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

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

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

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

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

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

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

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

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

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

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

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