Search Results

The pros and cons of constantly striving for the next goal. Are you an extreme perfectionistic or a chronic workaholic? If so, an avoidant attachment style might be the underlying culprit. Learn the pros and cons of the avoidant attachment style and how to achieve unconditional self-acceptance. High achievers consistently strive for excellence and excel in various aspects of life. They possess many admirable qualities that others look up to. In our hustle and bustle culture, it seems like the quintessential characteristic everyone wishes they had. But some high achievers might put too much stock in their achievements—so much that their self-esteem is often predicated on what they do. When they reach a goal, they start planning for their next one. They can become prone to workaholism, as their relationships fall to the wayside. If this sounds like you, the roots of these behaviors may come from an avoidant attachment style. Not sure if this is you? Think back on your childhood. Do some or all of these ring true? As a child, did you often use achievements or accolades to get your parents, caregivers, and other important adults to pay attention to you and give you positive reinforcement? Were you asked to take on adult responsibilities at an early age or made to feel responsible in some way for the feelings and well-being of other people in your family (including, to some extent, your parents)? Were you given direct or indirect messages about emotional expression? Were you taught to hold back on talking about negative feelings? And when you did express negative feelings, were they dismissed or waved away—or did you otherwise get the sense that important adults in your life viewed talking about emotions as some type of character weakness? If you resonated with any of the above, it's quite possible that over time, your self-concept became mostly or solely based on how much you can accomplish. Rather than having a constant, internal sense of your value, you’ve come to believe that you’re only as worthwhile as your accomplishments are. Here are some of the potential downsides of this attachment style . As you go about life, your self-worth can become so entangled in what you do, that you can’t stop doing it. You might find yourself committing to even bigger personal and professional aspirations, often at the expense of important aspects of your life—your health, friendships, family, and romantic relationships. It's also possible that you've taken the viewpoint that it's easier to invest in yourself and your goals rather than in others. You may fear letting your guard down and relying on others, only to be disappointed—so why bother in the first place? You may constantly beat yourself up when you don't achieve as much as you planned, perhaps thinking on some level that this will motivate you to do better. But then you find that you're self-sabotaging more than ever. There are wonderful parts of being a high achiever. But how do you retain that without suffering the other consequences and achieve balance in your self-concept and your life in all important aspects? The Answer is Self-Acceptance Self-criticism is the opposite of self-acceptance. By turning down the volume on that part of you that's fixated on your next goal—harshly prodding you to do more, better, and faster—you can make room to see that you are worthwhile, lovable, and deserving of care from others even without any accomplishments. You can hold space for your emotions, both positive and negative, and become more mindful of all of your experiences in the process. There are no conditions required to give yourself grace, empathy, or compassion, and no hoops to jump through before you can feel good about who you are. Divesting yourself from the armor of your achievements can feel terrifying, but it is one of the most transformational opportunities for your healing. Here’s a simple exercise to do just that. Self-Acceptance Exercise 1. Find a comfortable place to sit. 2. Close your eyes and pay attention to your breath. (If thoughts pop into your head, gently guide your attention back to your breath.) 3. Once relaxed, think back to the first time you remember thinking or feeling that you needed to achieve, to do something productive or constructive, or perhaps take on a responsibility that a child usually doesn’t take on to feel safe, protected, and loved. 4. Turn your attention to the child (or younger) version of yourself in your memory. Ask your inner child how they felt having to do something to earn support and safety. Ask them to share their thoughts or feelings about what they think would happen if they didn’t do these things. 5. Once you identify this, read the following out loud: Whatever you are feeling, my inner child, know that nothing you can do can increase or decrease your unique worthiness. You don’t need to prove your worth because you have worth just by being. Your worth does not depend on your achievements or others’ judgments. Your worth is not based on your degrees, titles, performance, wealth, actions, or the opinions of others. Despite your good qualities and your not-so-great qualities, you are no more or no less worthy than any other human. Your approval of yourself does not come from any external source—it comes from you. Unconditional self-acceptance means that you accept and celebrate yourself as a living human being. You can choose to accept yourself any time of the day, at any moment, and even during difficult times. 6. Close your eyes and bring your attention back to your breath and feel the flow of air moving into your lungs and then back out into the world. With each exhale, release any negative self-talk, self-criticisms, and self-judgments. With each breath, tell yourself, “I am worthy just as I am. I am worthy of being happy.” 7. When you’re ready, take a few more deep breaths and then open your eyes and come back into the room. Reflection Write down one thing your adult self will do to show unconditional self-acceptance to yourself today. It might be an affirmation, or you can simply permit yourself to take a break from productive tasks to engage in a hobby. Repeat this exercise whenever you need just a little grace, and you might just find that day by day, you'll achieve more balance in your life and begin to build toward secure attachment. Judy Ho, Ph.D., ABPP, - Website - Book - References Ho, Judy. (2024). The New Rules of Attachment: How to Heal Your Relationships, Reparent Your Inner Child, and Secure Your Life Vision. Hachette Book Group.

Panic attacks can be terrifying, but very treatable, if you know how. Resisting a panic attack makes it worse. Focus on slow, mindful diaphragmatic breathing. When anxiety first arises, consider it an energy burst to reduce resistance. We don't have to believe all of our thoughts. Panic disorder can be devastating. It accounts for untold suffering and frequent emergency-room visits. The mainstay for pharmacological treatment is SSRI or SNRI medications. Cognitive behavioral therapy (CBT) and mindfulness-based therapies can also be helpful. However, I’ve also seen the need for a quick psychological intervention, for multiple reasons: Immediate, high-quality, in-depth psychological care may not be immediately accessible. Some people are resistant to getting counseling for numerous reasons, including insurance coverage and financial limitations. SSRI and SNRI medications can take a month to have their full effect, and benzodiazepine medication can be addictive. With the right tools and information, patients may not need long-term therapy or long-term medication. (Treatment with SSRIs and SNRIs typically lasts a year.) A 10-minute discussion and a simple mnemonic has helped many of my patients effectively deal with panic, often without needing medication or long-term therapy. Even for those who still need medication or therapy, reviewing the information has been an important adjunct. Patients can remember the mnemonic HR BET by thinking of a baseball player whom they would bet on to have a home run or their “home run bet”: HR BET for short: Harmless: It’s helpful for patients to remind themselves that although panic attacks are very scary, they are usually harmless. It’s usually important for a patient to talk with their physician to ensure that the diagnosis is panic disorder and not another problem. Sometimes, further testing can help reassure both physician and patient. Resistance: Panic attacks are fueled by resistance: people get anxious about being anxious, leading to a vicious cycle of escalating anxiety. With less resistance, the panic attack will be briefer and less intense. Breathing: When people are anxious, they tend to breathe fast and high in their chests. Instead, slow mindful diaphragmatic breathing is helpful. Tune into the sensation of the abdomen slowly expanding with the inhalation and slowly relaxing with the exhalation. It may take time to get used to this style of breathing, and it may be helpful to first practice it when one is relaxed. Energy: Instead of calling it a panic attack, call it an “energy burst.” Instead of launching into that vicious cycle of resistance and anxiety, when there’s that first burst of energy, just feel the energy flow through your veins. You might use the energy to do something active or just feel it without resistance. Be like Popeye who just ate a can or spinach or a superhero who got an extra burst of energy. Thoughts: Remember that you don’t have to believe all of your thoughts. You also don’t have to resist your thoughts or wish them away. When you have a thought like “This panic will last forever,” you have two helpful choices: You can dispute it, in this case, thinking, “I’ve had this before and it always eventually goes away.” Or you can just note those thoughts as they come and go, without believing them This can be hard to remember in the midst of a panic attack. Therefore, I recommend that patients keep the five words in their wallet or take a picture of them on their phone: Harmless Resistance Breathing Energy Thoughts Jay Winner, M.D., - Website - References Winner, Jay. Relaxation on the Run. 2015: Santa Barbara, Blue Fountain Press For more in-depth information on panic and anxiety, check the video "Dealing with Anxiety and Panic." There’s more information on dealing with stress and anxiety.

Exploring the phenomenon of posting self-harm-related content online. Self-harm-related content is prevalent on social media and addressed in many platforms' community guidelines. Social media users may post about self-harm online to find a sense of belonging and to communicate the extent of their distress. Exposure to self-harm content can lead to curiosity about the behavior, trigger cravings to self-injure, and contribute to social contagion. Why do most (if not all) major social media platforms address self-harm in their community guidelines? Why are algorithms needed to respond to social media searches for self-harm with the message, "Can we help”? Why do so many “maneuvering” hashtags (Fulcher et al., 2020; e.g., #selharn, #selfharmmm) exist to circumvent the algorithms? Why are there 119,000 members of the subreddit, r/self-harm? The answer is because of the well-known, persistent prevalence of self-harm-related content on social media The draw to post, share, and discuss self-harm online is evident and has been the subject of much research and debate. Some people note concerns of online self-harm content serving to perpetuate social contagion (the imitation of a behavior by others in a social network; Seong et al., 2021; Walsh & Rosen, 1985), triggering negative reactions and urges to self-injure, and normalizing or encouraging the behavior (Dyson et al., 2016). Others highlight the potential benefits of self-harm posts for users, such as garnering support, finding non-evaluative acceptance and understanding, and avoiding stigmatization (Lavis & Winter, 2020). Yet what do we know about the motives and potential effects of posting self-harm content online? Why post about self-harm? Scholars who have investigated social media users’ motives for posting about self-harm noted that a primary function of the behavior is to experience a sense of belonging and find community (Brown et al., 2020; Dyson et al., 2016). Researchers also identified the theme of posting about self-harm in order to communicate the extent of one’s distress (Shanahan et al., 2019). In addition, those who post about self-harm may be motivated by the desire to raise awareness about the issue (Brown et al., 2020). Moreover, scholars have found that subreddit members discuss the addictive nature of self-harm and report important milestones like the number of days clean (Himelein-Wachowiak et al., 2022). Finally, it has been proposed that the anonymity provided by social media platforms can shield those who engage in self-harm from the stigma and shame associated with the behavior (Moss et al., 2023). So, what's the issue if posting about self-harm online is often motivated by finding community and a sense of belonging? Potential Risks of Online Self-Harm Content There is some evidence that those who post about self-harm online have more clinical symptoms, more suicidal ideation, lower resilience, and more craving for self-injury than those who self-harm but do not post online (Lee et al., 2022). Indeed, a recent exploration of hashtags associated with self-harm posts identified those related to “depression” and “suicide” (e.g., #wanttodie, #depressedgirl) as the most common (Giordano et al., 2022). Thus, although those who engage in self-harm may receive supportive comments and messages from other social media users, they may not be particularly effective or useful in addressing self-harm and co-occurring mental health concerns. Scholars studying those who post about self-harm online noted, “help offered by peers on Instagram was rarely helpful and did not lead to a reduction of their NSSI [nonsuicidal self-injury]” (Brown et al., 2020, p. 6). It could be that the severity of the behavior and extent of psychological distress among those who post about self-harm online is beyond what a helpful or supportive social media comment can abate. In addition to being unable to solve the psychological distress spurring the self-harm, posting about self-harm may create an artificial sense of belonging that hinders the development of supportive offline social connections (which, by nature, are more fulfilling and meaningful than virtual connections). For example, scholars found that high schoolers who engage in self-injury used social media significantly more than those who did not (De Riggi et al., 2018), indicating more time spent in virtual networks. Escaping into online social media to discuss self-harm may further isolate individuals from developing helpful offline relationships and community (Dyson et al., 2016). Lewis et al. (2011) noted that in light of our brain chemistry and neuronal synchronization during in-person attunement (called limbic resonance), online connections could not replace face-to-face connections. Furthermore, if an individual is discussing self-harm with others online, they may not feel a need to seek professional help from a trained clinician. Another potential risk of online self-harm content is the effect of exposure on children and adolescents unfamiliar with self-harm. Young internet users may come across these images, videos, and posts and become curious about the behavior or negatively respond to the potentially disturbing images. It may be helpful for caregivers to discuss the topic of self-harm with children before online exposure. For example, a parent/caregiver may explain, “Sometimes people have to deal with really difficult emotions and situations. If they don’t know what else to do, they may hurt themselves. We call this “self-harm.” If you see a picture of self-harm or read a post about it online, tell me so we can talk about it.” Being Informed and Taking Action As technology continues to evolve and permeate society, we must be vigilant about monitoring its effects, especially on children and adolescents. One potentially unanticipated impact of the ubiquitous nature of social media is the prevalence of self-harm-related content. As social media platforms work to create effective algorithms and enforce their policies and community guidelines related to self-harm, clinicians need to be aware of online behaviors related to self-harm (e.g., uploading, sharing, liking, and viewing posts) and broach the subject with clients who engage in self-injurious behaviors. Developing technology plans and/or periods of abstinence from social media may be helpful for clients who engage in self-harm. Moreover, parents/caregivers should also be aware of self-harm content online and consider this when determining when, if at all, a teenager/young adult should use social media. It is important to prepare all children and adolescents for what they may see online (e.g., self-harm images, videos, stories, graphics) and to have frequent, open conversations about their online activities. Amanda Giordano, Ph.D., LPC, - Website - References Brown, R. C., Fischer, T., Goldwich, D. A., & Plener, P. L. (2020). “I just finally wanted to belong somewhere” –Qualitative analysis of experiences with posting pictures of self-injury on Instagram. Frontiers in Psychiatry, 11, Article 274. De Riggi, M. E., Lewis, S. P., & Heath, N. L. (2018). Brief report: Nonsuicidal self-injury in adolescence: Turning to the internet for support. Counselling Psychology Quarterly, 31, 397-405. Dyson, M. P., Hartling, L., Shulhan, J., Chisholm, A., Milne, A., Sundan, P., Scott, S. D., & Newton, A. S. (2016). A systematic review of social media use to discuss and view deliberate self-harm acts. PLoS ONE, 11, e0155813. Fulcher, J. A., Dunbar, S., Orlando, E., Woodruff, S. J. & Santarossa, S. (2020). #selfharm on Instagram: Understanding online communities surrounding non-suicidal self-injury through conversations and common properties among authors. Digital Health, 6, 1-13. Giordano, A. L., Lundeen, L., Wester, K., Lee, J., Vickers, S. & Kim, I. K. (2022). Nonsuicidal self-injury on Instagram: Examining hashtag trends. International Journal for the Advancement of Counselling, 44, 1-16. Himelein-Wachowiak, M., Giorgi, S., Kwarteng, A., Schriefer, D., Smitterberg, C., Yadeta, K., Bragard, E., Devoto, A., Ungar, L., & Curtis, B. (2022). Getting “clean” from nonsuicidal self-injury: Experiences of addiction on the subreddit r/selfharm. Journal of Behavioral Addictions, 11, 128-139. Lavis, A., & Winter, R. (2020). #online harms or benefits? An ethnographic analysis of the positives and negatives of peer-support around self-harm on social media. Journal of Child Psychology and Psychiatry and Allied Disciplines, 61, 842-854. Lee, S., Yim, M., & Hur, J. (2022). Beneath the surface: Clinical and psychosocial correlates of posting nonsuicidal self-injury content online among female young adults. Computers in Human Behavior, 132, 107262. Lewis, T., Amini, F., & Lannon, R. (2001). A general theory of love. Vintage Books. Moss, C., Wibberley, C., & Witham, G. (2023). Assessing the impact of Instagram use and deliberate self-harm in adolescents: A scoping review. International Journal of Mental Health Nursing, 32, 14-29. Seong, E., Noh, G., Lee, K. H., Lee, J., Kim, S., Seo, D. G., Yoo, J. H., Hwang, H., Choi, C., Han, D. H., Hong, S., & Kim, J. (2021). Relationship of social and behavioral characteristics to suicidality in community adolescents with self-harm: Considering contagion and connection on social media. Frontiers in Psychology, 12, Article 691438. Shanahan, N., Brennan, C., & House, A. (2019). Self-harm and social media: Thematic analysis of images posted on three social media sites. BMJ Open, 9, e027006. Walsh, B. W., & Rosen, P. (1985). Self-mutilation and contagion: An empirical test. The American Journal of Psychiatry, 142, 119-120.

You can have meaningful purposes even if the universe does not. Arguments that the whole universe has a purpose are weak. Some people despair of having meaning and purpose in their lives. People can have meaningful lives if they pursue needs tied to relationships, accomplishments, and freedom. Billie Eilish won an Oscar for her heartfelt Barbie song, "What Was I Made For?" An even bigger question is: What was the universe made for? Science suggests that the universe wasn’t made for anything, but instead resulted from a series of chaotic episodes, including the Big Bang and the formation of galaxies, solar systems, and planets, eventually leading to humans as possibly the only instance of intelligent life. British philosopher Philip Goff thinks that human purpose depends on cosmic purpose: The goal of the universe was the emergence of life. He thinks that physics shows that the universe was “fine-tuned” for life, making cosmic purpose more probable than the alternative hypothesis that we are just a cosmic fluke. Goff defends this hypothesis, the Value-Selection Hypothesis: Certain of the fixed numbers are as they are because they allow for a universe containing things of significant value. He is right that life could not have evolved if numbers such as the cosmological constant for the expansion of the universe were much different. But his argument for the Value-Selection Hypothesis has multiple flaws and amounts to a parody of probabilistic reasoning. First, Goff’s hypothesis is too unclear and vague to be assigned a probability. What does he mean by “because”, “allow”, and “value”? A clearer version would be something like: The existence of life in the universe is the cause of the physical numbers. But this makes no sense because those numbers preceded life by billions of years. Goff rejects the theological view that some god designed the universe to eventually end up with life. But without theology, he has no way to provide an explanatory connection between value or purpose and the physical constants. Goff’s hypothesis is an instance of the “anthropic principle” which lacks scientific credibility. Second, Goff invokes probability theory in an attempt to show that his Value-Selection Hypothesis is more probable than the alternative, which he never states. It would be something like a Chance Hypothesis: Fixed physical numbers are what they are because of random events in the formation of the universe. Science cannot currently tell whether the universe originated because of fluctuations in a quantum field, a repeated oscillation in which universes expand and contract, or some other process. Any of these processes could have caused physical numbers that turned out to allow for life. Goff simply asserts that actual physical numbers are more probable given value selection than given chance, but his assertion is based on nothing more than wishful thinking. He wants the universe to have a purpose so that he can have a purpose. He makes no connection between the universe having a supposed value and its existence. Third, even if Goff’s argument worked and that there is cosmic purpose, this conclusion would not help with the problem of human purpose. Billie Eilish could worry that maybe the universe has a purpose of producing life, but that does not help her with her own personal question of what she was made for. Fortunately, psychology and biology provide an alternative approach to finding value and purpose in human lives through investigations of human needs. Abraham Maslow’s claims about a hierarchy of needs have not stood up to empirical investigation. But extensive research on human needs has found that three psychological needs drive human motivation and behavior: autonomy (freedom), relatedness (connections to other people), and competence (achievement, accomplishment). I adapted this result into a slogan that the meaning of life is love, work, and play. The universe may have originated randomly, but human life has evolved to give people the purposes of trying to meet their needs, and not just their own but also the needs of others. Biological needs are also relevant, in tragic situations in which people lack food, water, clean air, shelter, and health care. Billie Eilish should answer her despairing question by recognizing that her life can be purposeful, meaningful, and valuable if she acts in ways that improve human relationships, accomplishments, and freedom. That’s what all of us are made for, even if the universe was not made for anything. Paul Thagard, Ph.D., - Website - References Earman, J. (1987). The SAP also rises: A critical examination of the anthropic principle. American Philosophical Quarterly, 24(4), 307-317. Goff, P. (2023). Why? the Purpose of the Universe. Oxford: Oxford University Press. Ryan, R. M., & Deci, E. L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. New York: Guilford. Thagard, P. (2010). The brain and the meaning of life. Princeton, NJ: Princeton University Press. Thagard, P. (2023). The relevance of neuroscience to meaning in life. In I. Landau (Ed.), Oxford handbook of meaning in life (pp. 127-144). Oxford: Oxford University Press.

In my clinical experience, these fears have roots in childhood and adolescence. Because of the strong mothering pressure that some men experience growing up, they may fear being controlled. Some men have a core unconscious fear that they are not lovable. Some men don't feel like they're adults who are ready to take on the responsibilities of a relationship, children, and family life. Over the years as a clinical psychologist and researcher, I’ve found that guys have eight common fears of commitment, all of which have their roots in childhood and adolescence. The process of picking, projecting and provoking these fears can lead men to recreate their negative relationship scenarios and sabotage themselves when it comes to romance and love. Unfortunately, if a man is not growing and working on his issues, he will often follow these same patterns over and over again with woman after woman—sinking his possibilities of committed love into the netherworld. I know you may be all too familiar with men’s fears in this department, but bear with me. I want you to have a much deeper understanding of the minds of men. Remember, there is a matter of degree of difficulty: some men are truly mired in their issues, while others are growing and working on themselves. You want to determine if your prospective partner is in the mired-in-quicksand category so that you can get out quickly and cut your losses. But if he is moving forward with developing himself, understanding these self-sabotaging patterns will help you know how to key into his psychology. 1. Fear of Rejection: The Story of Emmett This is a man who is afraid a woman will suddenly lose interest and abandon him. Because of this, he has a hard time having honest straight talk and is very afraid of conflict. When the inevitable disagreements and differences come up in a relationship, he stuffs his feelings and drifts away. He prefers email or texts when dealing with uncomfortable issues. He doesn’t have the courage to stand up to his partner, so problems fester and blow up. When tension reaches the boiling point, he doesn’t have the cajónes to break up. Instead, he becomes passive-aggressive, gently slipping away as his texts and calls fade out—or he quickly dumps you before you can dump him. Above all, he fears rejection, a feeling so painful, that it is almost like annihilation, like being completely destroyed. So, he slithers around any direct conflict. Many men suffer from some degree of this conflict-avoidant pattern. That’s because guys tend to have much more difficulty in dealing with stress. Research shows that after an argument, men’s heart rates and blood pressure readings get more elevated than women’s[i]. And they stay elevated. Why? Because men, unlike women, have a more difficult time soothing and quieting themselves down after any kind of upset. So they may pull away and distance themselves emotionally in order to calm down. Emmett, one of my therapy clients, was a computer security expert who had a history of falling for gorgeous Asian women whom he believed were “out of his league.” Emmett met Riko, a much younger Japanese woman, online. He was awestruck by her delicate beauty. Riko looked up to Emmett and his great intelligence. Nonetheless, he told me in numerous sessions how he was sure she would get disenchanted and leave him. After several months, Emmett was very unhappy with Riko’s passivity during sex. He shared his unhappiness with me but even after my prodding, he refused to tell his lover. Eventually, Emmett agreed to a joint session with Riko. He was very nervous that when he was straight with Riko she would storm out (like his mother, who had a difficult personality). But with support, he was able to speak his truth. Riko was fine about it. She had her own issues about Emmett’s lack of support for her work as a graphic designer. Whenever she brought this up, Emmett tended to clam up and withdraw. But he was committed to therapy and over time the couple worked together and to Emmett’s great relief, became engaged. Fear of Rejection Warning Signs: He avoids angry exchanges like the plague. If there is a disagreement, he tends to pull away and use text/email or simply does not respond to your messages. 2. Fear of Being Controlled and Smothered Because of the strong mothering pressure that most men experience growing up, fear of being controlled is also a common pattern. In my experience, men value their independence and freedom even more greatly than women. Remember that in order to define their own separate identities, they really had to pull away from their mother early on in their lives. This battle for a separate identity is, according to some scholars on gender differences, harder for men than women.[ii] As a result, many men grow up with a view of women as weights that hold them down or as controlling objects that won’t let them go. You can hear these fears echoed in the phrases men use, like, “the ball and chain,” and “she had me by the balls.” It’s easy to see then how marriage becomes the definite marker of an imbalance of power—where the woman-as-wife simply takes over the man’s life. When the fear of smothering is very strong, it leads to classic commitment phobia. Talk of a future makes this guy quiet, nervous, upset, or angry. He may be reluctant to act like he’s in a couple when you are with friends or out in public. He may only speak in the first person, saying “I” instead of “we” or “me” instead of “us.” He may keep you away from his friends and family. Guys who are afraid of smothering may be in an on-again-off-again relationship for years—where he always seems to want you when you break up because he then feels free and unencumbered—yet he just cannot pull the trigger and commit when you are together because it feels like he is losing his independence. If the relationship has progressed to having regular sex, he may need to make an escape by asking you to leave or going home instead of spending the night. He may feel distant and emotionally unavailable to you. He may say he is not sure what love really is or that he is incapable of experiencing love. This is the guy who comes right out and says that he does not believe in love and marriage or getting serious and settling down with one person. No matter how much love he feels, this is a man who is terrified of jumping fully into a long-term relationship. Bottom line: he believes he can’t be himself and fully be with a woman. In his view, he has to give up the lead role in his own life if he is stuck in a supporting role with you and/or the children. It seems like his golf, buddies, bar days, sports, and even the Super Bowl are going to be ripped away by the all-powerful, all-controlling vortex of the couple. For this man, commitment, love, and marriage mean being trapped in a cage from which there is no escape. Fear of Being Controlled: The Story of Jon Jon, a 40-year-old businessman had a series of relationships each lasting around six months to a year. He fell madly in love with brunette after brunette and pursued each of them vigorously until the moment things became serious and “her thoughts of marriage” were in the air. At that moment everything would reverse, and he would feel like the hunted one instead of the hunter. Jon would become anxious and agitated and feel like he had to get away from each woman at all costs as if his very life depended on it. In his last relationship, Jon claimed that he was forced into an actual engagement. But he was saved by an unlikely ally. He told me that right after he gave her the ring, he started having full-blown panic attacks. Jon described them as attacks in which he couldn’t breathe, and his chest became so tight and painful that he thought he was having a heart attack. With these frightening symptoms, Jon felt like he had the excuse he needed. He told his girlfriend that something was really wrong with him and he broke up with her. During therapy, Jon came to realize that his fear of being smothered had destroyed his last relationship and would prevent him from any chance at real love. Only then did he begin working seriously on facing and overcoming his severe commitment fears. Fear Of Being Controlled Warning Signs: He may act like a super confident captain of industry until he has to say the three magic words, or you want a definite date or commitment. Then he turns and runs for cover. Or he may act like your knight in shining armor where he takes orders from you, always looking to please you in a way that feels like he is one-down in the relationship. Until he balks when it comes to moving in together or getting engaged. Only then do you realize that his cooperation was an illusion. 3. Fear of Not Being Lovable Because of not being prized and validated growing up, a man may have a core unconscious fear that he is simply not lovable. He feels insecure and not good enough. This type of guy is looking to you for approval, asking what you think, before he makes decisions. In the beginning, he tries hard and works overtime to make you happy. His feelings depend on what you think and feel. If you are sad, disappointed, or afraid, he is really upset and takes it as a measure of his fundamental lack of worth. The net effect is that he feels emotionally uncomfortable in the relationship, like it is not a good fit for him. He may feel like the woman is out of his league. So when it comes time to take that next step to commitment, to say the "L" word or talk about a future, he is passive, quiet and tends to pull away from you. Another sign of this particular type is the man that cannot tolerate your innocent flirting with guys or talking about your ex. He gets depressed, moody and withdraws. If you cheat, forget about it: this man will not fight to win you back. Instead, he will collapse internally under a mountain of self-hate. Fear of Not Being Lovable: The Story of Jason Jason, a 31-year-old internet marketer, suffered from a fear of not being lovable, or worthy. At a local bar, he met Felicia, a sloe-eyed and beautiful Pilates trainer. Jason was tipsy and confident as he swept Felicia away with his quick wit. They wound up sharing that first night together. Felicia pursued Jason, asking him to join her at various parties and events. Jason came along, but usually had a few drinks to loosen up. A few “good” months went by. One night, Felicia met her ex at a party and flirted with him. Seeing this, Jason sulked and withdrew from her. He was not responsive to any of her attempts to reconnect, even refusing to come over for “make-up” sex. A few weeks later, he called the whole thing off, rejecting Felicia apparently before she could reject him. Fear of Not Being Lovable Warning Signs: He may be very quiet or shy. Or he seeks approval by doing things that are helpful or giving. He finds it hard to talk about his own wants and needs. He is more passive and tends to enjoy solitary activities including sports or computer games. He cannot handle any competition from other guys—it usually spells the end of the relationship. 4. Fear of Not Measuring Up While the fear of not measuring up is closely related to the fear of not being lovable, it has its roots in men’s biology and in our culture. Men are biologically wired to perform and produce. Plus they have been taught by this materialistic culture that the measure of a man’s worth is how successful he is in terms of power and money. Men often feel they must succeed at everything they do: in school; sports; video games; relationships; as lovers; as parents; and, as breadwinners. Some men feel that if they fail in any of these arenas, they are losers. The fear of not measuring up also has its origins in families where boys are driven to be perfect; to get all “A”s, to excel on the football field or by their mothers (often single or divorced) to be the “men of the house.” It’s very difficult if not impossible for a boy or even an 18- or 21-year-old to feel like a man. So you can understand how he might still feel like he isn’t man enough or that he doesn’t measure up. This particular fear can make it very difficult to move forward into a committed relationship with a partner, no matter how terrific she is. At his core, this type of man is terrified that he can’t give a woman what she deserves or needs. His anxiety can be magnified if he is really smitten with her—so the more he is into her, the faster he thinks he will fail in some irretrievable way. Often this type of guy needs a “trophy” girlfriend who is sexy and over-the-top beautiful to “prove” that he is measuring up as a successful man. He may or may not have real feelings for her, even if they are together for years. Fear of Not Measuring Up: The Story of Wayne Wayne, a 29-year-old event promoter had a strong fear of not measuring up. He grew up with a “Great Santini” father, a career military man who constantly pushed Wayne but rarely praised him. Yet, Wayne turned out to be very successful at a relatively young age winning over club owners with his brash can-do attitude. On top of that, Wayne had managed to win the heart of the stunning Li, a 30-year-old Broadway dancer, who had her choice of suitors. They had been together for two years, but as she pressed to move into his place, he nervously told her he was not sure, that he did not know what love really was. When Wayne’s business slowed down, he began withdrawing from Li so that they were down to seeing each other about once a week. Then, at one of his events, Wayne met a young model and took her right to bed. He began courting the new girlfriend while still maintaining some contact with Li. Finally, Li confronted Wayne and he confessed. Wayne tried to make it up to her but he refused to make a commitment for the future. After a few torturous months, Li told him that she was done. Li packed up the things she had left at Wayne’s apartment and slammed the door while he watched helplessly. That’s when Wayne came to see me. After a few months of therapy, Wayne realized how he had self-destructed when his business started to fail. His fears of not measuring up had grabbed him by the throat and to make himself feel like a man again he went after the model. Unfortunately, that only worked for a short period of time. Wayne told me that he was ashamed that his fears had driven away the only woman he had ever loved. With my encouragement, Wayne asked Li to come back. Actually, he begged her. Wayne also invited her to join him in a few therapy sessions. When Li saw that Wayne had true remorse and after he asked her to marry him (with a ring) she did forgive him. They continued in couple’s therapy until after they were married. Fear of Not Measuring Up Warning Signs: He brags and may exaggerate his accomplishments to the point of lying about them. Winning at work or with women is critical to his feeling OK. If this type of guy experiences a setback in work, he may slink away in shame or like Wayne find another woman to boost his ego. 5. Fear of Being Found Out As a man gets closer to a woman, he may fear that he will become exposed, because he has to reveal fears or feelings that are “unmanly” or a shameful family secret. This is especially true if he had difficult, demanding parents that shamed him when he cried or acted like a “wuss.” A similar fear of commitment can also develop when a man is ashamed about his history or family. He may harbor secrets about relatives who are in mental hospitals, in jail or just poor. You may have seen this type of guy depicted on film or TV as the man who can only get married if he completely hides his past. On the award-winning series Mad Men, the super successful hunky lead, ad executive Don Draper, has completely hidden his background and even changed his identity including his name. For a long time on the show, no one, including his beleaguered upper-middle-class wife, knows his true history. Draper’s whole life is about keeping secrets, all driven by the fear of being found out. For this type of guy, opening up and expressing his deeper feelings is impossible because he will have to come clean. And in his world, confession is definitely not good for the soul. Another variation of this fear has to do with an inner sense of having some horrible and unfix-able flaw. It might be a perceived physical defect like his height or the size of his “package.” Or it might be a feeling of intellectual inferiority, a sense of being a “B” player who’s not good enough to be an “A.” This type of man works harder, tries harder and puts down competitors with sarcasm or contempt. In relationships, he will often project onto his partner by being super critical and judgmental and looking for her fatal flaw. Unconsciously, he doesn’t want to be with anyone who would be in a club that would have him. In therapy, he says that there are no great women out there and that he is super picky because he deserves “the perfect woman.” As he makes progress in therapy or some other growth process, he will admit that the truth is that he is afraid to commit because he’s afraid he will be found out as the imperfect man. Fear of Being Found Out: The Story of Guy, the Little Napoleon Guy was a lawyer who was somewhat short in stature, something that had bothered him since he stopped growing at 14. His brutal father, a big and burly Italian pizza restaurant owner, frequently beat him when he was a child. But Guy was tenacious, studied hard, and made it into one of the top law schools. Years went by and with his hard work ethic and pitbull attitude, he became one of the top litigators in Philadelphia. When I first met him, he was dressed impeccably in head-to-toe Armani. He had dated Sherri, a quiet social worker for three years. She looked up to Guy and was very shy socially. Guy complained that even though Sherri was kind and beautiful, that she was boring, especially in bed. According to Guy, his friends really liked her because Sherri had humanized him, that he was “tolerable to be with.” Guy told me all this with a smirk as if he gave a crap about “being more human.” I wanted to meet Sherri but Guy refused because then “we would gang up on him.” Despite my jokes about how he wanted two women to gang up on him, Guy really was afraid for Sherri to find out the truth about him: that he came from a brutal and humble family of modest means. Finally, as Guy continued to waffle, Sherri got the courage to have “the talk.” Faced with what he saw as an ultimatum, Guy broke up with her. It was only then that Guy’s progress in therapy really began. He lost a great gal but the next woman he really liked learned about his sad but true history. Fear of Being Found Out Warning Signs: He denies having any needy-type feelings, like being anxious, insecure, or lonely. He may not be able to use the "L" word. He is extremely judgmental about others, especially if they make demands of him. 6. Fear of Trusting A Woman If a man had an erratic or manipulative mother and a history of being cheated on, used or disappointed by women, he may have major trust issues when it comes to making a commitment. Mistrusting all women, he vows never to be vulnerable again--because if he is, he will just be hurt. If he took a hit financially in a divorce and/or is wealthy, he may be afraid that women just want him for his money. He may fear that all women are mean, manipulative and exploitative. Sometimes this fear can develop when a guy is stuck struggling to extricate himself from an ugly divorce or an angry battle with his ex over their children. He may come right out and say that he will never marry again. Fear of Trusting a Woman: The Story of Kai Kai was a flight attendant who navigated a difficult divorce from a very nasty alcoholic woman, who was very much like his raging mother. In order to get out, he basically caved in and gave his wife the house that he loved and “most” of his money. When he met Saidah, an earthy warm woman on one of his flights, he was entranced. They had a delightful six months together. But when she started asking about a future, he started to experience her as pushy, just like his ex. He said he didn’t think he would ever be able to live with a woman again—and definitely would never marry. Saidah was patient and kind. She felt Kai would come around, especially if she nurtured him. But after two years went by with very little movement on Kai’s part, she gave him an ultimatum: move in together or break up. Kai felt put upon and abused. He went MIA, finally writing her a long goodbye letter. Saidah, on the other hand, learned her lesson and went to one of my trained love Mentors. She started dating guys who were more open to creating a committed love relationship. Fear of Trusting a Woman Warning Signs: He talks negatively about his mother and/or exes. He feels like he has been victimized by women. He may come right out and say he doesn’t believe in love or will never marry. 7. Fear of Growing Up A man may not feel like he is an adult who is ready to take on the responsibilities of a relationship, children, and family life. This so-called Peter Pan syndrome may have its roots in various types of family dysfunction. He may have been coddled by his parents who protected him from the real world, from the possibility of failure. Any difficulty or trial at school might have been dismissed as someone else’s problem and never his responsibility. Or he may have never been encouraged to try something really hard like a competitive sport or an accelerated school subject where trying and not winning or getting a high grade is a real possibility. Or he may have been sickly and had overprotective parents who wouldn’t allow him to play with other kids and compete in sports. Other Peter Pan guys were just ignored by a divorced or missing father and an overworked Mom. As a result of any of these dynamics, the young man fails to build up his identity as a competent and solid adult male. Internally, he feels like a child, a kid who wants to play, get high, sleep late and work menial jobs with little no responsibility. No wonder then that our Peter Pan is boyish in his leisure activities. He may be a video game addict, who is glued to his game console at all times. Or he may spend many hours watching or playing sports. Or he worries about his health while smoking pot every day. He may be still living at home into his 30s. This is a guy who wants to date and have fun, but balks when it comes to having a committed ongoing and serious relationship. Fear of Growing Up: The Story of Jermaine Jermaine was an eternal student, with a master's degree and not a pot to pee in. He worked at Starbucks and lived with his single mom, who was a teacher. His main passion was writing and although he had never published anything, he was always starting a new novel—“his big breakthrough." When Shelly, a frustrated nurse whose dream was also to be a wife and mom, first met Jermaine in a graduate course, she was drawn to his creativity and over-the-top ability to spin yarns. He had a childish air about him that Shelly found endearing. Thus began an on-again-off-again relationship that lasted 10 years. During that time, Shelly would leave Jermaine because the relationship and his career were “going nowhere.” He would then pull his act together and get a full-time job. They would reunite, but never in a serious fulfilling way. Eventually, Shelly met with me and decided to end the relationship for good. Once she was finally free, she began dating men who actually had their own places and real careers that were also looking to be in permanent relationships. Eventually, through an on-line service, she met the “nerdy guy” of her dreams, a man who was successful and crazy about her. They are married and have adorable twin rascals. Fear of Growing Up Warning Signs: He acts juvenile, makes ridiculous jokes or even burps or farts like a little boy. In a conflict, he tends to either quickly back down or have a tantrum to get his way. He may be very concerned with his bodily functions or getting ill. 8. Fear That He Can’t Make The “Right “Decision This type of man has a very hard time making up his mind or trusting his own judgment. When he picks one movie to see, he immediately regrets not choosing another. He is not sure that the company he works at is really the best one for him. This guy is afraid of making a decision that forecloses on all his other options including choosing you. Every time he does so, he has a burst of anxiety and thoughts about other, “better” women. Fear He Can’t Make the “Right” Decision: The Story of George Leeza, a 40-something cosmetics manager at a department store, was a stunning blonde who met George online. George was a community college professor who was close to 50 and yet had never been married. Leeza was drawn to George’s brilliant mind and loved the fact that he didn’t have an ex or kids. George took her out for dinner and bought her expensive gifts at high-end department stores. At first, Leeza was blown away. But as the months wore on, she noticed that George was really very depressed and never seemed to enjoy the fantastic activities they shared. He was always worrying about work, reading his “Crackberry,” or quipping that the service or the meal wasn’t good enough. After about nine months, Leeza wanted to know where things were heading in the relationship. George said that he just didn’t know for sure if marriage was for him, although he thought it was time and Leeza was really terrific. Leeza asked him to figure out where she stood but all he could say was that he was afraid of making a mistake. With the encouragement of her Love Mentor (see Chapter Five), Leeza finally left him and started dating other guys. George begged her to come back. After he went into therapy and attended some growth courses with her, Leeza did take him back, under the condition that they get engaged. George says it was the best decision he ever made. Fear He Can’t Make the “Right” Decision Warning Signs: He is very intellectual. He tends to overly think things through and obsess. He is always second-guessing himself. Often this type of guy needs to be left to realize what he’s lost. The Fear-O-Meter You can think of the Fear-O-Meter as a continuum of intensity of the eight fears. They can occur at normal level, where they are being faced and overcome or they can be exaggerated to the point that the man is so neurotic as to be unable to move into a committed relationship. Signs of Extreme Commitment Fears When men’s fears of commitment are extreme, they can play out in many different ways. Some men become addicts: compulsive video game-players, eaters, drinkers, or workaholics. Others become argumentative, contemptuous, critical or domineering. Still others may act extremely passive or shy or withdraw from any meaningful conversations about the future. Some act more like hypochondriacs or child-like. Others disappear on you. Still others cheat. When fears are extreme and the guy is acting out in response to those fears there is often nothing that can be done. Their fear is operating at an unconscious level and therefore controls the outcome of any love relationship. In other words, it goes nowhere. Once the deeper fear is triggered, whether it is by the prospect of seeing each other more regularly, discussing a future together, moving in or getting engaged, a man with extreme fear will at a fundamental level do all he can to pull back. He is not willing to examine himself, his motives or his fears. Here’s what you need to get: this type of guy is fundamentally happy with the status quo of his love life and does not want to change. Therefore, it’s best to get out quickly and cut your losses. No matter how hard or unfair it seems. You’re better off leaving because if you stay, all you will end up with is a lot of wasted years you can never get back, not to mention bitter disappointment and heartache. Normal Fears All of us are faced with two conflicting urges: to merge and become one vs. being independent and free. When a man and woman fall in love and come together, it is normal and common to have fears come up about losing one’s separate sense of self, one’s space, one’s own identity, and unique pursuits and interests. Both men and women experience these fears. This is reasonable compromises have to be made in order to have a relationship. Time needs to be set aside. After all, how many times has it happened that you get involved with some guy and wind up having little time for your girlfriends? It is normal in the development of a new relationship for your boyfriend to have doubts, to have some measure of virtually all the fears we have been talking about. The key variable here is this: If a man’s fears are at the normal level, they do not stop him from moving forward over time into increasing intimacy and commitment. Sometimes it is hard to tell if a guy has an unworkable commitment phobia or more normal fears that he is willing to work on. You have to examine whether your boyfriend is trying to be self-reflective and willing to grow. Is he taking growth courses, on a spiritual path, or in therapy? In the last several months or year, is he making progress in his ability to move forward with you? In opening his social world of friends and family to you? In sharing his physical space? In his ability to discuss what he wants for the future? In his willingness to express love for you? Is he growing more open to taking the next step in moving forward together, i.e., moving in together or getting engaged? If he is moving forward in many of these ways, it shows that his fears are more manageable and in the normal range. Helping Him Overcome Normal Fears If a guy is truly into you and willing to grow, he will face down his fears and make it work with you. Especially if you accept his need for space and independence, validate his worth and continue to nurture yourself. Remember, he will tend to project his fears and negative expectations onto you and even unconsciously provoke you into being angry, critical or distant. If you understand this, you can practice loving kindness and not engage in that negative pattern from his past. You can show him that love is possible. You can gently let him know that, as James Baldwin says, To defend oneself against a fear is simply to ensure that one will, one day, be conquered by it; fears must be faced.[iii] Helping a guy face his demons is not so easy to do. Especially when you have your own issues about love and commitment, as well as your own needs, as we all do. In my newly revised book, Love in 90 Days, I show you how to handle the baggage from your pastiv that will allow you the freedom to not drag old wounds or bitterness into your future. So you will be able to love from your best and highest perspective of self and, in so doing, inspire your beloved to find his strength and courage. Diana Kirschner, Ph.D., - Website - References [i] J. M. Gottman, The Marriage Clinic, (New York: W.W. Norton & Co., 1999), pp.83-84. [ii] See for example, Irene Fast, Gender Identity: A Differentiation Model. (London: Lawrence Erlbaum Publishers, 1984), pp.67-69. [iii] J. Baldwin, The Fire Next Time (New York: Vintage Books, 1993), pg. 27. [iv] D.A. Kirschner, Love in 90 Days (New York: Center Street, The Hachette Group, 2019) pp. 46-75.

Can you have too much of an admirable quality? As working hard is perceived as a virtue, overworking can be a difficult habit to break. Overwork leads to a drop in productivity, stress, and burnout. Breaking unhealthy habits for overwork and creating a healthier work-life balance are goals worth working on. Most of us consider working hard a virtue. We value and admire those who work endlessly and rarely take time for themselves. We come by our devotion to work honestly. We are taught from an early age that in order to achieve goals and make something of ourselves, we need to work hard, and that hard work is a virtue. The reality is that there are times in our working lives when we feel it is important to go that extra mile to show our value to employers, teachers, or mentors. Going above and beyond what is expected of us signals our value as an employee, our commitment to a task or goal, and our willingness to do what needs to be done to get ahead. The downside of overwork There are times when going that extra mile or burning the midnight oil to make that impossible deadline is counterproductive. As many a productive high achiever will tell you, the employee who works efficiently and effectively and out-performs colleagues is often rewarded with an increased workload. According to a 2022-23 Aflac Workforces Report, 59 percent of workers report experiencing “at least moderate level of burnout. Furthermore, while people are working longer hours than ever and experiencing high levels of burnout, according to 2023 Pew research, close to half of American workers take less time off than they are entitled to. The expanding workweek While the 40-hour work week has long been the norm, the number of hours a week the average employee works is increasing. A 2021 Gallup survey found that the average full-time employee works 44 hours a week and that a whopping 41 percent work 45 or more hours each week. Remote and hybrid workplaces—where employees work at least some of the time from home—can lead to overwork and eat into time with family, time to relax, and even time to sleep. Numerous studies report that overwork can lead to a drop in productivity. A 2019 Sanford University study reports that working over 50 hours a week results in a sharp decline in productivity. Stress, burnout, and disconnection Falling into habits of overwork can result in chronic stress and burnout. The impacts of chronic workplace stress and burnout include physical symptoms like fatigue, hypertension, difficulty concentrating, irritability, changes in appetite, insomnia, headaches, and—in the long-term—an increased risk of type 2 diabetes and serious heart issues. Mental health symptoms related to chronic stress and burnout include depression, anxiety, feelings of detachment, isolation, a decline in job satisfaction, and disconnection from friends and family members. Working toward work-life balance Renowned singer-songwriter Hoyt Axton—best known for having penned the song “Joy to the World”—offers a humorous take on overwork in a song that poses the question: Work your fingers to the bone, what do you get? The answer, and the song’s title: “Boney fingers!” Though there are occasions when we are unable to avoid working longer hours than usual, falling into regular, long-term patterns of overworking can damage our work-life balance, which negatively impacts our physical and mental health, our relationships with others, and our ability to stay connected to ourselves. How to combat overwork and achieve a greater work-life balance Breaking unhealthy habits around overwork and striving to create a healthier work-life balance are goals worth working on. Here are eight steps to help break patterns of overwork: Bring awareness to your habits around overwork: Awareness is the first step to creating positive change. Tune in to what keeps you working into the wee hours. Realize that your resources of time and energy are finite and that habitually dedicating the lion’s share of your limited resources to your working life negatively impacts your relationships and your health. Prioritize your workplace tasks, goals, and responsibilities: Be realistic about what you hope to, need to, and can achieve in the course of a day, a week, and within a deadline. Ask for help when timelines, responsibilities, and commitments are unrealistic: It is important to be realistic about the time, resources, and support required to meet deadlines, achieve goals, and manage workloads. Talk with team leaders and managers when expectations are unrealistic and require more resources. Consider taking your talents elsewhere. If you are constantly struggling with impossible deadlines and managers who are unresponsive to your input or concerns, consider seeking a healthier, more supportive working environment. Pay attention to your reasons for overworking. Are you overworking to achieve a goal or to feel worthy and of value? Schedule downtime: As those of us who overwork understand, what gets scheduled gets done. Start scheduling leisure activities with family, time for friends, and time to pursue activities that bring you joy. Seek the help of a mental health professional: If you are struggling to break entrenched habits of overwork, a therapist can help you address underlying issues, explore your set and maintain healthy boundaries, and create a sustainable work-life balance. Monica Vermani, C. Psych., - Website - Youtube - Book - This article was brought to you by Phycology Today - Website -

A conference at UCLA dispels the myths about Generation Z and mental illness. Community and social supports are critical components of coping with depression and anxiety. Social media can be a way of creating a supportive community and decreasing one's feelings of stigma. Individuals need to reframe the narrative of their mental health journey and not submit to others' beliefs. Be open about your own sources of distress and listen to those expressed by others, without judgment. Mental illness—particularly depressive and anxiety disorders—is on the rise in children and teenagers, with rates doubling (by some estimates) in the past four years. The explanations for this increase have included the effects of the COVID-19 pandemic, widespread racism and social injustice, war, climate change, rampant disinformation, and the ever-encroaching effects of social media. There is much to be learned from journal articles, books, and podcasts on these topics, but not everyone’s voice is heard through those outlets. What if we just ask Gen Z teens themselves? Gen Z Wellness On February 25 of this year, the Teen Advisory Group of the Friends of the Semel Institute at UCLA sponsored an all-day “Generation Z Wellness Summit” focused on the experiences of young people with depression, bipolar disorder, anxiety, substance abuse, and eating disorders. The Friends of Semel group (Vicky Goodman, Founder and President; Wendy Kelman, Executive Director) has a long history of supporting research and educational programs for people with mental illness and their families, with the aims of raising public awareness, erasing stigma, and supporting innovative treatments. I am a UCLA medical school faculty member directing a treatment program for teens with mood disorders and their families, so attending the Summit was of considerable interest to me. With the unifying theme of “We’re all in this together” and over 600 people in attendance on a Sunday morning, the conference speakers talked about their struggles with mental health. These well-spoken teens and young adults emphasized the importance of interpersonal connectedness, being open about one’s distress, and finding community—whether in person or online. All of the speakers acknowledged the important role that family support and psychological or psychiatric treatment played in their recovery—in fact, several called out their parents in the audience, without whom, they said, they would not be alive. What surprised me most was the degree to which social media had provided the interpersonal supports that were absent during and following the pandemic. Social media has become the boogeyman that adults blame for all behavioral or emotional problems in youth. As one young man reminded us, “Don’t believe everything you read.” A more nuanced view is reflected in reviews of the nascent research literature (e.g., Valkenburg, Meier & Beyens, 2022; Nesi, 2020). A consensus report from the National Academies of Sciences, Engineering, and Medicine (Galea and Buckley, 2014) concluded that any causal link between social media use and teen mental health problems cannot be established from the existing (largely cross-sectional) research. The effects of social media on adolescents’ depression or anxiety differ depending on what kinds of content teens seek and how they interact with this content over time. Simple measures such as “screen time” (even though easily available) do not distinguish whether the child is streaming movies, watching pornographic videos, doing homework, or engaging in meaningful dialogue with communities that share their interests or identities. The latter would appear to be salutary, especially for isolated or marginalized youth. In one panel, speakers emphasized personal agency in navigating social media: “You have to tell Instagram or TikTok or Facebook what you want, ask questions of it, talk back to it. It’s your responsibility to make it your own,” explained one of the teen speakers. Disclosing personal details, several pointed out, may connect you with a community that understands you. If you are feeling depressed and ostracized, look for an online community that shares your personal characteristics (e.g., your sexual orientation, gender identity, race, ethnicity, or mental health status), and other communities for different interests, even if it means setting up different profiles for each community. A panel on drug and alcohol abuse was eye-opening. Two young people, one of whom had become a recording artist, talked about how they had come through years of addiction with the help of friends, family members, and mental health professionals. Interestingly, psychiatric medications and rehab facilities were mentioned only in passing. As UCLA professor Timothy Fong put it, “Addiction is often driven by loneliness and lack of community. The antidote is connection.” Lili Rinehart, an actress who has been very public about her personal journey through depression, anxiety, and body dysmorphia, had an inspiring conversation with the chair of the UCLA Psychiatry Department, Helena Hansen, M.D. Lili described an early warning sign of depression: being in social situations where you should be having fun but you’re not. Use these and other internal signs of distress to ask for help, she said, cautioning against withholding important information from your therapist because you find it shameful. If you aren’t feeling comfortable with your mental health providers, speak up and tell them what you need, which may be different from what they’re offering, she emphasized. She closed with “Don’t be afraid to share online because people will respond. You will be building a community. It’s a powerful experience to be surrounded by people who understand you and have been there.” In a panel on relationships and communication, singer/songwriter SkyDxddy spoke about the importance of protecting your personal boundaries in close relationships. She pointed out that many women are trained to be nice and not make others disappointed or uncomfortable. She modeled for the audience how to say no to a person who wants to exploit you. “Tell people what you do and don’t want… don’t tolerate relationships where your boundaries aren’t respected, where you give and give and don’t get back what you need.” I thought of the many advantages of teen participation in social skill groups, where behaviors such as limit-setting can be practiced with peers. Perhaps certain social media sites can serve the same group support function for youth. Molly Kawahata, a climate change activist, strategist, and public speaker who was a former climate advisor to the Obama White House, spoke about hope and empowerment. A person with bipolar II disorder, Molly encouraged young people to not fall prey to the stigma of mental illness. “Learn to reframe the narrative—others’ perceptions don’t have to dictate your story,” she said, expressing her pride at having lived through multiple depressive and hypomanic episodes. After she left the White House, she continued her work on climate change and became an alpine ice climber. She attributed her successes to having known the extremes of high and low moods. She advised attendees to “Embrace your full journey with its ups and downs. Lean into the discomfort.” I found much to agree with in Ms. Kawahata’s approach, with a few caveats. First, although empowering to the individual, there are also risks that young people take when publicly disclosing their disorder and celebrating their journey towards wellness. They may have their story eviscerated by an anonymous “troll” who feasts on humiliating others, or they may have to explain their disclosures later when applying for jobs. In my experience in working with teens with depression, there can be a thin line between leaning into one’s discomfort and ruminating on it – having repetitive cycles of negative thinking that contribute to depressed mood. A Shattering of Myths Generation Z is often described negatively in the press. We’ve heard that they are misguided youth who have grown up in the worst era for education, personal growth, health, environmental safety, social injustice, and economic freedom. We hear that they are addicted to their phones, live inside video games, and can barely hold a conversation. This conference certainly dispelled those stereotypes for me. I heard nothing but compassion, thoughtfulness, and empathy for others. Participants spoke of how their generation has used social media to connect with one another when personal contact was impossible. They are teaching the rest of us the value of being open about one’s struggles, owning one’s identity, and challenging pain through community. In the words of Coretta Scott King, “Struggle is a never-ending process. Freedom is never really won, you earn it and win it in every generation.” David J. Miklowitz, Ph.D., - Website - References Galea, S., & Buckley, G. J. (2024). Social media and adolescent mental health: A consensus report of the National Academies of Sciences, Engineering, and Medicine. PNAS Nexus. 27;3(2): 0-37. doi: 10.1093/pnasnexus/pgae037. Nesi, J. (2020). The impact of social media on youth mental health: challenges and opportunities. North Carolina Medical Journal, 81(2):116-121. doi: 10.18043/ncm.81.2.116. Valkenburg, P. M., Meier, A., & Beyens, I. (2022) Social media use and its impact on adolescent mental health: An umbrella review of the evidence. Current Opinions in Psychology, 44, 58-68. doi: 10.1016/j.copsyc.2021.08.017.

When co-parenting fails, parallel parenting can guide you to success. Co-parenting requires significant effort and collaboration. Instead of co-parenting, divorced parents with different values can choose "parallel parenting." Parallel parenting empowers each parent to establish independently the rules and values in their home. When I was recently interviewed for The Puberty Podcast, hosts Cara Natterson and Vanessa Bennett Kroll asked me a question they get asked frequently by their audience: What can a divorced parent do when the other parent does not follow the same values about parenting? My answer, which may have surprised them, was that parents who do not share the same values should give themselves permission to not cooperate with the other parent in agreeing and implementing the same values. Obviously, it is great when parents align their values and parenting philosophies, which can often make raising kids together easier. But for some separated parents, finding this alignment isn't feasible or comes with a cost. In those cases, I said, the answer is parallel parenting. To understand the value of parallel parenting, we have to appreciate its more prevalent counterpart, co-parenting, the model many of us see more frequently. When is Co-Parenting a Fit? If parents were generally on the same page while living in an intact marriage, a structured co-parenting process may work for them. These people can sometimes easily align on divorce terms and resolve issues out of court. The co-parenting model is a fit when parents can communicate respectfully and regularly about their children and commit to working together to accommodate their children's needs over their own. An example of effective co-parenting is when parents agree that their children will play a sport with frequent practices and games that span both parents' parenting time. This means that: both parents are committed to getting the child to practices and games regardless of whose parenting time it is, and they both share the burden of transporting the child to and from such activities; the parents cooperate to make sure the child has his uniform and equipment so the child has it for each practice; and the parents and their significant others or extended family can all attend the child's games without tension or conflict. In an intact family, ensuring our kids get to the right places, with the right stuff, is hard enough; doing it from two different homes requires serious collaboration. Other examples of quality co-parenting are when parents communicate to ensure that a child completes a month-long school project from both homes, parents who implement the same rules about bedtime and screen time, or parents who regularly share their observations about their child's emotional and physical growth. They inform one another when a conversation about puberty, drugs, or pornography is had in their home. There is no exact co-parenting protocol. Some parents may elect to have a meeting once a week; some parents hire a professional to help them structure their communications; and some parents co-parent with their former spouse's new spouse. Regardless of how it works, the general idea is that children feel the same encouragement, reinforcement, and continuity while residing in each parent's home. Co-parenting requires an immense amount of grace and conciliation from both parents, and it comes with a significant burden of forcing ex-spouses to stay in regular, consistent contact with one another and to agree on and implement the same parenting rules and values. When Is Parallel Parenting a Fit? Parallel parenting is effective when contact between the parents must be minimized. Under parallel parenting (which one parent can unilaterally effectuate), a parent sets forth their rules, routine, and values in their home, irrespective of what happens in the other parent's home. This allows parents to "rule the roost" as they see fit in their own homes without worrying about the other parent's interference, judgment, or the need to collaborate. It may be hard to imagine, but children living with parents practicing parallel parenting will adapt to having separate activities and different bedtime or homework rules in each home. If their parents are healthy and appropriate, the children will thrive from having relationships with both parents without exposure to their parent's conflict. The concept of parallel parenting may not have been the answer the Puberty Podcast audience was expecting from me since, as parents, we are taught that consistency is critical for our children. But there is a reason influencers and other public personas—most recently Ashley Darby of The Real Housewives of Potomac—are openly discussing their decisions to parallel parent their children. Parallel parenting is protective of parents and their values, especially those still recovering from the wounds of a rough marriage or an unexpected divorce, and, as such, this model benefits their children by shielding them from parental conflict. Crucially, parallel parenting allows parents to establish and develop relationships with their children, separate from the other parent. Which Post-Divorce Parenting Model Is Right For You? Just as many people don't find easy alignment on their marital issues, many people cannot simply transition from a divorce to a workable, respectful co-parenting structure. In fact, it would serve us well to deemphasize the need for divorcing parents to align in general, as this shouldn't be the de facto goal for estranged couples. A recent New York Times article about the affordability of divorce serves as a great reminder of just how much emphasis is placed on aligning with a former spouse—without acknowledging the problematic reality of doing so. For many people, the end of a marriage comes with financial complexities and a heavy emotional toll, especially when their decision will impact their children forever, making an easy "alignment on the issues" impossible. Post-divorce, parents should be kind to themselves and patient in deciding which method works best for them and their children. No parent should be afraid to parallel parent if that works best. Sophie Jacobi-Parisi, J.D., M.S.W., - Website -

Personal Perspective: Living with a serious medical diagnosis challenges our identity. Cancer rates are increasing among young adults. Anyone facing a serious diagnosis must choose how they will think and talk about it. The first people with AIDS offered a powerful example of claiming their humanity above diagnosis. The frankness and public vulnerability displayed by Catherine, Princess of Wales, in the recent video sharing the news of her cancer diagnosis, offered a curious and concerned world a glimpse into a very public woman’s very human effort to come to grips with a shocking and life-changing medical diagnosis. Although it may seem surprising that such a young, fit woman—Kate is 42—should face cancer when we typically associate the disease with older age, the fact is cancer is increasing in younger adults. The American Cancer Society’s 2024 annual report on cancer facts and trends shows that younger adults are the only age group who have experienced an increase in cancer incidence—rising by 1% to 2% each year between 1995 and 2020. It also shows increasing rates of breast, prostate, and endometrial cancer in young adults. Colorectal cancer is now the leading cause of death for men under 50; it’s second for women in that age group. Each woman and man who—like the Princess of Wales—receives a cancer or other serious medical diagnosis, faces the prospect of not only treating their illness but figuring out for themselves what it will “mean” for them to have it. Here’s how I know. I had recently turned 47 when my doctor called to tell me I had tested HIV-positive. Suddenly, without warning because I had no symptoms, I had to learn how to think of myself as “living with HIV”—rather than simply encouraging friends who had it or writing about it as a health reporter, as I had done for the previous two decades. What would it mean to me to have the very virus that had killed so many of my friends? One thing I was certain of from the beginning of this new “after”: I did not want to be defined by my new HIV status. I wanted simply to keep being John—not “John, the person with HIV.” As I eventually came to put it, HIV is something I have; it’s not who I am. Getting to that point required me to make some choices. For example, I chose to reject the shame and stigma too many people still attach to HIV because of its association with how the virus is mainly transmitted—through sex and injection drug use. Instead, I looked for role models in the earliest people with AIDS—as they insisted on being known. These gay men had already pushed through the shame and stigma they were expected to accept as their plight for being homosexual. As openly, proud gay men, they weren’t about to accept others’ judgments about the deadly new virus that seemed to single them out in the early years of the now 43-year-old HIV pandemic. They insisted on being recognized foremost as persons. Unlike those people back in the 1980s, when there was no effective treatment and a positive HIV test almost certainly meant getting gravely ill and dying prematurely, I had the good fortune to be diagnosed at a time when there were powerful medications available to keep the virus in check and let me go about simply living my life. I made another choice: I would focus on being grateful for those medications, the resourcefulness I needed to ensure I had access to them even during financially challenging times, and that they have let me live with HIV rather than die from it. Choosing how to frame the story we tell ourselves in our self-talk about what a serious diagnosis means is important to how well we live with it. We choose whether we will define our illness—or let it define us. It has huge implications for our mental health and resilience. It’s unlikely the Princess of Wales will become known as “The Princess with Cancer” because her royal title trumps her diagnosis. As it should. Cancer is something she has and must deal with; it’s not who she is. John-Manuel Andriote - Website - Book -

Emotions like anxiety can manifest as unexplained symptoms in children. School-related anxiety accounts for a large percentage of pediatric visits. When school-related anxiety presents with physical symptoms, the child is experiencing the symptoms. Neuroscientific advances shed light on how the emotional brain can send false messages of bodily symptoms. Pediatricians know firsthand that anxiety is a universal experience. Children naturally feel vulnerable and crave protection. We also know that children have feelings in abundance, but often lack the cognitive skills to express them. So, it is not surprising to us when we find that kids, with their limited ability to navigate emotional storms, start experiencing their scary emotions not as feelings but rather through their bodies. According to pre-pandemic data school-related anxiety presenting as unexplained medical symptoms accounted for 5-12 percent of outpatient pediatric visits1. That’s a lot of frightened kids missing a lot of school. Jason, 7 years old, flanked by two unhappy parents, was waiting for me when I arrived at my pediatric office early one Monday morning. Jason had been experiencing frequent unexplained belly pain over the past month and the symptoms had flared again the previous night. By this morning the mid-abdominal pain was sharper, and Jason cried and pleaded that he could not go to school, again. His parents had a list of diagnoses they felt should be ruled out. The school was asking for a “doctor’s note” so he could be allowed to make up the work at home. Then came an important diagnostic clue: “He’s missed five days of school in the past two weeks because of this.” School attendance is one of the most significant markers for how well a child is functioning, and recurrent absenteeism due to unexplained medical symptoms is a red flag for any pediatric provider. The neuroscience of brain mapping that links physical symptoms to the emotional brain has been rapidly advancing in recent decades. Treatment approaches, however, have been slow to make it out of academic centers to professionals in the community. In my work as medical director of the Inpatient Med/Psych program at Hasbro Children’s Hospital, I learned a great deal about the mechanisms of these emotionally based illnesses from the remarkable psychiatrists and psychologists I worked with. I also began to look back on my previous outpatient pediatric practice with dismay. I came to realize that I, like most pediatricians, had been treating minor versions of these emotional illnesses without understanding their full nature. Jason was perched on the edge of the exam table as if preparing for flight. He stared down at his toes with an alertness that made it clear he was listening closely to every word that was spoken. When I attempted to engage him in the conversation, he looked to his parents to answer for him. His lips trembled as I gently pushed my hands around his soft belly. Diagnostic clue number two: Jason seemed more worried about this visit than he was about his belly pain. Pediatricians are pretty good at recognizing emotionally driven symptoms in children. Sure, we include a careful history and physical exam, but when all that is reassuring, and the timing of the pain seems directly related to the anticipation of a school day, then school-related anxiety moves to the top of our diagnostic list. We don’t close the door on other possibilities. But trying to rule out every possible cause of a physical complaint before diagnosing an emotional source is for amateurs. Many parents, on the other hand, are understandably frightened by these symptoms. They know their child is not a liar. They might take offense that I thought the problem was “all in his head,” or feel that I was being dismissive of their concerns. My recommendation to get the child back in school would often sound counterintuitive. There were a few that even left my practice out of fear and frustration that I was unable to quell. A simple, solid MedPsych toolkit that provided me with a clearer understanding of the dynamics of the illness and honed the language I used would have helped me provide clear psychoeducation and align better with many of these worried parents. It would have improved my effectiveness. What did my MedPsych experience teach me? For one thing, “pain is pain,” whether it is caused by the inflammatory mediators that rush to a very sprained ankle, or by misleading signals across the emotional matrix of the brain, sending messages of pain out to a specific body part. In short, Jason may have had the healthiest belly in southern New England, but as I now realize, he was actually experiencing pain. He truly had no understanding that it was related to school. In a pediatric Catch-22, if he was able to recognize how anxious he actually was about school, his emotional brain wouldn’t have produced these decoy abdominal symptoms to begin with. Simply put, Jason was not faking. His anxiety at the thought of walking into that giant brick building was overwhelming his fledgling coping mechanisms. His emotional brain, in a frantic display of strength, was using a host of neurotransmitters and specialized proteins to send out false but compelling messages of physical symptoms. Pediatric providers need to look these young patients in the eye and tell them, not as an attempt at diplomacy but with conviction, that we believe them. We understand they are experiencing the symptoms they say they are experiencing. And we follow that with basic psychoeducation about the role of the emotional brain in producing these very real symptoms. That is where trust and healing begin. That is how we align with the child and their family. Only then can we help them better understand and connect with their feelings. Sometimes they will need to continue this work with a therapist. Sometimes not. The next critical step is to restore function. Jason’s pediatric provider, his parents, and his teachers must be able to expect and tolerate the inevitable distress, both Jason’s and our own, as we avoid excusing absences and help the distraught child back into the classroom in a compassionate way. Maggie Kozel, M.D. - Website - References 1. Ramsawh HJ, Chavira DA, Stein MB. Burden of anxiety disorders in pediatric medical settings: prevalence, phenomenology, and a research agenda. Arch Pediatr Adolesc Med. 2010 Oct;164(10):965-72. doi: 10.1001/archpediatrics.2010.170. PMID: 20921356; PMCID: PMC3106429.

Here's how perceived financial constraints can ruin happiness. Making a purchase should give someone pleasure. However, feeling financially strained, even if it's not true, can undermine purchase happiness. After making a decision to buy, it's often best to leave any second-guessing at the door. If you are like most people, you have probably experienced financial constraints at some point in your lifetime. We go to college or graduate school in lieu of working a full-time job, yet we experience financial constraints, or scarcity, during this time. Getting a pay cut or, even worse, being laid off creates feelings of constraint and financial scarcity that are both objectively and psychologically constraining. Americans are notorious for carrying debt, and most Americans don’t have enough money saved to cover an unexpected emergency costing a few thousand dollars. Financial issues are so common that there is even a “Financial Health Matters Day.” Financial constraints are often thought about in objective terms, yet financial constraints can also be perceived in our minds. For instance, if you have money invested in the stock market and your portfolio has been steadily (or rapidly) declining, you will likely feel financially constrained or downright unhappy, even if you are objectively doing OK. On Warren Buffet’s drive to his office, he stops at McDonald’s for breakfast each day and will order a couple of sausage patties when the market is down and he is not feeling “prosperous” ($2.61), whereas he will splurge when the market is up and order a bacon, egg, and cheese biscuit ($3.17)1. The richest investor in history appears to experience subjective feelings of scarcity, even if they are delusional. Objective and subjective feelings of scarcity have been researched extensively, finding that scarcity can decrease intellectual performance and happiness2. Recently, a team of consumer psychologists set out to examine how perceived financial constraints influence our happiness when it comes to spending money. The researchers conducted experiments with over 7,000 participants to investigate how perceived financial constraints impact how happy we are when making a purchase3. Across these experiments, the data showed that feeling financially constrained made people less happy when they decided to buy something. In other words, feeling like our personal finances are tight makes us less happy when we decide to make a purchase. The objective relationship between financial constraints and purchase dissatisfaction is intuitive, so the researchers also looked at perceived constraint by asking participants to write about ways they feel financially constrained (versus not). Even when holding participants’ objective financial status constant, perceived constraint made people less happy when recalling a purchase they had made. This effect occurred, in part, due to opportunity cost. When we feel financially constrained and decide to buy a new TV, we are more likely to think about how we could have spent that money on the new pair of sneakers that we also need. In a time when the stock market is perpetually down, and many Americans are getting laid off, the findings from this research are more relevant than ever. So, how can you overcome the feeling of not enjoying your purchases when times are tight? The best strategy is to consider your options upfront, make the best decision you can, and then leave any second-guessing at the door. Considering your other options after the fact does more harm than good, so just tell yourself that you made the right decision for yourself at the time. Budgeting can also help, and keep in mind to budget for unexpected expenses, such as car repairs or medical bills. Financial constraints are a foe, not a friend. They can put us into a scarcity mindset and make us less happy with buying things that should bring us joy. But by making informed purchases, budgeting wisely, and not thinking about what else the money could have gone towards once it is already, well, gone, you can enjoy what you spend your hard-earned money on and improve your happiness. Max Alberhasky, Ph.D., - Website - References 1. Warren Buffet Morning Routine 2. Mullainathan, S., & Shafir, E. (2013). Scarcity: Why having too little means so much. Macmillan. 3. Dias, R. S., Sharma, E., & Fitzsimons, G. J. (2022). Spending and Happiness: The Role of Perceived Financial Constraints. Journal of Consumer Research, 49(3), 373-388.

Hoarding research has uncovered a genetic link and high heritability rates. Hoarding is often mocked, stigmatized, and used as entertainment in shows like Hoarders. Previously regarded as a form of obsessive-compulsive disorder (OCD), in 2013, hoarding was designated as a separate disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, hoarding disorder (HD), for which approximately 2 percent of the population meets the criteria. HD not only affects the person diagnosed, but it can also affect the family unit. As the person acquires more possessions over time, they place more value on these items. They become reluctant to part with these belongings and develop unhealthy attachments to the possessions. Amelia* spoke to us about her experience growing up in a hoarding household. She shared that while growing up, her mother often bought or held on to an assortment of items they didn’t need or had no use for. She would keep various broken items to be used later in art projects. Any attempt to throw out any items, including those that belonged to Amelia, was met with resistance and anger. As a result of her upbringing and her now conflicting values, Amelia hates cluttered spaces but also struggles to throw out items she doesn’t need. “I was taught that everything has value," she said. "I was taught that to get rid of things, even when broken or unwanted, was wasting money and irresponsible.” Amelia shared that her mom did not have much of her own when growing up and had to work for everything she now owned as an adult. Her hoarding behavior increased in severity over time, especially after Amelia left home. “It was like walking into an episode of Hoarders,” she recalled. Interestingly, it was discovered that Amelia’s maternal grandfather and great-grandfather were hoarders for similar reasons. In her study, hoarding researcher Carol A. Mathews at the University of Florida’s Department of Neuroscience found significant heritability for hoarding, a subtype of obsessive-compulsive disorder. Genetic factors accounted for 36 percent of the variance for hoarding. In a 2007 study, gene researchers analyzing samples from 999 OCD patients in 219 families found that families with more hoarding relatives displayed a unique pattern on chromosome 14. While research continues to unfold, this suggests that, in addition to environmental factors, genetics may play a role in hoarding in families. Mathews clarifies that these findings do not mean that those with a genetic susceptibility are destined to be hoarders. The development of hoarding habits can be influenced by factors such as the individual’s upbringing, whether they are aware of their vulnerability to the behavior, and the prevalence of hoarding within the family. With mental health support, one can learn to cope with hoarding and prevent the increasing severity. It is important to recognize the risks and signs of developing HD and to engage in preventative measures. While current hoarding interventions focus primarily on addressing the problem once it has started, individuals can take preventative measures themselves. When it comes to treatment for hoarding, psychotherapy, particularly cognitive behavioral therapy, is recommended to address the underlying mental health challenges at play. Individuals can also seek out resources such as decluttering programs and other resources that can provide them with advice and assistance. Robert T. Muller, Ph.D. - Website -