have control of (ourselves); and how we could learn to manage conflict better. In therapy, I often work with clients to shift the focus from others to themselves. In sessions, I ask questions like, "What does your father's criticism of your marriage bring up for you?" "How did you react to his criticism?" "How would you like to respond to him in the future that allows you to communicate your thoughts constructively?" and "What is your father up against if you yell and criticize him for criticizing you?" Our complicated relationships are the ones that can help us grow the most—if we let them. The emotions that others trigger within us tell us some important information about ourselves. First, we can learn what bothers us, telling us where to set a boundary. We can discover if there is an unmet need or a wound we must heal and when we should speak up more or let something go. When we take control of navigating complicated relationships, triggering moments can help us learn how to better self-regulate when we are upset, communicate more constructively, be vulnerable, and remain connected to people even if we don't always get along. The person you find difficult might be challenging and need to change, but trying to push them to change or being reactive yourself isn't helpful when trying to mend those relationships. Also, we have no control over whether someone will change, potentially creating more pain and suffering if we continue going down that path. It is wasted energy that could go into more helpful areas of your life. So, when navigating complicated relationships, don't blame the other person entirely, force others to change, and react without thinking first. Instead, try to accept them for who they are, take accountability for yourself and your part, better communicate what is and isn't okay with you from a clear mind, and lean toward connection instead of protection. Accepting Others When we accept others, it doesn't mean we are okay with everything they do and say. We acknowledge this is who they are now and become aware that their behaviors show us that. We see them more objectively when we accept them; we can respond to them from a place of calm, not anger or reactivity. When viewing the situation from a place of acceptance and objectivity, you can decide if you want the person in your life as they are or if you can work on mending the relationship. Inner peace and calm come with acceptance and a clearer sense of what is happening in the relationship. Taking Accountability Many focus on others to remove any accountability from themselves. Your difficult family member may overreact or not treat you well at times; but how often have you said "yes" to them when you wanted to say "no"? How often have you ignored bad behavior to "keep the peace"? Taking accountability goes hand in hand with advocating for yourself in your relationships. It also means becoming more self-aware and noting how you might contribute to the issues. Communicating Clearly When it comes to communication, many know it's essential but have yet to be taught how to communicate appropriately. Many people yell and scream from anger or don't communicate at all. People can't hear you when you yell and scream, and they especially can't listen to you when you say nothing. Communicating is about sorting through your emotions, then talking clearly and openly about what behaviors you want to see change or continue. Communicating is not a way to control or put the other person down. It is a way to express yourself to others concerning you so they know what you are thinking and feeling. Leaning Toward Connection When emotionally triggered, we lean toward protecting ourselves instead of connecting. Even without a threat to our lives, when we are emotionally triggered in our relationships, we go into our fight, flight, or freeze response, which can look like verbally attacking, avoiding issues, or feeling helpless. When we lean toward connecting to others, even when we go into protection mode, the better chance we have at repairing our relationships. Family relationships are essential, although they can be challenging and hard to manage. You might decide a relationship is beyond repair because the person is abusive or harmful to your mental well-being, which is okay. Sometimes that is the more objective and honest approach; other times, some people are just harder to get along with, and working on repairing complicated family relationships can benefit your personal growth and mental well-being. Ilene S. Cohen, Ph.D. - website - books

Too much can lead to more abuse. KEY POINTS - It is difficult to tell whether remorse is about the offense or being held accountable for it. - The brain may treat remorse as something to be hidden, not as a deterrent for future behavior. - Remorse without compassion can perpetuate the cycle of abuse. If you’ve been abused or betrayed, you probably want to see a lot of remorse from your offender. No remorse is a hallmark of narcissism and psychopathy. But too much remorse leads to more abuse. Remorse keeps abusers in a devalued state. Because they don’t like themselves, they’re apt to re-offend. Consider who is more likely to abuse (or indulge in impulsive behavior) the valued self, or the devalued self. Remorse powers the well-known cycle of abuse, giving false hope to victims: Abuse-Remorse-Honeymoon-Tension-Abuse-Remorse-Honeymoon-Abuse-Remorse- Tension-Abuse-Remorse-Tension-Abuse-Remorse-Abuse-Remorse-Abuse… The “honeymoon” phase falls out of the cycle with repetition. Displays of remorse give way to minimizing or justifying abuse. Remorse disappears, but the cycle of abuse often persists: Abuse-Period of Peace-Abuse-Shorter Period of Peace-Abuse-Brief Peace-Abuse… How Remorse Leads to Recidivism Remorse causes shame. The human brain tries not to think about things that cause shame. (The root of the word, “shame” is cover or hide.) Remorse is absent from implicit (autopilot) memory, until more harm occurs. Remorse is after the fact. People who don’t carry much shame (or who live in denial) may be easily misled into giving too much importance to remorse. If you’ve only done one or two dreadful things, you might associate remorse with the behavior that invoked it and avoid that behavior in the future. But if you’ve done many things that invoke shame, your brain associates remorse with other experiences of shame, not with the behavior that stimulates it. Eventually, abusers view their shame as punishment and their partners as perpetrators. They interpret their victims’ expectation of remorse as a desire to make them feel bad. Retaliatory abuse seems, in their minds, justified. The flawed notion that feeling shame about a behavior will guarantee its extinction operates in overeating, over drinking, and infidelity, to name just a few undesired behaviors. “If I feel bad about doing it, I won’t do it again,” leads to binges and impulsive behaviors, not to restraint. Compassion as Deterrence Compassion concerns the victim’s well-being. It makes offenders want to help with recovery and do whatever it takes for as long as it takes. Remorse is self-obsessed, focused on how bad abusers feel. They’re impatient for your recovery so they can feel better. The experience of compassion puts abusers in a valued state. They like themselves better and are less likely to abuse again. For remorse to deter, it must stimulate compassion in the abuser. In our boot camps for emotional abuse, we show abusers how to increase self-value through compassion and how to view their shame not as punishment but as motivation to be better persons and partners. Steven Stosny, Ph.D. - website - books

The psychology of extraordinary stress may teach us much about mental health. KEY POINTS - The psychological consequences of chronic high stress can prove extremely serious. - Some of the consequences of chronic high stress may have arisen from processes that were actually adaptive in specific ancient contexts. - A psychoeducational approach to understanding processes behind chronic high stress may prove to be productive and useful. Law enforcement officers, firefighters, and other emergency personnel face stressors the rest of us generally do not. These extraordinary stressors influence the mind. Long-term immersion in high levels of the adrenergic human "fight-or-flight" response can result in negative behavioral consequences. We may develop insomnia and be hypervigilant about such things as potential insults. We may be aggressive and irritable, subject to dissociation and to "tunnel vision," focusing on the core of events rather than on peripheral elements that may be of psychological and social importance. We may be impulsive to the point that we do things that are very negative for our futures; we may, under stress, resoundingly insult our bosses or explain to our spouses that their family resembles a herd of musk oxen with poor hygiene habits. We may do this without the slightest rumination or remorse—until, of course, the consequences catch up with us later. The psychological effects of stress can introduce us to the unemployment line, our spouse's divorce lawyer, or the inside of a prison cell with extraordinary alacrity. These impulsive and aggressive behaviors have essentially no place in the modern world (Sharps, 2022); yet we may engage in them anyway. Who do we think we are, Vikings? But what if we were Vikings? Or other ancient warriors? This question is by no means trivial; it goes directly to the heart of our conceptions of mental health. Mental health conditions frequently grade into normal human life The idea of mental health presupposes the concept of mental illness. There is a dichotomy: We have a mental illness, and we wish to remove it to create mental health. In much of organic medicine, this idea generally works. A given microorganism is attacking our bronchi, so we introduce an antibiotic to kill the offending germ; illness is destroyed, and health is restored. It's a dichotomous, yes/no, bimodal situation: Either we have some level of bronchitis, or we don't. Yet mental conditions are, symptomatically, frequently less bimodal than unimodal; we can be slightly sad, or very sad, before we reach the heights of clinical depression, on a relatively smooth, unimodal symptomatic distribution. Attention deficit hyperactive disorder (ADHD) provides an excellent example of this concept; ADHD symptoms tend to be distributed unimodally, not bimodally, in large populations (Buitelaar & Van Engeland, 1996). In other words, with important exceptions such as tertiary neurosyphilis and traumatic brain injuries, mental conditions tend to differ from many purely medical conditions in that they frequently grade into normal human life, rather than deriving from the attacks of identifiable pathogenic influences. This line of reasoning implies that many mental conditions, such as those frequently inherent in chronic exposure to very high stress, may not be the same as physical illnesses. High-stress symptoms could have been adaptive in the past Physical illnesses are not useful in any environment; if one is vomiting, the vomiting in question will have no utility in any conceivable human social environment. Yet, think of the symptoms involved in states of very high stress, as frequently demonstrated by first responders: Insomnia? Suppose, for a moment, that we really were Vikings. Did we really want to be firmly asleep when the enemy attacked? Light sleep, and even insomnia, may have had utility in the ancient world. Hyper-alertness and aggression? Perhaps useful, in ancient context: Did we want to ignore, or fail to recognize, a challenge from a rival? Dissociation? Did we want to make a careful analysis of our relationship to Thor and Odin, or did we want simply to believe that the Gods would protect us within our fate under the governance of the Norns? How about tunnel vision and impulsivity? Did we wish to hang back and consider the psychological provenance of an enemy's attack, or did we need to focus and stab him as quickly as possible? Human actions typical of high-stress, fight-or-flight psychology can prove disastrous in the modern world, which contains attorneys. However, for ancient warriors such as Vikings, these crucial elements of their everyday lives, the extraordinary stressors of combat, may not have proven pathological at all; some of them may have formed a job description. In no conceivable human social environment are fever or nausea good things; yet many psychological symptoms, including those that are characteristic of extreme stress, may have proven to be virtues rather than defects in specific environments of human history and evolutionary descent. The medical model, in which a given type of psychopathology may be dependent on disease processes, is of course useful in context; the potentially psychotic consequences of tertiary neurosyphilis provide an obvious example. Yet many psychological conditions display unimodally distributed characteristics, which may indicate a biological distribution within human evolution rather than an identifiable disease process. It is interesting that symptoms of extraordinary stress may in fact be essentially identical with those of PTSD or incipient PTSD, simply with a much greater elevation of these symptoms in these conditions, and that we see similar symptoms in cases of traumatic brain injury afflicting the prefrontal cortex. The prefrontal cortex is clearly the home, so to speak, of these behavioral anomalies; yet their manifestation in the real world may be dependent, in terms of its relative valuation, whether we are in the world of Eric Bloodaxe and Thorfinn Skull-splitter, or whether we inhabit our modern world of divorce attorneys, industrial tribunals, and lawsuits for perceived offenses. Stress, first responders, and the need for psychoeducation These concepts may be important for the modern psychologist who deals with the extraordinary stresses of first responders, as well as with the less profound stresses typically experienced by the rest of us. Are we dealing with some form of disease process in many mental conditions, or are we frequently dealing with maladaptive responses to modern conditions, seated in what may have been essentially adaptive responses to conditions of the ancient world? If the latter situation is the case, an obvious solution lies in the realm of psychoeducation, training in the reconfiguration of essentially natural responses from their currently maladaptive ancient sources toward a more adaptive series of responses to the modern world. Matthew Sharps, Ph.D. - website - blog References Buitelaar, J.K., & Van Engeland, H. (1996). Epidemiological Approaches. In S. Sandberg (Ed.), Hyperactivity Disorders of Childhood. Cambridge: Cambridge University Press. Sharps, M.J. (2022). Processing Under Pressure: Stress, Memory, and Decision-Making in Law Enforcement (3rd ed.). Park City, Utah: Blue 360 Media.

KEY POINTS - Toxic relationship dynamics often involve one-sided power and control. - Other signs that a relationship is unhealthy are often more subtle and difficult to recognize. - It's important to listen to gut instincts and pay attention to family and friends warnings. Many people are aware of the repercussions of unhealthy relationships, but often the signs that a relationship is toxic are recognized after it’s too late to withdraw easily. The consequences of toxic relationships can be immense—emotional damage, difficulties trusting in future relationships, depression, anxiety, and more—making it all the more important to be able to recognize the subtle signs of relationship toxicity early in the game. It’s All About Power and Control Toxic relationships tend to center on power and control, and the victim in these relationships is consistently at the losing end of these dynamics. As more research delves into why toxic relationships are so difficult to leave, it’s becoming increasingly evident that fear (of being alone, of others’ opinions, of starting over) plays a central role in why people choose to stay in unhealthy relationships. For some individuals, these relationships can initially appear to check all the right boxes (depending on how sophisticated the toxic individual really is)—and, for those who have historically struggled to find fulfilling relationships, the idea that “this finally seems like the one” can be irresistible. This is an ideal setup for power and control dynamics to come into play: One person feels almost desperate for a relationship to work out, while the other senses a situation where power can be usurped for personal gain. The Hidden Warning Signs But toxic relationships aren’t always so simple and easy to characterize. Sometimes, the power and control dynamics happen largely behind the scenes, subtly choking the relationship until a devastating end is staring its victim in the face. These toxic relationships seem to cause even more pain when they end—the unseen, hidden nature of their poison is silent-but-deadly. Recognizing and understanding the more subtle signs of toxic relationships could be key to avoiding these setups altogether. 1. You feel a general sense of unease when thinking about the future. Your body is alive with instincts. It’s a goldmine of subconscious awareness that should be a primary clue to the undercurrents in any situation. When it comes to a toxic relationship, your body holds invaluable information that, if you take the time to slow down and listen, can save heartache on the other side. If you feel a small voice of doubt when thinking about the future of your relationship or vague discomfort that’s easy to rationalize away, take the time to stop and explore those senses. They could be a red flag for something more sinister beneath the surface, or they could just be initial relationship jitters. Without fully examining those emotions, you may be ignoring a built-in warning system that’s trying to get your attention. 2. You’re having trouble eliciting serious emotions or conversations with your significant other. As relationships progress, so too should the level of trust and camaraderie. Conversations at the start of a relationship are understandably more superficial and lighthearted—but if you’ve been in a relationship for an extended period of time and still can’t seem to have a serious, heartfelt conversation, it may be a signal something’s off. Healthy relationships are built on mutual respect, and the trust that accompanies that respect opens up both partners to vulnerability—it’s a necessary part of the process. If you find yourself consistently being more vulnerable in a romantic relationship than your counterpart, it needs to be explored and brought out into the open. Vulnerability is a major way toxic individuals gain power and control over another person. While it can be a beautiful part of a blossoming relationship, it can also be deadly if it’s one-sided. 3. You have an overwhelming sense of responsibility for the relationship’s outcome. Healthy relationships are characterized by an equal balance of power and investment, a concept that involves each partner taking responsibility for the quality of the relationship. If you find yourself more concerned and focused on preserving your relationship than your significant other is, you need to rethink the trajectory of your time together. Mutual dependence can be an enjoyable experience if it’s built on a foundation of trust, empathy, and self-care. When relationships become unbalanced—depending on one person to keep the relationship afloat while the other has free reign to act as they desire—it’s a classic sign that toxicity is lurking behind the scenes. 4. Their family or friends imply there’s danger ahead. If you’ve been in a relationship long enough to meet your significant other’s family or friends, pay attention to the signals they give. Do they joke about your partner’s dating history or tease you about being able to “put up” with them? Those people who have been in long-term relationships with your significant other can be a valuable source of information on the validity of your relationship. Recognizing subtle warning signs from family and friends can be one of the most challenging symptoms to see in a toxic relationship, as lighthearted banter and teasing are often just a normal part of healthy interactions. However, if your gut’s telling you there may be something behind the comments—or your partner’s loved ones give you more overt warning signals—it’s important to pause and reflect on what you may be hearing or sit down with them and clarify their intention. 5. Your arguments never seem to end in a comfortable resolution. “Good arguments” are a genuine part of a healthy relationship. Being able to discuss your thoughts, differences, and emotions openly and without fear of retribution is vital to developing a long-lasting foundation. When your arguments seem to go around and around without any definite solution and keep cropping back up in the same way, it could be a sign of trouble on the horizon. Communication is a definitive cornerstone for healthy relationships, and learning how to disagree respectfully is vital. If you’re constantly feeling discomfort when you bring up a different opinion, or you get the sense you need to tread very carefully when it comes to disagreeing, it could be a sign of a toxic relationship. Learning how to “fight fair” is a process, but it should be one that moves forward—not one that gets stuck on a repeat cycle with no end in sight. Listen to Your Gut Every relationship is unique, and the most knowledgeable person about your relationship is you. Listen to your body, pay attention to your instincts, and take the time to really examine any potential red flags. It could save you a load of heartache in the long run. Jamie Cannon, MS, LPC - website - books

Understanding memory, brain fog, neuroplasticity, and more. Brain fog broadly describes a problem with attention and memory, but the details vary from person to person. Causes of brain fog include fatigue, inflammation, and pain, among others. Tools for neurologic recovery include working with numbers, exercise, socialization, and mindfulness. Fumbling for the right words is frustrating. Why do I feel this way? It didn’t used to be this hard to think. Memory problems and brain fog, which are distressing symptoms for many people, make everyday functioning more difficult. Brain fog comes and goes. It can change day to day, even hour to hour. Its episodic nature can make it hard to capture, treat, and study. When many people talk to their practitioners, the brain fog they describe often gets brushed aside. But brain fog is real. What Is Memory? How does an experience become a memory? It starts with paying attention. If we can’t focus on something, the brain can’t understand and store it. Poor sleep, anxiety, depression, trauma, and inflammation can all worsen attention. What we think is a memory problem can sometimes be an attention problem. Once you’ve paid attention to and taken in an experience, it is stored as a short-term memory. More short-term memories are forgotten than transferred to long-term storage. Memories that get prioritized are often those associated with new experiences or those with emotional significance. Your state of mind plays a big role in whether a short-term memory goes into long-term storage. The brain can’t prioritize thinking and learning if it feels like there is an imminent threat or something more important to pay attention to. When you try to remember something, you must retrieve that memory out of storage. Your memories are scattered strategically throughout the brain, not stored all in one place. Finding where the memory is stored requires some degree of organization. When this search for the memory is slow, we call it a problem with processing speed. There is some evidence that processing speed can be reduced by a number of factors common in long illness, including increased inflammation and depression. In most cases, brain fog impairs attention and usually affects processing speed too. Brain fog is just like foggy weather: fog covers up details and slows everything down. What Is Brain Fog? Brain fog broadly describes a problem with attention and memory. The details, though, vary from person to person: some have problems with multitasking, others respond slowly to questions, and still others are unable to pay attention at work or school. Improving brain fog requires a holistic approach. Why? Because brain fog is a symptom. It appears to be the brain’s reaction to imbalance, overload, and inflammation. We need to target the roots of the problem—or problems. We don’t yet understand why some people’s brains are more predisposed to developing fog. For some, it’s their mind’s way of telling them they are overloaded. For others, brain fog can be caused by something as specific as a food they have eaten. Here are some causes of brain fog. Fatigue Inflammation Pain Medication effects Allergies Gut problems Trauma Migraines Hormone imbalances Blood pressure changes Concussions Depression Anxiety ADHD Dehydration Poor sleep Food sensitivies Brain Fog Vs. Dementia For the most part, brain fog and dementia are very different conditions. Think of the brain as a computer. As we said earlier, brain fog is a problem with the software: the fog slows everything down and makes the software slow to run, but the structure of the brain, the hardware, is okay. Dementia, on the other hand, is a hardware problem. In dementia, the brain gets more and more damaged over time, and thinking and memory become impaired as a result. We worry about dementia when someone isn’t just having difficulty thinking quickly or paying attention, but also seems unable to manage their usual activities of daily living and may be inadvertently putting themselves in unsafe situations. This is different from the normal memory changes with aging. In healthy brain aging, people can be expected to have a harder time remembering details or names, but this doesn’t impair their ability to take care of themselves. Brain Fog Clearing and Memory Optimizing Tool Kit Once you have targeted underlying causes and understand your unique brain’s strengths and weaknesses, you can design an integrative medicine recovery plan. Some large medical centers offer cognitive rehabilitation, a type of rehab specifically aimed at strengthening thinking and memory. If this service is not available where you live, your health care team can design a recovery program for you. Maximizing Neuroplasticity Adult brains can develop new capacities and make new connections, even in the face of illness. This is called neuroplasticity. Neurologic recovery looks different depending on what is happening with your unique brain. With the right brain training and environment, you can clear the fog and harness your neuroplasticity. Even just one activity a day is a great place to start and is likely to help your brain grow. Here are some tools and ideas to help: Play cards. Start with a simple game like War, then try Go Fish or Uno. Even simple games keep your brain engaged. Work with numbers. Try simple calculations in your head. Try Sudoku or balance your checkbook. Enhance your spatial reasoning. Assemble puzzles, draw a map of your neighborhood from memory, or sketch the fruit on your table. Strengthen your memory. Try to recall meaningful life events. Tell them to a friend or write them down. Push yourself to remember as many details as possible. Involve all the senses. Seek out experiences that bring together sound, taste, smell, sight, and touch. For instance, go to a farmers’ market or interactive museum. Try something new. New activities create new networks in the brain. Go to another part of your neighborhood or town and explore, pick up a few words in a new language, or listen to new music. Move your body. Exercise enhances neuroplasticity, prevents cognitive decline, and supports thinking. Socialize. Loneliness is hard on the brain. When you socialize, you are using multiple parts of your brain to process language and pick up on social cues. From research, we know that socializing protects against dementia. Thinking of it as a tool for neurologic recovery can motivate you to find a way to socialize that works for you. Stay hydrated and eat a MIND diet: The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet has been shown in studies to improve brain health, slow cognitive decline, and protect brain functioning. For most people with brain fog, we target 2.7 liters of fluids a day for women and 3.7 liters for men. Check with your primary practitioner to see if these are the right goals for you. Go outside. Getting connected to nature has an anti-inflammatory effect and reduces stress hormones. Being in nature can strengthen memory and attention. The more time you spend in nature, and the more removed it is from urban settings, the better. Practice mindfulness. Mindfulness can be a powerful tool for balancing your nervous system and reducing brain fog. Juliet Morgan, MD, and Meghan Jobson, MD - Blog - Book: Long Illness: A Practical Guide to Surviving, Healing, and Thriving.

What is empathy, and how do I help my child manage it? KEY POINTS Children who are empaths often have big feelings that they don't know how to manage. Parents need to be alert for certain signs that their child is high in empathy and struggling with it. Parents can make life easier for their child by planning ahead a little and not overscheduling. I don’t know about you, but in my house, my children and I have big feelings. As an empath who has three empathic children, our interactions and emotional experiences are a bit more intense than most. Dr. Judy Orloff defines an empathic person as one who is deeply in tune with the feelings of others in their environment. She further describes an empath as an “emotional sponge who absorbs both the positivity and the stress of people and the world.” Empaths process the emotional tone and energy of those around them, whether they want to or not. This also means that the “energy battery” drains quickly, which can lead to overstimulation by one’s thoughts and environment. For example, a child or person who is at school or work may find that within an hour or a few hours, people’s voices and lights may feel like “too much.” For our children who are empathic, their nervous systems are also wired a bit differently. Jean Decet and Yoshiya Moriguchi found that the limbic system, the part of the brain responsible for processing emotion, has more complex neuronal connections in the brains of people who are highly empathic (BioPsychoSocial Medicine, 2007). Jen Granneman and Andre Solo stated that the empathic brain connects emotion with action. Thus, if another person is observed to be in distress, the empathic person will feel compelled to help rather than observing alone. According to “15 Signs You May Be An Empath”, the following is a list of traits that are associated with a child, teen, or young adult who is empathic: Becoming easily overwhelmed Having a strong intuition Finding comfort and peace in being outside or in nature Dislike of crowds Having a strong sense of caring for other Being a good problem solver Needing to rest after being around people Dislike of conflict Difficulty with fitting in Judy Orloff noted in her book, The Empath’s Survival Guide, that “empath children feel too much but don’t know how to manage the sensory overload. They see more, hear more, smell more, intuit more, and experience emotions more.” Parent Strategies for an empathic child As parents, what can we do to honor and help our empathic children to manage their abilities and their interactions with others and their environment? Give the Feeling a Name. One of the hardest things I’ve had to witness as a parent is when my child was dysregulated and overwhelmed but didn’t know why. A strategy that has been helpful for all three of my kids and for the many other children, teens, young adults, and adults with whom we work is giving the sensation or feeling a name. Name it. Call it anger. Call it overwhelm. Call it fatigue. Call it what it is. As parents and as educators, it’s important that we recognize the behavioral signs of a child who is overwhelmed, and rather than treating it as a “behavioral” response that requires a consequence or a behavior plan, ask the question and then give the space and validation for the child to feel what they feel until that feeling passes. If it won’t pass on its own and a sensory break is needed, provide it. Create a plan in advance and set aside space within the classroom or school building to sit in silence with the lights turned off, run around the gymnasium, or take a walk. An Occupational Therapist, private or within the school, can help with finding the appropriate strategies for different physiological sensations at different times of the day. The other thing to emphasize and help your child recognize is that feelings come in like big waves: They crash, and then they subside. That is, there is the build-up, the crash, and then the release and calm down. As a parent or professional, you will notice that the recovery time will decrease, and the child will be able to bounce back with greater ease. Again, I say child, but this applies to children, teens, young adults, and adults. A parent can do the same at home. When my now-14-year-old daughter was in elementary school, she was very overwhelmed by the end of the day. I created a tent for her with sensory calming activities inside, such as coloring, water beads, fidgets, a pillow, and a blanket. She sat in this space, which was created just for her, whenever she felt overwhelmed or whenever I saw that she was feeling overwhelmed. It helped a great deal. It made her more available after her body and mind had calmed, to process what she was feeling and to think of other strategies that could help before she got to this heightened place. Further, help your child to understand that sometimes they will feel other people’s energy and feelings and not know they are not their own. For example, your child can feel when another person is angry or can feel the tension between two people in a room. These feelings are absorbed into their body, and they may not know why they feel “off,” and they may not know how they got here. Ask your child the questions: “Is this your feeling or someone else’s?” “Were there people in the room with you who were feeling angry, sad, or mad with themselves or with another person?” “If it’s not yours, how can you let it go?” Avoid Overscheduling Your Child. Empathic children struggle to transition from one activity or event to the next. This doesn’t give them time to decompress and get ready for the next thing. My policy has been, and continues to be, one activity per child per season. If you have therapies scheduled as well, be mindful of not scheduling an appointment right after school or scheduling too many nights in a row. Avoid Rushing Your Child. If your children are anything like mine, they can not be rushed. With that said, have a schedule or calendar that your child maintains and that you can update each week with therapies, activities, birthday parties, and family events. This allows your child to anticipate and be aware of what’s coming up instead of “springing” it on them the day before or the day of. Our highly empathic children need time to wrap their minds around what’s happening next and go through their mental list of what they want to do before it’s time to go. Give notice of the time that you will need to leave your home and what time to start getting ready. Set alarms to guide the process so you’re not realizing the time, panicking and rushing to get out of the door. This will also create overwhelm and dysregulation for your child. Raising an empathic child requires a great deal of awareness and creating a strategy around helping your child to give a name to their experience and to recognize the ability that they have. Liz Nissim-Matheis, Ph.D. - website

Myth or mental health disorder? KEY POINTS "Sex addiction" is not a medical term. It's most often termed compulsive sexual behavior or hypersexuality. Sexual compulsivity is technically not an addiction, but it's an emerging psychiatric disorder. Sexual compulsivity is a trying condition, but with treatment and dedication to healing, can be overcome. Michael had an enviable career with a high-paying job, and he was happily married with children, not to mention he enjoyed a satisfying sex life with his attractive wife. However, this facade masked a double life, in which he surfed for hardcore pornography at every available opportunity and visited adult entertainment stores with arcades while he was also a paying member of multiple dating sites intended for hookups. Some mistake compulsive sexual behavior as "sex addiction." It's often mentioned in the media with glee, a sensational and salacious habit attributed to sports stars like Tiger Woods and Hollywood celebrities. While the term "sex addiction" is widely used in the media and popular culture, it isn't considered an actual addiction, disorder, or diagnosis. Sex addiction isn't a medical term. It's more of a media buzzword not included in the DSM-5. In psychology, it's most often termed compulsive sexual behavior, sexual compulsivity, or hypersexuality. Compulsive sexual behavior is technically not considered an addiction, although it's an emerging psychiatric disorder. Many people advocate for it to be considered as another form of unhealthy consumption, alongside addictions to alcohol, drugs, gaming, or gambling. The cravings for sexual activity are similar to cravings felt for alcohol or drugs by those with substance addictions. Sexual compulsivity can take many forms. It's not always about having indiscriminate and frequent sexual intercourse. It can also include a dependency on pornography or an obsession with, and an inability to control, various other sexual fantasies, urges, and behaviors. It's an out-of-control feeling of never being satisfied or a constant battle to control behavior that's on autopilot. People with sexual compulsivity return to their behaviors, time and time again, despite the negative consequences. There are many signs that someone you love may have a sexual compulsion. The individual engages in phone sex, cybersex, use of sex workers, pornography, or exhibitionism. The person might have multiple sex partners or cheat on their partners. They may habitually masturbate. On the other hand, they may develop a tolerance to pornography, meaning they will require more extreme and explicit imagery to become sexually aroused. Sexual compulsivity is more common in men than women. In some cases, men may develop porn-induced erectile dysfunction (PIED), impotence caused by excessive porn consumption. The person usually has trouble making and keeping healthy and stable relationships. They may also show a downward work performance and career loss from an inability to focus on work or watching pornography at work. Sometimes the person doesn't even recognize these signs as they disassociate themselves from their behaviors or rationalize them. Hiding, lying, and gaslighting are also characteristics of this compulsion as a result of the shame, guilt, and fear associated with the behaviors. When caught, the person may even be defensive of their actions, arguing that indulging in pornography, even to an excessive degree, is "just what men do" and that "boys will be boys." Others feel remorse and regret for their behaviors but also a deep sense of hopelessness and powerlessness. Their temporary pleasure and unhealthy relationships precede forming healthy, intimate relationships. Sexual compulsivity has an enormous negative impact on those coping with it and those around them. It can cause great damage to relationships and result in the neglect and abuse of a spouse or partner, children, and other family members. It can cause negative consequences for a person's job, career, and finances. It can lead to substance abuse or jail time for sexual offenses. It affects a person's emotional and physical health, possibly leading to STIs. There is growing evidence that compulsive sexual behavior, over time, might cause changes in the brain's pathways, especially in areas related to reinforcement, creating new nerve pathways of addictive behavior. Over time, more intense sexual content and stimulation are needed for satisfaction or relief. There are many potential causes of compulsive sexual behavior. It may be based on childhood trauma, like molestation or rape, and may have a genetic component. Sexual compulsivity is often underpinned by depression, anxiety, and other mental issues, such as personality disorders or obsessive-compulsive disorder. Despite the denialism surrounding the condition, there are several treatments to help people recover from their addiction and abuse, including therapy, medications, and techniques like meditation and mindfulness. As always, having a healthy diet and daily exercise play a significant role in recovery. Some have success with support groups and 12-step programs, like Sex Addicts Anonymous or Sexaholics Anonymous. Most people will require a combination of these modalities to manage their behavior and ultimately regain control over their lives. Sexual compulsivity is an extremely trying mental health condition, but it can be overcome with appropriate treatment and dedication to healing. Karen Stollznow, Ph.D. - website - books

Understanding what enables happiness allows you to take the steps to reach it. Happiness is a highly sought-after, yet elusive, quality. Our culture sends unhealthy messages about happiness. A large body of research has identified the most common sources of happiness. There are other, less researched, though still impactful factors that can lead to happiness. Happiness is, for many in our culture, the Holy Grail of life. At the same time, is there a personal quality that we pursue with such vigor and commit so much time, energy, and money to with so little success? One reason why so many people are unable to find that mindset and feeling that we all seek is that they don’t truly understand what happiness really is and how to experience it. There is no doubt that the journey of the experience of happiness isn’t easy, but it is reachable if you can clearly see what that ethereal goal is. Where many people err in their striving for inner peace is how they try to get it. Our culture sends messages to us that happiness involves focusing on ourselves, maximizing pleasure, and minimizing anything that causes discomfort. For example, advertising campaigns equate consumption with happiness (e.g., Coca-Cola: Open Happiness). However, research suggests that this hedonistic approach actually creates unstable, fluctuating, and transitory states of happiness. In fact, happiness doesn’t equate at all with pleasure. It is also not unequivocally related to major positive or negative life events. Happiness is also not experienced as an emotional states often described as euphoria or elation. What the Research Says About Happiness If you have ever read about the research on happiness, you’ll have learned two things. First, over the last several decades, a large body of research has identified the key contributors to happiness. Second, that research has consistently shown that there are certain factors that most impact happiness (and they aren’t what many people think): Genetics Healthy relationships Meaningful goals Satisfying work Physical health Financial stability Though there is not a robust body of research that supports my additional contributors to happiness, both my professional and personal experience have demonstrated these to also impact happiness. Letting Go of Emotional Baggage I would suggest that no matter how many of the evidence-based influences on happiness you have, you will not be truly happy if you are burdened by emotional baggage that might include low self-esteem, insecurity, perfectionism, fear of failure, anxiety (non-clinical), expectations, need to please, and need to control, to name a few. Emotional baggage weighs you down psychologically (e.g., negativity), emotionally (e.g., sadness, anger, frustration), and behaviorally (e.g., self-sabotage), thus making any level of consistent happiness a near impossibility. To fully experience happiness, you need to let go of your emotional baggage, though admittedly, it is easier said than done. Emotional baggage is mostly unconscious and, even if you are aware of your baggage, that mindfulness isn’t always enough to gain control of it. There are many ways to attempt to let go of emotional baggage, including reading, seminars, and group support. At the same time, the best outcomes will likely come from addressing your emotional baggage with a trained mental-health professional. Reducing Life Stress Life stress, in the form of family conflict, work or school difficulties, financial instability, unexpected events, and health problems, just to name a few, is another aspect of our lives that can prevent you from being happy. Our primitive neurological and psychological reactions to stress, including activation of the sympathetic nervous system and hypervigilance, respectively, create body and mind states that also make happiness very difficult to experience. Life stress can be handled proactively and reactively. The ideal scenario involves taking steps to prevent stress from becoming debilitating. For example, you might end an unhappy marriage (though admittedly that can cause another, entirely different, set of stressors), leave a stressful job, maintain your physical health with a healthful lifestyle (e.g., healthy eating and exercise), or build a positive social support system. Unfortunately, some level of stress is an unavoidable aspect of modern life, so not all stress can be avoided. As such, when stress arises, it’s important to have the tools to manage and mitigate it; for example, exercise, meditation, sleep, mental imagery, massage, mindfulness, humor, and support from others. Controlling Your Life Being out of control is one thing that we humans do not like. This aversion arose due to evolution because, during primitive times, if our ancestors were out of control, death was likely to follow. Yet, there are many aspects of our lives with which we can’t be in total control, whether our physical or mental health, work, finances, or relationships. Ultimately, the only thing you can control is yourself, namely, the way you think, the emotions you experience, and how you act on and react to your world. At the heart of gaining and regaining control of your life is a simple distinction: do you react as a victim (i.e., “I’m helpless to change my life,”) or a master (i.e., “I’m going to take control of what I can in my life”)? This shift requires that you make a deliberate decision to take control of your life. Purpose Beyond Yourself Sadly, we live in a culture that venerates selfishness. We’re constantly bombarded by messages about putting our own needs first. Narcissism has become a cultural toxin. Yet, paradoxically, I have found that focusing on myself makes me less happy. To the contrary, when I focus on others, in terms of love, support, and their needs, I’m actually happier. That’s why it’s important to have a purpose in your life that is beyond your own selfish needs and wants. Your purpose outside of yourself could be a career path (e.g., working for a nonprofit) or an avocation (e.g., volunteering). In either case, that purpose offers you many benefits that can encourage happiness. First, you aren’t constantly dwelling on your own unhappiness or deficits in your life. Rather, you are focusing on helping others. Second, when you help others, you are connecting with and building positive relationships with them which, as I mentioned above, is the number-one contributor to happiness. Third, it is immensely gratifying and nurturing to see you are helping others find happiness. Finally, when you have a purpose beyond yourself, you experience changes in your brain including to endorphins, dopamine, and serotonin. Find Daily Joy Happiness is a psychological, emotional, and physiological state that can be nourished in your everyday life. Small experiences of joy (e.g., at work, with family, in avocations), feeling and conveying positive emotions (e.g., love, inspiration, excitement), simple acts of giving to others (e.g., helping family or friends), expressing gratitude to those who help you (e.g., thanking a waiter or cashier), and appreciating your good fortune (e.g., being healthy, having strong relationships) can all feed your happiness and make it more resilient when difficult times arise. The opportunity to appreciate and smile at the simple pleasures in life and, even better, to laugh also produce psychological, emotional, and physiological benefits that bolster happiness. As someone very wise once said, happiness isn’t a destination, it’s a journey. By understanding and being mindful of what enables happiness to emerge, you can take active steps to build and maintain your happiness through the vicissitudes of life. Jim Taylor, PhD - Website - Book

Our study reveals the challenges of moral consistency in infidelity. Many people have affairs even though they love their partners. Infidelity can act as a stressor, with negative, neutral, or even positive outcomes. We can cultivate a spirit of healthy curiosity towards relationship ethics. My colleagues and I recently published a study on romantic infidelity. We recruited a sample of individuals (mostly middle-aged, married heterosexual men) through Ashley Madison, a dating app for married people who are looking to cheat. The company's tagline is: “Life is short. Have an affair.” Just under 2,000 people participated in our study. They told us about their relationships with their spouses, their motivations, and how they felt about their affairs. Past studies in this area found that when people had worse marriages (i.e., they indicated low relationship satisfaction or high conflict), they were more likely to have affairs compared to those whose relationships were better. But we did not find evidence for that in our samples. Overall, our participants rated their relationship quality as decent (not extremely high, obviously, but not very low either). In particular, our participants noted how much they felt love for their partners, and about a quarter of them said they did couples counseling to improve their relationships. The one thing that seemed to be lacking was sex. Half of our participants said they weren’t sexually active at all with their partners, and sexual dissatisfaction was a major motivation for our participants to seek affairs. But among those who had affairs, their relationships did not get worse over time, nor did their psychological well-being. This is yet another result from previous studies that we could not find in ours. The participants who had affairs said they enjoyed them very much and felt little regret. This pattern was surprising in itself, considering that most people say that infidelity is morally wrong and a sign of a bad marriage. How can this be? And more generally, how can infidelity be so common if most people agree that it’s unethical? I’ll give you a handful of uneasy thoughts to chew on, which may help explain this paradox. People are complicated. Monogamy is arduous. Moral consistency may not truly exist in an objective sense. People’s behavior often stems from underlying goals and motivations. We have goals for social connection, intimacy, and sex, along with goals for virtuousness, productivity, freedom, variety, and a lot more. But we can’t have everything we want in life, so difficult tradeoffs often result. The various goals we have may come into conflict with each other. People want to stay devoted to their spouses, who sometimes may be disinterested in sex (or disinterested in their partner’s body). Some may rather have an affair than dissolve a sexless or unexciting marriage, perhaps because they value the other aspects of their marriage with a lifelong partner. Sometimes spouses end up becoming closer friends over time, even as passion fades. In this sense, people may be making a moral tradeoff. Even as the average person disapproves of cheating, they may do so if they believe it’s the lesser of two evils. As I wrote in a recent chapter for a psychology encyclopedia, some evolutionary theorists suggest that humans, like most animals, are not predisposed toward enthusiastically maintaining lifelong sexual exclusivity with one partner. In other words, monogamy can work for many people, but that doesn’t mean it’s enjoyable. It’s normal for people to desire others (romantically and/or sexually) throughout their lives. The challenge for us is how to contend with those feelings, and social norms often dictate how we do this. Some people attempt to repress those desires and internalize shame. Some engage with pornography. Some have open relationships. Some people cheat. Depending on social and environmental conditions throughout the world, most societies fall somewhere in the middle of a “monogamy spectrum.” In many societies, some type of open relationship is not only normal, but actively encouraged. Knowing how common that is, it’s a bit peculiar that people anywhere would show such extreme distress toward an instance of infidelity. Not only do people strongly disapprove of their partners cheating on them, they also express moral condemnation toward others’ infidelities. People seem really bothered when other people are unfaithful to their spouses. Fellow PT contributor Justin Lehmiller and I also noted in a separate book chapter that people often treat infidelity in absolutist terms—an ethical failure to be avoided at all costs. Scientists may have adopted this moralistic view as well. But we suggest more nuance. Infidelity can act as a stressor, which could result in negative, neutral, or even positive outcomes, depending on other variables, including personality traits, community norms, and other relationship factors. Both exclusive and open relationships have strong ethical boundaries. Sometimes those boundaries are bent, and sometimes they are broken. But people often don’t stop to consider why those boundaries are set in the first place, what purpose they serve, and whether they actually strengthen or weaken relationships. Many people believe that having an agreement to be sexually exclusive with a partner will protect them from betrayal, but this is unwise considering how commonly infidelity happens, even in relationships that are happy and satisfying. I suggest we have a healthy spirit of curiosity when thinking about relationship ethics. Instead of being reactive to the idea of others’ affairs, we should be genuinely inquisitive and responsive. We should try to understand why people behave the way they do, instead of just writing it off as sinful. People are more complicated (and more interesting) than merely “good” or “bad,” and there’s a lot more we have yet to learn about this fraught area of human experience. Dylan Selterman, PhD - Website References: Selterman, D., Joel, S., & Dale, V. (2023). No Remorse: Sexual Infidelity Is Not Clearly Linked with Relationship Satisfaction or Well-Being in Ashley Madison Users. Archives of Sexual Behavior, 1-13; Selterman, D. (2022). Monogamy and Relationship Ethics. Routledge Encyclopedia of Psychology in the Real World. https://doi.org/10.4324/9780367198459-REPRW58-1; Lehmiller, J., & Selterman, D. (2022). The Nature of Infidelity in Nonheterosexual Relationships. In T. Delecce & T. K. Shackelford (Eds.) The Oxford Handbook of Infidelity. New York, NY: Oxford University Press.

Learning more about our values will help us proactively prevent bullying. In 1999, nearly 51 percent of LGB teens reported being depressed. The figure has not changed. One of the most significant ways we can prevent bullying is to help youth connect to their values. Children need to understand that their identity should not be a cause for bullying. Once, while teaching a social-emotional learning (SEL) class, one of the youths I worked with told me how badly he was bullied during high school. I was shocked because he was such an outgoing and gregarious young man. When I expressed my disbelief, he said, “Why is that so surprising? I’m a little gay boy.” Even though he was 22 and came from a completely different generation from me, it was still the rule, not an exception: LGBTQ+ youth get bullied. Also, his language and referring to himself as “a little gay boy” was almost as if he subconsciously blamed the reason for getting bullied on himself. As parents and caregivers, we must continue to reinforce at home that, no matter what, a child is never the cause of getting bullied. Nothing about an individual needs to change in order to prevent bullying. That’s like saying a person who dresses a certain way is responsible for being harassed. The bully and the reasons they choose to bully are what needs to change. Creating a new narrative and shifting the focus will prevent shame from continuing to be the subconscious self-talk of bullied youth. Each of us is familiar with bullying. We’ve either been bullied ourselves, or it has indirectly touched our lives. For LGBTQ+ youth, the numbers are consistently higher. Institutional, cultural, familial, and interpersonal discriminatory beliefs are the root causes of violence toward LGBTQ+ individuals. There are many intersectionalities related to these types of discrimination, but the key factors related to LGBTQ+ bullying are sexism, racism, classism, misogyny, toxic masculinity, queerphobia, heteronormativity, and shame. What LGBTQ+ bullying boils down to is fear. And fear can manifest itself in many ways. What drives bullying is usually related, but not limited to lack, unhappiness, insecurity, disempowerment, no feeling of purpose, hurt, anger, blame, peer pressure, group dynamics, rite of passage, need to fit in, and power dynamics. Ultimately, LGBTQ+ bullying looks like fear + misguided beliefs = LGBTQ+ bullying. One of the principles of non-violent communication is that we always operate from our values. At any given moment, our actions reflect our values. One of the most significant ways we can prevent bullying is to help youth consciously connect to their values. Only when we know our values can we know when we aren’t connected to them. Proactive Prevention A few years ago, I remember talking to my six-year-old niece. She told me how two of her friends had come by earlier in the day. I said, “Oh, how fun. Did they come over to play?” She replied, “No, they came over to say sorry for pulling my hair.” Surprised, I asked my niece, “What did you say after they apologized?” She immediately said, “I accept your apology!” I had to laugh at how cute she was. Then I asked where she learned such a mature response. She told me it was something they learned at school, so I asked her to give me an example of how it’s taught. She said, “Well if one student is mean to another student, our teacher will bring us together and ask them to apologize. The apology isn’t complete until the other person says, ‘I accept your apology.’” Then, in the most matter-of-fact way and in her cute six-year-old voice, she said, “I don’t know why we don’t do that at home. Home is just the same as school, so I don’t understand why it’s not something we do at home.” I had to pause with what she said because it was true. What I learned teaching social-emotional learning for six years is how important it is for parents to reinforce at-home concepts our students learned in class. Most children of marginalized groups, including LGBTQ+ youth, have received some form of shameful message about their identity. Especially if their identity isn’t spoken about or affirmed by an adult when they are young. The more we engage in open and honest conversations with children at home, the more we can proactively prevent bullying and shame–including some of their most harmful effects, like addiction, suicide, and depression. The Centers for Disease Control and Prevention (CDC) published a study in The Journal of the American Medical Association (JAMA) in 2019 that shows the suicide rate in the United States among 15-24-year-olds has increased to its highest point since 2000, with a recent increase, especially in males 15-19 years old. Not long after, US News and World Report released a study published in JAMA Pediatrics showing while depression rates for heterosexual teens have dropped since 1999, the rate for LGB teens hasn’t dropped. Depression rates for LGB teens have remained the same (the study didn’t include results from transgender youth). According to the study, each year between 1999 and 2017, roughly 33,500 teens were surveyed on their struggles with sustained bouts of depressed moods, such as sadness and hopelessness. Among the teens who identified as straight, about 3 in 10 reported being depressed for two weeks in a row or more in 1999. By 2017, the number dropped five percentage points. For sexual-minority teens, the numbers were much worse. In 1999, approximately 51 percent of LGB teens reported being depressed. And nearly 20 years later, the figure hasn’t changed. Caitlin Ryan, director of the Family Acceptance Project at San Francisco State University, says that while images of LGB people have become more positive over the past 20 years, “there is an enormous gap between need and reality when it comes to social services for LGBT youth.” Caitlin talks about the importance of getting families and more social services involved to support youth. She says, "Kids are coming out earlier, and parents are much more aware of sexual orientation and gender identification than ever. That’s great. But that means we now have to step up and fill a huge and continuously growing need for more and more child development and family support to help these kids." Ultimately, having systems in place at home, in schools, and on playgrounds will help us empower youth and prevent LGBTQ+ bullying. “The answer to the bullying problem,” says Brené Brown, “starts with this question: Do we have the courage to be the adults that our children need us to be?” If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. Chris Tompkins, AMFT - Website - Book References: “National Survey on LGBTQ Youth Mental Health,” The Trevor Project, 2019, https://www.thetrevorproject.org/wp-content/uploads/2019/06/The-Trevor-….; Oren Miron, MA et al., “Suicide Rates Among Adolescents and Young Adults in the United States, 2000-2017,” JAMA, June 18, 2019, DOI: https://doi.org/10.1001/jama.2019.5054; Alan Mozes, “Depression Rates Not Budging for Lesbian and Gay Teens,” US News & World Report, October 22, 2019, https://www.usnews.com/news/health-news/articles/2019-10-22/depression-….

Carefully consider what you say and how you say it. Parents naturally want to give their children advice about handling future situations or past actions. Parents should consider whether their advice fits their children’s personality. Short-term imperfection is to be expected when cultivating the longer term goals of autonomy and competency. As parents, you will advise your children throughout their lives, and you will likely feel that certain advice is especially critical for your children to hear. But how can you ensure that your child will listen to your messages? What follows is context for understanding some of the factors that can affect your children's receptivity to guidance, as well as some suggestions about ways you can communicate to promote their listening. One quality that constitutes good counsel is presenting your children with possible actions they might implement that fit their character or personality. Most of us have had the opportunity to witness peers or colleagues handle situations in ways we admire but that feel foreign to us. When you present solutions to your children, consider the temperamental or maturational differences between you and them that might make your suggestions difficult to enact. While you want to stretch your children's capacity to try different problem-solving solutions, it’s important that the solutions you offer aren’t ones they will be unlikely to use. You may also think there is one optimal way your children should respond in a given situation, especially if you believe that their responding any differently would encourage someone to mistreat them. Although you may be right, remember that you are in this for the long haul. You are not just trying to give the best advice in the moment, but cultivating in your children the necessary skills to make good decisions down the road when you might not be around to influence their actions. To encourage reasonable and healthy risk-taking, it is important to communicate that their minor missteps are not tragedies. Help them know that your goal for them is autonomous, thoughtful problem-solving that they reflect upon and revise accordingly. How advice is delivered often determines the likelihood that it will be used. Because most of us don't want to hear what we're doing wrong, the manner in which our flaws are pointed out to us is critical. For many, hearing implications that there was no possibility of a positive outcome due to their actions leaves them feeling ashamed or put down. Even great advice will likely be ignored if it is delivered with overtones of shaming, contempt, or derision. Some people are more sensitive than others to feedback when the delivery is perceived to be harsh. Think whether, in offering your children advice, you are intimating something fixed about their character that will shift their focus from the corrective action you want them to take and make them focus instead on what a disappointment they think they are to you. You don't want your child's attention divided between taking and implementing your present advice and defending their past actions. Are you a parent who communicates your judgment of others openly? If so, your children will quickly learn the criteria for your praise and criticism. They will also grow to know what you think about their actions. It will not matter if you openly express your opinions or not. This is called vicarious learning, and parents frequently teach in this way, though often unknowingly. For example, if your children watch you dismiss or think little of people you believe are lazy, they will know, when you casually suggest that they don’t seem very goal-directed or as interested in doing well, that your words are code for “lazy” and that laziness disgusts you. How best, then, to present your feedback? For starters, try to avoid words like “always” or “never” —they are extreme and absolute, and there are usually exceptions that make such statements untrue. As I have recommended in earlier posts, it’s helpful to begin with a soft start-up that does not place blame. Start with expressions like “You may not have realized it,” “I wonder if,” and “Do you think things would have turned out differently if…?” Also, if you know reasons that would make your child less likely to take your advice, it’s a good idea to address those reasons from the outset. For example, if they fear you are undercutting their autonomy, then be clear that that is not your intention. This helps dispel any misperceptions about why you are offering your guidance. If you would like your children to consider other options than the ones they seem inclined to pursue, consider gentle reflecting questions like these: “What's your goal?” “What are you hoping will happen?” “Is there something that you're hoping for in the other person’s response?” “Do you think they will be receptive?” “Have you thought of how you will feel if they're not receptive?” “Will it bother you?” As your child gets older, you can be more explicit with them about your intentions and ask them directly about the best ways for you to offer advice. For example, “You know that my wish as a parent is to help you navigate tricky situations with more ease and success than I did. But I also realize that I may not always offer advice in ways you like. Can you give me an idea of what approach works best for you?” Any of these scripts are drafts that you can change to sound truer to your own voice. And just as I am suggesting that your children may not come up with the perfect solution for any given situation, you may not either in terms of how you offer them advice. And remember to check in with your children later to see how things worked out. Besides asking them whether their strategy was successful, you can also ask if there is something more you could have done or said to be supportive. You, too, will get better at this with time. Pamela Brown, PhD, Website

Research is increasingly teaching us how to match treatments to the individual. With so many options, it can be hard for providers and patients to know which treatment to start with. Personalized medicine can be applied in behavioral health disorders such as depression. However, experts are still debating the effectiveness of some tools, and there is still much to be learned. If there’s one consistent truth in behavioral health treatment, it’s that one size does not fit all. Cookie-cutter treatment often doesn't work, even if an accurate diagnosis has been made and standard-of-care interventions are applied. In the case of major depressive disorder, for example, numerous options are available. In terms of pharmacotherapy, there are many medication treatments all with different mechanisms of action. Drug classes include selective serotonin reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and more. But not all patients with a diagnosis of depression will respond to all of these treatment options. The truth is we are all different. Heterogeneity within a diagnostic group is the rule, not the exception. And, as a field, we are still in the early stages of trying to figure out what treatment is best for the patient. In the real world, prescribers, like psychiatrists, often have to try several medicines, before finding the best one for a particular patient. Sometimes it takes weeks or months before we get an answer to the question of which medication is best for that individual. It’s an often-frustrating process of trial and error. Therapists also struggle with a similar situation. Often trained in several modalities, we will often pick and choose from our various skill sets, trialing one kind of intervention, and then another, until finding the one that fits the person's needs in front of us. Meanwhile, the patient’s life continues to unravel. Wouldn’t we all be better off if we better knew how to match treatments to a patient’s individual needs off the bat? How Things Work Today: Where Your Behavioral Health Provider Is Coming From When mental health practitioners first evaluate patients in their offices, we may spend the first session, or several, to identify any underlying diagnoses, based on the diagnostic bible, otherwise known as the Diagnostic and Statistical Manual. One of the primary reasons we do this is to inform our recommendations and treatment plan. A diagnosis gives us a treatment direction. Once we know the diagnosis, we have an idea about the next steps; our training has taught us about the standard of care, and we already know the first-line treatments. If we don't know, we can go to the literature to identify the treatments that are most likely to work best for this diagnosis. Results from clinical trials, especially large, double-blind, randomized controlled trials, are the foundations of a psychiatrist’s decision-making about treatment. A typical study of this type takes a large group of people with a single diagnosis—say, major depressive disorder—and randomizes them to active treatment or placebo. The patients are followed over time. Measurements of the patient’s clinical status, after weeks of treatment, are compiled and analyzed to answer the following question: Does the active treatment get people better faster than the placebo, and if so is it a statistically significant difference? If so, then several more studies, in different populations, need to be done. If several studies show the medication to be effective, the field adopts that medicine or psychotherapy as a recommended standard of care intervention. But, unfortunately, not all treatments work for all people. There is significant variability within each diagnosis, based on metabolism, brain chemistry and function, genetics, comorbidity, and any number of other factors. The fact is that individual patients respond differently than the populations in the drug studies do. Many medicines have been studied and found, on the whole, to be effective within the categories of addictions, anxiety disorders, major depressive disorder, bipolar disorder, and psychotic disorders, to name just a few. Numerous psychotherapies, also growing in number, are also evidence-based within each diagnostic category. So, in the face of numerous treatment options to choose from, providers don’t have much information on which one might be best for the patient. Sometimes they’ll go with experience, familiarity, and intuition. Occasionally, there is guidance from the literature about how to match treatment to the individual. But often times it’s just a guessing game. To avoid the time-consuming and in some cases life-threatening trial and error process, where we pick treatments based on intuition and personal experience, we need better ways to know ahead of time what the individual in front of us needs most. The Importance of Defining Subtypes to Inform Treatment “Precision medicine” and “personalized medicine” have been high-priority research agendas for over a decade. These terms refer to medical care designed to optimize efficiency or therapeutic benefit for particular groups of patients and involve using genetic or other biomarker information to make treatment decisions. This is especially important as more and more treatment options are coming out. Research to define subgroups within diagnostic categories, with the end goal to increase the efficiency and effectiveness of treatment, is a major focus of behavioral health research. Genetics, radiologic imaging measures, demographic information, blood tests (such as hormone levels), cognitive function, and behavioral traits are examples of markers that can be utilized to define these subgroups. Examples of disorders being studied using these methods include post-traumatic stress disorder, mood disorder, psychotic disorders (like schizophrenia), substance use disorders, and other addictions. The more researchers explore the validity of subgroups, the closer we will come to being able to identify which medication is best for the individual patient in front of us—treatment matching—thereby improving the outcomes of patients and the efficacy of existing treatments, potentially saving lives. The Future Research in this area of behavioral health and addictions is still in its early phases. For major depressive disorder, there are some early signs of useable tools. Some facilities and providers are, for example, encouraging patients to do genetic testing to identify the medications to avoid, and the ones that are most likely to work with minimal side effects. Some experts express concerns that these expensive tests are not yet ready for prime-time, because it is still not established whether they actually improve patient outcomes—i.e. that testing helps patients get better any faster. Yet other studies (many, it must be said, funded by the companies that produce these testing kits) have reported that they do have clinical benefits and cause overall cost savings. However, more research needs to be done to find affordable, accessible, and accurate ways for behavioral health providers to individualize treatment with medications. In addictions—which will be the focus of my next four articles—there are some signs of affordable, accessible markers that can be deployed now. Although the work is preliminary, these potentially useful markers are not costly, and if clinicians are to have this information in mind when making decisions, it is unlikely to cause harm. Conclusion In this age of a ballooning number of treatment options, researchers have been working hard to identify the best ways to subtype people within a diagnostic category in order to pick the best medication. A textbook, or several, could be written about sub-typing in behavioral health disorders to guide pharmaco- and psycho-therapeutic treatment for mental health and addictive disorders. I don’t have the space to cover it all. Therefore, in the next group of articles, I’ll limit my review of the literature to three groups of clinical diagnoses: alcohol use disorders, other substance use disorders, and the debated topic of food addiction. I’ll also do an additional article on the promise of sub-tying using an addictions neuroscience framework. I’ll primarily be focusing on sub-typing to guide medication treatment rather than choosing between psychotherapeutic modalities. That said, there is a growing (exciting) literature focused on treatment matching in psychotherapy, too, and in a few places (like in the article about the neuroscience-based sub-typing paradigm, and in the article about alcohol use disorders), I’ll occasionally reference treatment-matching in psychotherapy too. June 14, 2023 - Claire Wilcox, MD - Website - Books by Author: Food Addiction, Obesity, and Disorders of Overeating: An Evidence-Based Assessment and Clinical Guide