A Personal Perspective: Finding clarity through diagnosis can turn fear into relief. Key points Accurate diagnosis transforms confusion into clarity, reducing emotional distress and self-blame. Validation through testing aligns internal experience with objective data. Research shows that diagnostic certainty improves well-being by easing uncertainty and restoring control. During feedback sessions, when clients and I review their psychological test results together, I often hear how comforting it feels to have their internal experiences validated by objective data. They describe the relief of seeing their struggles reflected in numbers and patterns that make sense. I’ve heard everything from quiet sighs to laughter through tears — “I knew it,” “That explains everything,” “It finally makes sense.” As a clinician, I’ve always loved those moments. They represent the power of assessment done well: data meeting humanity, insight meeting empathy. When I see a client’s shoulders drop in relief, I know we’ve bridged something important between their lived experience and the language of psychology. A therapist attentively listening during a counseling session. This summer, I found myself on the other side of that equation. After years of helping clients find clarity through testing, I suddenly understood, viscerally, what it feels like to be the one waiting for an answer. Early in the year, I began having severe joint pain, pain so consuming that I could hardly sleep or write or even twist open a jar. My hands and wrists swelled until I couldn’t bend them, and stairs became a slow, deliberate climb. I tried everything that seemed reasonable: collagen, fish oil, supplements, dietary changes, gentle movement. I saw doctors, cried from frustration, and scoured the internet for clues. Nothing fit. Then came a morning when I woke unable to move. I couldn’t bear weight on my knees or ankles, couldn’t crawl because my wrists throbbed, and sat frozen in bed, terrified. My partner was out of town, and the dogs needed me. I texted my sister, who urged me to go to the hospital, but I stayed, immobilized by pain and logistics. Eventually, I crawled to the freezer, gathered ice packs, and began documenting everything — what I ate, how I slept, what hurt most, how my mood shifted. When a trusted nurse practitioner finally ran an extensive blood panel, the results came back: rheumatoid arthritis. And for all the fear that diagnosis carried, I also felt a strange calm. The data matched what my body had been screaming and the puzzle had a name. That moment of validation mirrored what my clients often describe: the peace that comes when your lived experience finally aligns with objective truth. For my clients, a diagnosis of ADHD or autism often brings tears first and relief second. For me, the rheumatoid arthritis diagnosis felt exactly the same. Understanding why my joints burned and swelled didn’t make it easy, but it made it comprehensible. Once the problem had a name, I could act. For my clients, that next step might mean medication that helps the world quiet enough for focus to return; for me, it meant treatment that transformed nights of sleepless pain into manageable aches. Their reports become roadmaps for therapy, lifestyle changes, and self-compassion. My medications and medical team now serve that same function. What has surprised me most is how much identity can settle after clarity arrives. Before my diagnosis, every new pain felt like a personal failure and an uncertain future. Afterward, the pain had context. For many clients, the same shift occurs once they see their cognitive profile on paper. The test results don’t define them; they explain them. And that explanation opens a doorway to action and grace. Across psychology and medicine, accurate diagnosis plays a vital role in restoring a sense of coherence and reducing affective load for clients. According to Merle Mishel’s Uncertainty in Illness Theory, when individuals can't make meaning of their symptoms or condition, the state of uncertainty acts as a cognitive stressor that undermines adaptation (Mishel, 1988). Her work showed that sources of uncertainty, such as unpredictable symptom patterns or lack of credible information, heighten distress, whereas diagnosis, information, and credible support help reduce it (Mishel & Braden, 1988). Integrating this lens helps us understand why the moment of diagnosis can bring relief: the internal chaos of “I don’t know” gives way to clarity and a framework for action. I’ve found deep power in my own diagnosis. I moved from fear and confusion to empowerment and strategy. My clients often describe the same trajectory: beginning the assessment process anxious and unsure, then leaving with renewed self-understanding and agency. Testing, when done with care, isn’t about assigning categories. It’s about returning people to themselves with clearer language for what they’ve already known in their bones. Diagnosis, at its best, is the beginning of understanding. When a client receives results that finally mirror their lived reality, or when a patient learns the name of what their body has been fighting, the world calms just enough for healing to begin. A correct diagnosis doesn’t change who you are; it restores faith in your own experience. It reminds you that the signals you’ve been feeling were never imagined, they were data waiting to be understood. And once they are, both clinician and client can finally meet in the same language of truth, relief, and possibility. Melanie McNally, Psy.D - blog

GLP-1 drugs affect reward circuits to reduce alcohol, opioid, and nicotine use. Key points GLP-1 drugs show potential to treat substance use disorders. These effects appear to be mediated at least in part through the modulation of reward pathways in the CNS. Early results show reductions in cravings, substance use, and other related outcomes. Glucagon-like peptide-1 (GLP-1) is a hormone responsible for most of the insulin release after consuming a meal. Its effects are mediated by activation of GLP-1 receptors (GLP-1Rs) in the central nervous system, which help regulate hunger signals that prompt people to eat when hungry and stop when satisfied (Fig. 1). The introduction of GLP-1 therapeutics has revolutionized the treatment of type 2 diabetes and obesity, with other potential indications under investigation. One such additional indication is the treatment of substance use disorder. Because reward pathways that contribute to pathological overeating and obesity are also implicated in addiction (Fig. 1), scientists have begun to explore GLP-1 therapeutics as possible treatments for substance use disorders. Early studies suggest that these drugs may lower cravings and use for alcohol, tobacco, and even opioids. These studies are described in a recent review published in the Journal of the Endocrine Society. Alcohol Studies in rodents and nonhuman primates show that the GLP-1R agonists dulaglutide, liraglutide, semaglutide, and exendin-4 reduce alcohol intake and other alcohol-related outcomes. Anecdotal evidence and pharmacoepidemiological studies in humans report reduced alcohol use by patients using GLP-1RAs for other indications. In a randomized controlled trial, the GLP-1R agonist exenatide showed reduced alcohol intake in a subgroup of people with both obesity and alcohol use disorder. More recently, another randomized controlled trial showed that a low dose of the GLP-1R agonist semaglutide reduced alcohol consumption and craving in people with alcohol use disorder. A subgroup analysis also showed a reduction in the number of cigarettes smoked per day among those individuals with alcohol use disorder who were also smokers. Opioids In animal models, several GLP-1R agonists have been shown to reduce self-administration and relapse behavior for heroin, fentanyl, and oxycodone. Two pharmacoepidemiological analyses using electronic health records have reported that use of GLP-1R agonists is associated with lower rates of opioid overdose. Tobacco Animal studies indicate that GLP-1R agonists reduce nicotine self-administration, relapse, and other nicotine-related outcomes. A study of social media posts showed that around 23 percent of posts about nicotine mentioned a cessation in use in conjunction with GLP-1R agonists. A pharmacoepidemiological study analyzed electronic health records from people with both type 2 diabetes and tobacco use disorder and found that semaglutide was associated with improved smoking-related outcomes. Results from initial clinical trials suggest that GLP-1 medications promote smoking abstinence, reduce nicotine craving and withdrawal, and prevent weight gain that frequently occurs with smoking cessation. Psychostimulants Several animal studies have shown that GLP-1R agonists reduce cocaine-seeking behavior, relapse, and other related outcomes. Other animal studies have found that GLP-1R agonists reduce amphetamine use and amphetamine-induced hyperlocomotion. Next Steps Although more research is needed to confirm how effective GLP-1 medications are in treating addiction, researchers are optimistic. "This research is very important because alcohol and drug addiction are major causes of illness and death, yet there are still only a few effective treatment options," said lead researcher Lorenzo Leggio, MD, Ph.D., of the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism. "Finding new and better treatments is critically important to help people live healthier lives." Ed Ergenzinger, J.D., Ph.D - blog

Primitive fear responses can be overwhelming and can worsen anxiety. Key points Learning to assess perceived threat versus tangible threat can help us to control physical anxiety responses. Psychological threats are not necessarily soothed by animalistic physical anxiety responses. The brain can be retrained to more accurately respond to perceived danger. A woman with eyes closed, calmly enjoying sunlight When I was a social work graduate student, one of my professors had the class perform an interesting exercise. For five minutes, she instructed us to clench our fists, close our eyes tightly and sit with our muscles tensed. She then had us observe our physical and emotional feelings. After that, she had us sit for another five minutes with our palms open, our eyes closed gently and our bodies relaxed and untensed. Needless to say, there was a significant difference in the physical feelings following each exercise. Not surprisingly, after the first exercise, I noticed that I was severely uncomfortable; my body felt constricted, my heartbeat tightly and quickly, and I actually felt an overwhelming feeling of fatigue and discomfort. Following the second exercise, I felt comfortable, at peace, and relaxed. Though not scientific, this exercise was representative of the body’s fight response: In a tightened, constricted pose, we tend to feel boxed into our discomfort, like a suitcase packed too tightly or a cup filled to the very brim. When we experience anxiety, our body’s natural, automatic response is to shift immediately into a tightened, constricted state, much like an animal bearing down to protect itself from an attack by a predator. This mammalian response, though instinctual, can in fact be altered through cultivating mindful attention to the actual level of danger or threat rather than to the perceived threat. In his book, Waking the Tiger, Peter A. Levine puts it this way: “Today, our survival depends increasingly on developing our ability to think rather than being able to physically respond…the fundamental challenges we face today have come about relatively quickly, but our nervous systems have been much slower to change.” In simple terms, our world is complex and sophisticated, yet our bodies and nervous systems remain at some level, primitive and animalistic. In my book, Overcoming Panic and Panic Attacks, I explain that “our bodies, as sophisticated as they are, struggle at times to differentiate between something that might happen and something that is happening. In these moments, they elicit an emergency response by releasing cortisol, the body’s naturally occurring stress hormone.” The psychological implications of this commonly experienced confusion of true versus tangible danger include panic attacks, chronic anxiety, disruption of daily life and functioning, and avoidant behaviors. So, if the crux of the matter is that if our bodies naturally, instinctually tighten, bear down, and constrict when we perceive a threat, then the antidote is to learn how to measure these “threats” more accurately, which in turn will retrain the body’s automatic stress response. Were we to simplify things further, we might look at our lives as containing both safety and risk. A Buddhist might posit that this is, indeed, the nature of life and human experience: that two things can be true simultaneously. In some moments, we are completely safe; in others, there is risk or threat. But—and here is the larger point—the threats we face are not like those that our hominid predecessors faced: They are typically not immediate, tangible dangers such as predator attacks. They are, however, more sophisticated “threats” such as humiliation, failure, judgment by others, illness, aging, and other mainly existential threats. These are psychological, not tangible, threats and, therefore, are not necessarily soothed by an animalistic response such as tensing, gripping, or bearing down. In fact, this type of response my cause anxiety to worsen and bring about severe feelings of panic. In his book The Untethered Soul, mindfulness guru Michael A. Singer writes, “stress only happens when you resist life’s events. If you’re neither pushing life away, nor pulling it towards you, then you are not creating any resistance.” In that graduate school exercise, we practiced both pushing and pulling at life (the first exercise of tensing) and allowing life (the second exercise of sitting comfortably.) What does this look like in daily practice? One section of Peter Levine’s book is aptly titled "When the Reptilian Brain Speaks, Listen!” Translation: When we notice our bodies having an automatic response, investigate what underlies the response. For example, if I am noticing my body tightening, my heart rate quickening, and my nervous system acting up, I can consciously take a look at what is going on in my life at that moment—perhaps I am stressed at work, maybe I am tired or dehydrated, maybe I have a pending deadline or something important hanging over my head. While Levine’s reptile is unable to think this way and must simply react, humans possess the ability to be curious about the body’s response and to apply logic to physical experience. And this is how we differ from the reptile and how we can retrain the brain to not unthinkingly jump to its reptilian stress response. Using our sophisticated brains, here are a few questions we can ask ourselves when we notice our bodies entering into that tense, tight, uncomfortable state: What is my body trying to tell me? What is it responding to? What is happening in my life at this moment? What events or situations might be communicating to my body that it needs to tighten up? What is the perceived threat or danger that my body might be responding to? How can I reassure myself that I am, in fact, safe? In this moment, can I remind myself that while my body might be responding in a primitive way, this does not mean that there is an actual, tangible danger? Phil Lane, MSW, LCSW - blog

Helping college-age kids with their mental health is a balancing act. Key points Family continues to be a trusted source of support, encouragement, and guidance for college students. Normalizing common struggles—such as poor grades or homesickness—can help students transition to college. At the same time, college students need space to make their own mistakes without parental involvement. A college student Before they head off to college, families have likely played a central role in students’ lives. If there are mental health issues of any type, the family may have been even more involved. It can be difficult for anyone to switch roles. And as students begin college, the responsibility for both their education and their mental health care shifts to them. This transition can often be a challenge for parents. Yet family continues to be a trusted source of support, encouragement, and guidance. Here are some ways to balance our (formerly) tried and true way of helping our kids with what is actually more helpful for them. 1. Be clear about values. Studies show that students are influenced by their families, even though they might not show it. Inspire your student to discover what mental wellness skills work for them, and what behaviors don’t work for them, just as they are discovering what academic courses they do and don’t enjoy the most. Never forget to let your student know you care about their mental health. We often forget to say this simple but profound message. 2. Refer to campus resources. By serving as a referral source instead of trying to solve a problem for them, you show your commitment to empowering them to take ownership of solving their own challenges. You can help them without doing it for them. 3. Make a safety plan. If your student has struggled with serious mental health issues or suicidal ideation in the past, it’s a useful strategy to mutually agree upon what steps to take in response to personal red flags for their situation, such as changes in behavior or isolation. Setting up care resources on campus before classes even start is a helpful step, so that students can have a plan that is ready and actionable. 4. Normalize the struggle. Understand the normal struggles of college, so not everything is seen as a crisis. It’s pretty normal, for example, for students who were confident and successful in high school to hit some bumps once they’re surrounded by lots of other high-achieving peers. Getting an average grade for the first time, being unsure about friendships, missing home, etc., can feel discouraging or worse. Families can be helpful by reassuring students that they are on the right track. Refer them back to college resources as necessary. 5. Communicate about communicating. I recommend having a dedicated conversation about how much texting and calling they want to do. Some students love to get texts whenever, but many students can feel interrupted in their lives by getting too many texts or calls from family. Meet your student where they are at and expect many changes over the next few semesters. At the same time, a surprise care package or a favorite treat will always be appreciated. And when you do get a chance to talk or text, never underestimate how much it matters to hear that you’re proud of them—those words of encouragement carry extra weight during this season of transition. 6. Sit on your hands. Unless directly asked for advice, the best advice for parents is to “zip your lip.” Understand that your child needs the space to stumble, face setbacks, and explore their identity and beliefs. These experiences are essential for growth—they teach accountability, build resilience, and help students develop a strong sense of self. Offer support and encouragement, but trust that they have the tools and resources to find their way. 7. Be a role model. I would also argue that parents/families and loved ones of those students are crucial role models, so working on your self-care and wellness benefits not only you but your student. They are watching what you do, not just listening to what you say. By fostering open and supportive communication, you show your student that you respect their growing independence while still being a steady source of care. In doing so, you create the kind of relationship where they feel both valued and understood—and more inclined to seek your guidance when they need it most. Mia Nosanow, MA, LP - Website

How keeping the focus on yourself can transform conflict into connection. Key points When conflict arises, the impulse to focus on your partner can block self-awareness. Keeping the focus on yourself shifts attention from blame to accountability. Real repair begins when each partner takes responsibility for their own part. When couples come to us for therapy, they usually want the same thing: fewer fights, less hurt, more harmony. They imagine that the healthiest relationships are the ones with the least conflict. But that’s not how love actually works. The goal isn’t the absence of conflict (rupture)—it’s how we use the conflict to repair—create and sustain meaningful connection. In our book, Love. Crash. Rebuild, we teach every couple two unexpectedly simple rules. They sound almost too basic to matter, but if you really live by them, they can transform your relationship from the inside out: Rule 1: Keep the focus on yourself. Rule 2: Refer to Rule #1. That’s it. Just two rules that, if practiced with intention, can change everything about how you love. Rule 1: Keep the Focus on Yourself When tension rises, most of us go straight into reflex mode: “You’re making us late.” “You’re not listening.” “You always do this.” It’s a natural human response. We feel uncomfortable, and we believe—wholeheartedly—that our partner is the source of our discomfort. But when we focus on our partner’s behavior, it blinds us from seeing our own contributions to the issue at hand. Keeping the focus on yourself means pausing long enough to ask: What’s happening in me right now? How am I feeling right now? Is this feeling intolerable to me? What am I afraid of, defending against, or needing? It’s not self-blame—it’s self-awareness. And it’s the foundation for real accountability. Example: The Time Cop This one’s personal. I (Mark) have what Haruna affectionately calls my “time cop” mode. I get anxious about being late—whether it’s to a punk show, the opera, or a dinner reservation. If I sense we’re running behind, something in me tightens. I start pacing, muttering about when we need to leave, convinced that every lost minute means disaster. And then, predictably, I’ll say something critical—“Do you have to change your shoes again?”—which immediately changes the mood. Now we’re not talking about time anymore. We’re in a power struggle about respect, control, and who’s right. When I catch myself and come back to Rule 1, I start to notice what’s really happening: I’m anxious. I feel out of control. I’m scared of missing something I’ve been looking forward to. When I can own that instead of projecting it—“I’m feeling wound up about being late”—the energy between us shifts completely. Haruna can respond with empathy instead of defensiveness: “I get it. You hate rushing. I’m almost ready.” The moment I turn the focus inward, the rupture begins to transform—initiates the process of repair. Rule 2: Refer to Rule 1 That’s the whole thing. There isn’t another rule. Every time you forget Rule 1—and you will—come back to it. It sounds almost silly, but it’s not. It’s a commitment to self-reflection even when you’re convinced your partner is wrong. In our marriage, we still use this rule constantly. When one of us starts veering into “you” territory, the other might say, with some degree of humor, “Hey—Rule 2.” It’s not a jab; it’s an invitation. It’s a reminder that the moment we start blaming each other, we’ve already left the road of repair. Not to mention, also giving up our power to contribute to the solution to whatever problem we are having. Example: The Unanswered Text Once, after a long day, Mark texted me (Haruna) asking what time I’d be home. I saw it, got distracted, and forgot to reply. By the time I walked in the door, he was irritated: “You never answer when I text you!” I immediately went defensive: “I was busy! Why are you making such a big deal out of this?” Classic rupture. Later that night, after we both cooled off, I realized I’d missed my own cue to apply the rules. I had made it about his tone instead of my impact. When I went back to Rule 1, I saw what had happened: his message had triggered my guilt—I knew I’d dropped the ball. The next morning, I said, “You were right. I ignored the text and didn’t own it. I think I felt ashamed.” His shoulders relaxed instantly. He said, “I wasn’t angry about the text. I just felt ignored.” That was repair. Not because we avoided conflict, but because we used it. Why It Works The two golden rules may sound overly simple, but they go to the core of what makes relationships thrive: personal responsibility and emotional awareness. When both partners stay focused on themselves, neither has to be the villain. Each person stays accountable for their own feelings and actions. The argument stops being a tug-of-war and becomes a shared inquiry: What’s really happening here? These rules turn conflict into a classroom. Every rupture becomes a chance to learn—not just about your partner, but about yourself. Mark B. Borg, Jr, Ph.D., and Haruna Miyamoto-Borg LCSW - Blog, Website

How alcohol fuels the social anxiety cycle—and what to do instead. As the cold beer ran down my throat, the sharpness of my self-conscious thoughts started to lose its edge. The conversation started to flow, and the laughter became easier. The first time I discovered the social lubricant magic of alcohol was at a high school party. The music was loud, and I was anxious. A friend handed me a beer; told me it would help me loosen up. And it did. From then on, I learned to turn to alcohol for a little confidence boost every time the discomfort of social anxiety rises. Why Alcohol Feels Like a Quick Fix for Social Anxiety I am far from the first one who discovered alcohol’s “confidence boost” effect. The fermented juice has long been thought of as a social lubricant for a reason. Acting as a central nervous system depressant, alcohol temporarily eases anxiety by slowing down brain activity, boosting GABA release to prompt calming effects, and shutting off glutamate to lower inhibition. To put it simply, the depressant effect of alcohol does calm the nerves and make socializing seem smoother in the moment. However, it comes with a catch. Alcohol’s help often comes with a hidden fine print in its cost. The Hidden Cost of Alcohol’s “Anxiety Relief” Effect Like a high-interest debt, alcohol offers us the immediate reward with delayed interest. When it comes to its “anxiety relief” effect, the delayed interest is an intensified anxiety cycle over time. Using alcohol to cope with anxiety is essentially a form of avoidance. Numbing up mentally allows us to avoid facing what scares us. While the anxious thoughts magically dissipate, we are left with an unfortunate confirmation that whatever we just avoided—making small talk with a colleague—is indeed dangerous. In CBT, avoidance behaviors are called “anxiety fuel,” as they deny a person the opportunity to sit through their fear and discover that they are actually safe. (Yes, 99 percent of our anxiety, as catastrophic as it may feel, is, in fact, survivable.) Without these opportunities, the anxiety continues to run wild. When facing a similar situation, the internal alarm system screams “danger” even louder. In other words, avoidance behaviors help brew the perfect breeding ground for anxiety to persist and grow. From Confidence Boost to Crutch: The Social Anxiety Drinking Loop That’s why, although alcohol seemed to be a perfect solution for social anxiety at first, over time, one may find they become more and more reliant on alcohol. Toward the end of my drinking career, I found myself heading to the bar the first thing whenever I arrived at a party, barely saying hi to my friends. Sometimes, I would even have a drink or two before leaving home, just to “loosen up” ahead of time. I call this the social anxiety drinking loop. When the need to ease anxiety meets the belief that alcohol can help calm the nerves, and drinking becomes the default coping method, a person becomes trapped by the limiting belief that “I need a drink to survive this social event.” The 10-Minute Rule: A Practical Tool for Alcohol-Free Socializing The only true way to overcome anxiety is by facing what one fears. Anxiety is fueled by the anticipation that something unbearable will happen. In our mind, we fear that if we stay, the anxiety will keep climbing until it blows through the roof and then comes the irresistible urge to do anything to avoid what is about to happen. But the truth is, while the peak of anxiety might be high, it’s also a skinny little thing. Once we reach the peak, it doesn’t keep climbing. Instead, it goes over the top and quickly starts to descend. In fact, most peaks last about 10 seconds to a minute. The best part is that once you get over the top, each time you face a similar situation in the future, the peak will become lower and lower. That’s why I love the 10-minute rule. Make small talk with your coworker for 10 minutes and talk about last night’s game or the weekend plan. Setting a time limit helps calm the anxious anticipation of “this is going to last forever.” As life-threatening as those first minutes might feel, I have never heard of anyone dying from striking up small talk. The 10-minute rule gives your brain an opportunity to discover that what you fear is actually a false alarm, and the alarm may start to lower its volume and shorten its length. Jeanette Hu, AMFT - Website

How memory gaps may affect relationships for people with BPD. Key points Gaslighting increases the instability of relationships where one or both parties has BPD. The symptom of paranoia may cause those who dissociate to see others as gaslighting them. To avoid gaslighting, it is suggested that loved ones not challenge accusations based on BPD-related dissociative memory gaps. Gaslighting is a form of emotional abuse in which efforts are made to make someone feel crazy for believing what's true. When successful, it undermines a person’s self-confidence and weakens their ability to function, making them more vulnerable to manipulation and control by others. Gaslighting is by no means unique to individuals with borderline personality disorder (BPD), but certain symptoms make it more likely for people with BPD to feel gaslighted by others and create circumstances where others feel gaslighted by them. Dissociation Many individuals who cope with symptoms of BPD experience periods where they become less aware of their surroundings while they become inwardly focused or non-focused. Dissociation is also common in other disorders, most notably posttraumatic stress disorder and dissociation disorder, where it is a primary symptom. While experiencing these periods of reduced awareness of their environment, individuals miss events and conversations or parts of events or conversations, resulting in gaps in their recollections. Through the unconscious process of confabulation, they often fill in the gaps with things that might have happened or were said, resulting in a distorted memory of events. When discussing these events with others present, there is often disagreement about the details, resulting in conflict. Following is an example where dissociation resulted in distortion and the experience of gaslighting. Zina: What kind of friend are you? I told you I wasn’t feeling well, and you didn’t even call. Gary: I called you yesterday. Zina: I don’t remember anybody calling me yesterday. Gary: You told me that you were exhausted, and then you went to bed. Zina: Liar. Don’t play with me. Gary: I'm not playing with you. We had a conversation. Zina: Either you're crazy, or you're gaslighting me. Zina did not remember Gary calling. She felt gaslighted because she thought he was lying to make up for not checking in on her while she was sick. And Gary, in turn, ended up feeling gaslighted by her too, because he clearly remembered their conversation, but she wouldn't acknowledge it. The tendency to dissociate is increased in those prone to it by fatigue and/or sickness, weakening cognitive abilities. Zina might have entertained the idea that Gary called her and she had forgotten, but she may also be coping with paranoia, another symptom of BPD. It causes her to choose the most malignant explanation when in doubt. Unstable Relationships Zina’s view of Gary quickly changes from someone close and capable of caring and affection to a liar who doesn’t care about her and gaslights her as an excuse for his neglect. A core symptom of BPD is a pattern of unstable relationships associated with alternating between idealization and devaluation. In the above example, Zina began with an idealized version of Gary—that he will dote over her, especially while she is sick—which led to her being disappointed by his not being as present as she would have liked. Her experience of disappointment was followed by devaluing him. Her behavior towards him changed from receptive and encouraging to aggressive and accusatory. This made her more likely to feel gaslighted and to gaslight Gary, in return a pattern that further destabilizes the relationship. Chronic Emptiness and Fear of Abandonment Several symptoms of BPD increase the likelihood that the affected person and those around them will experience gaslighting in some form or another. The chronic feelings of emptiness and fear of abandonment that most affected people experience predispose them to view communications with people they are close to as either reassuring of the attachment or evidence of abandonment or impending abandonment. In this example, the dissociation—as a symptom of BPD—set up the gaslighting. Once this spark is ignited, other symptoms of BPD make the experience and the relationship worse. BPD is a perfect storm for introducing gaslighting into relationships. Ideally, individuals with symptoms of BPD can learn to accept that they dissociate at times and that this can leave gaps in their awareness and memory. Knowing this can mitigate the paranoid bias and decrease both the experience of feeling gaslit and the volatility of relationships. Unfortunately, many individuals with symptoms of BPD do not acknowledge these symptoms as doing so makes them feel flawed. This tends to add to the tendency to see other people as gaslighting them and makes them generally untrusting. What Loved Ones Can Do People whose loved ones have symptoms of BPD should understand that gaps in memory associated with dissociation are a frequent source of gaslighting and note that their loved one is not deliberately trying to make them feel crazy. Rather, they are searching for an explanation for a memory gap that they are not even aware exists. Trying to correct the memory gap of a person with BPD who dissociates is generally not recommended. They may see acknowledging that they have gaps as admitting that they are flawed, which often increases feelings of self-loathing. Trying to make these corrections typically results in the angry and defensive reaction that Gary experienced. To avoid gaslighting, it is suggested that you not challenge accusations based on gaps. A better outcome will be achieved if you validate their feeling. You should never validate an untrue fact, but you can validate the feeling. For example, Gary might have said to Zina: “I understand that you're disappointed that I didn’t contact you more while you were sick. In the future, I'll try to do a better job of being more attentive.” This allows Gary to authentically validate her feelings and address them appropriately without forcing her to accept that she had a gap in memory that was confusing to her. It spares her shame, and this will benefit the relationship. Daniel S. Lobel, Ph.D. - Website

Eye-level view of a couple sitting together in a cozy living room, discussing their future plans Marriage is a big step. It brings two lives together in a way that changes everything. But before saying “I do,” many couples overlook one important step: couples counseling before marriage. This kind of counseling helps couples build a strong foundation for their life together. It’s not just for couples who have problems. It’s for anyone who wants to start their marriage with clear communication, trust, and understanding. Taking time to work on your relationship before marriage can save you from future struggles. It helps you learn about each other’s needs, expectations, and ways to handle conflict. In this post, I’ll share why couples counseling before marriage is so important, what you can expect, and how it can make your relationship stronger. What Couples Counseling Before Marriage Can Do for You Couples counseling before marriage is a chance to explore your relationship with the help of a professional. It’s a safe space where you can talk openly about your feelings, hopes, and worries. Here are some key benefits: Improved Communication Many couples don’t realize how differently they communicate until they face challenges. Counseling teaches you how to listen and express yourself clearly. You learn to avoid misunderstandings and speak in ways that bring you closer. Understanding Expectations Everyone has ideas about marriage, roles, money, family, and intimacy. Counseling helps you share these expectations honestly. You can find common ground or agree on how to handle differences. Conflict Resolution Skills No relationship is without conflict. What matters is how you handle it. Counseling shows you healthy ways to solve problems without hurting each other. You learn to stay calm, respect each other’s views, and find solutions together. Building Trust and Emotional Safety Trust is the heart of any marriage. Counseling helps you build trust by encouraging honesty and openness. You create a safe emotional space where both partners feel valued and supported. Preparing for Life Changes Marriage brings many changes, like combining finances, living together, or starting a family. Counseling helps you plan for these changes and face them as a team. How to Choose the Right Counseling Service Prioritize Specialized Training General therapy and couples counseling require different skill sets. Look for practitioners specifically trained in evidence-based modalities like Gottman Method Couples Therapy or Emotionally Focused Therapy (EFT). These frameworks provide structured tools for de-escalating conflict and rebuilding emotional safety, moving beyond simple "venting" sessions. Verify Neutrality and Fit A successful counselor must remain a neutral third party. During an initial consultation, assess whether the therapist can balance perspectives without taking sides. You should both feel equally heard and respected. If one partner feels "ganged up on," progress will likely stall. Practical Considerations Logistics: Determine if you prefer the convenience of telehealth or the traditional setting of in-person sessions. Availability: Consistency is key. Ensure their schedule aligns with both of your peak energy times to avoid "therapy fatigue." Goals: Discuss whether you are seeking long-term maintenance, crisis intervention, or discernment counseling. Ultimately, trust your collective intuition; the "therapeutic alliance" is one of the strongest predictors of a successful outcome. What to Expect During Couples Counseling Before Marriage If you’re new to counseling, you might wonder what happens in a session. Here’s a simple overview: Initial Assessment The counselor will ask about your relationship history, goals, and any concerns. This helps them understand your situation. Setting Goals Together, you’ll decide what you want to work on. It could be communication, trust, or planning for the future. Learning Skills You’ll practice new ways to talk, listen, and solve problems. The counselor guides you through exercises and discussions. Homework and Practice Often, counselors give you tasks to try at home. This helps you apply what you learn in real life. Regular Check-ins You’ll meet regularly to track progress and adjust your goals as needed. Counseling is a process, not a quick fix. It takes time and effort, but the rewards are worth it. Close-up view of a notebook and pen on a table during a counseling session Real Stories: How Counseling Helped Couples in Houston I’ve seen many couples who thought counseling was only for problems. But they found it helped them grow closer and feel more confident about their future. Here are two examples: Sarah and James They had different ideas about money and family roles. Counseling helped them talk openly and find compromises. Now, they feel more connected and ready for marriage. Maria and Luis They struggled with communication and often misunderstood each other. Through counseling, they learned to listen without judgment and express their feelings clearly. Their relationship became stronger and more joyful. These stories show that counseling is not about fixing something broken. It’s about building something better. How to Start Couples Counseling Before Marriage Starting counseling is easier than you might think. Here are some steps to help you begin: Talk with Your Partner Agree that counseling is a positive step for your relationship. Research Local Services Look for counselors who specialize in premarital work and have good reviews. Schedule a Consultation Many counselors offer a first meeting to see if you’re a good fit. Commit to the Process Be open, honest, and willing to learn. Remember, counseling is an investment in your future together. High angle view of a couple holding hands while walking in a park Final Thoughts on Preparing for Marriage Marriage is a journey that requires care and attention. Couples counseling before marriage offers a chance to start that journey with confidence and understanding. It helps you build skills that will support your relationship through good times and challenges. Your relationship deserves the best foundation. Counseling can help you create it!

4 ways to find greater ease when things feel painful. Key points It's common to say to oneself, "What's wrong with me for feeling this way?" when difficult emotions arise. We not only tend to judge ourselves for painful emotions, but we also tend to avoid feeling our feelings. There is no right way to experience difficult emotions, and we can learn to meet our suffering in new ways. Finding comfort in each other during an emotional moment When we run up against difficult emotions, one of the places I find that people get most tripped up is expecting that there is a certain way that one should feel. And, taking this further, that often translates into “There’s something wrong with me that I’m feeling/or not feeling this way or that.” All too often, I’ve had patients cry in my office and apologize for doing so (as if crying is bad, a sign of weakness or something to be avoided). I’ve had patients who recently lost a loved one say, “What’s wrong with me that I’m falling apart” (as if somehow, we are supposed to perfectly hold it all together — i.e., not weep or sob or feel overwhelmed — after our world as we know it crumbles). Difficult emotions are hard enough on their own. Too often, we add self-judgement on top of this. Additionally, we are wired to avoid pain. Through evolution, there was survival value in avoiding physical pain (think being bitten by a poisonous snake or being attacked by a predator), but in our modern lives, this evolutionary wiring carries over to our human tendency to avoid our emotional pain. While many people are familiar with the five stages of grief (as written about by Elisabeth Kubler-Ross): denial, anger, bargaining, depression and acceptance, it is important to recognize that, in fact, there is no empirical validity for this as a stage theory to explain the grief process. An article in 2017 goes so far as to warn health care professionals and those who are bereaved that there are even dangers of using this as a guide. The authors write: “Most disturbingly, the expectation that bereaved persons will, even should, go through stages of grieving can be harmful to those who do not”. We all have our own way of processing grief and other difficult emotions. Importantly, grief is not linear. After my dad’s recent passing, some of the best advice my stepmom received was from another woman who had recently lost her husband. She said, "Forget the stages of grief. You will feel things in waves. You will likely be all over the place, experiencing a whole range of emotions that swing from one extreme to another in no particular, predictable way. Let yourself feel what you feel and know that however it presents is OK". One of the gifts of mindfulness practice for me has been learning how to hold a space for all my emotions – the good, bad and the ugly – meeting each one as the poet Rumi suggests, as a guest being welcomed and invited in. Somehow learning to meet and greet my emotions in this way gives the message that my feelings are OK as they are. They don’t need to be fixed or changed. I am not broken or flawed. I am having a human experience. And in doing so, in meeting the rawness of what is here, I am also opening up to life. In the difficult moments when I can say to myself, and to the parts of myself that are holding intense feelings – “I see you, I hear you, I’m with you” – something eases just a bit. There is more spaciousness. Something in me relaxes. But how do we turn toward and be present with difficult emotions that can be quite intense at times and sometimes feel overwhelming? Having ways of working with them can be important. Working With Difficult Emotions Here are some things I’ve found helpful, personally and professionally, as shared in my book You Don’t Have to Change to Change Everything. 1. Take an anchor view. Like a ship at sea that is safely anchored and thus will not get swept away by intense storms, we can learn to anchor our nervous system to find more balance and stability during challenging times. We can practice allowing our emotions to be present while also inviting in “cues of safety” for our nervous system to be soothed. Some ways of doing this include: Slow and regulate your breathing, especially slowing down your exhalation and making it longer than your inhalation when you are feeling activated. Increasing or emphasize a deeper inhalation when you are feeling immobilized or have low energy. Engage in activities that bring your awareness as fully as possible to your senses (what you can see, hear, touch, taste or smell). This helps bring one’s mind into the present moment and not be carried away into the future “what ifs” that often add to overwhelm. Use your imagination to comfort you. Imagine being in a place that evokes a feeling of serenity, peace or calm. (Or go to such a place if you are able!) Even a few minutes of doing this can help to then better face whatever challenges are at hand. 2. Take a compassionate parent view. Like a compassionate parent comforting a child in distress, we can learn to self-soothe through self-compassion (whether or not we had a compassionate parent as a role model). Some questions to ask oneself include: What do I need right now? (Is it reaching out to someone, some solitude, a walk, listening to music, or something else?) What will feel nurturing in this difficult moment? How might I speak to myself in the second person, as if I am speaking to a good friend (e.g., "Hey Beth, I can see you are feeling a lot of pain right now and that’s understandable given what you’re going through; all your feelings are welcome here"). 3. Take an audience view. Recognize the narratives that come along with your emotions and treat these stories as actors on a stage that you can see from the vantage point of the audience. Rather than being swallowed up in the drama, when we locate ourselves in the audience, there is more space and distance between us and our thoughts. This helps to loosen the grip of unhelpful thoughts such as: I’ll always be alone. I’m not lovable. I’m being punished for something I did. I’m weak for feeling this way. 4. Take an ocean view. Often, we can feel isolated and alone in our difficulties. We feel like we are the wave and forget that we are part of an interconnected ocean. When we can find ways to connect with others, receive or give support to others, or do something that connects us to the larger world, this can help our difficult emotions feel more tolerable. Consider: Who might support you? Who might you reach out to by phone, text or otherwise? What activities bring you into connection with others? What things do you do that give you a feeling of meaning or purpose? Picture yourself surrounded by a circle of care (of friends, family, pets, mentors, spiritual leaders, nature, people who inspire you, etc.) and feel this care with you in your heart, even if these people are not physically present. There is no “right way” to experience difficult emotions, but when we practice ways to meet and greet these unpleasant visitors, they become more bearable to navigate through. Beth Kurland, Ph.D. -website, blog

Proposals to restrict social media access for people under 16 have sparked a surge of attention—especially as parents, educators, clinicians, and policymakers try to respond to rising concerns about teen mental health. Much of the debate centers on “online safety,” but the conversation often blurs together very different issues: exposure to harmful content, harassment, privacy risks, and the way algorithmic feeds shape what teens see (and how long they stay). Why this debate is getting so much traction The proposed under-16 restrictions are gaining momentum because they offer a clear, simple lever: limit access. But the reality is more complex. Teens use social platforms for connection, identity exploration, creativity, and community—especially those who feel isolated offline. At the same time, the risks are real, and they’re not evenly distributed. Some teens are more vulnerable due to anxiety, depression, trauma history, neurodivergence, sleep problems, or social stress. What “online safety” actually includes When people say “online safety,” they may be referring to several overlapping areas: Content safety: exposure to self-harm content, eating-disorder content, sexual content, hate speech, or misinformation. Contact safety: grooming, unwanted sexual messages, coercion, or manipulation by adults or peers. Conduct safety: cyberbullying, harassment, social exclusion, and the pressure to perform socially. Privacy and data safety: tracking, targeted advertising, and the permanence of digital footprints. Design safety: features that encourage compulsive use—endless scroll, autoplay, streaks, and algorithmic recommendations. A ban debate often focuses on age verification and access, but many families are also asking for stronger protections inside the platforms themselves—especially around design and algorithms. Algorithmic feeds and teen brain development: what’s the concern? Algorithmic feeds don’t just show what friends post. They learn what captures attention and then serve more of it—often optimizing for engagement. For teens, whose brains are still developing in areas related to impulse control, emotional regulation, and reward sensitivity, this matters. Common concerns raised by clinicians and researchers include: Reward loops and habit formation: variable rewards (likes, comments, new content) can reinforce checking behaviors. Attention fragmentation: rapid, high-stimulation content can make sustained focus feel harder over time. Sleep disruption: late-night scrolling and notifications can reduce sleep quantity and quality—both strongly tied to mood and learning. Social comparison and body image: curated feeds can intensify appearance pressure and “not enough” feelings. Emotional amplification: feeds can repeatedly surface distressing content, escalating anxiety or hopelessness for some teens. A key point: the same platform can be neutral or even supportive for one teen and destabilizing for another—depending on what the algorithm learns to serve and what the teen is already struggling with. What a ban can (and can’t) solve Age-based restrictions may reduce exposure for younger teens, but they don’t automatically address the underlying design issues that drive compulsive use. They also raise practical questions: How will age be verified? What happens to teens who rely on online communities for support? Will restrictions push use into less visible spaces? Many experts argue that the most effective approach is layered: age-appropriate protections, stronger platform accountability, and family-level skills that help teens build healthier digital habits. Practical steps families can take right now Regardless of where policy lands, families can reduce risk and increase resilience with a few concrete moves: Make sleep non-negotiable: charge phones outside bedrooms and set a consistent “screens off” time. Audit the feed together: talk about what shows up, what it makes them feel, and how the algorithm “learns.” Turn off non-essential notifications: reduce the constant pull back to the app. Create “high-risk” rules: no social media when upset, late at night, or during homework—times when self-control is lowest. Watch for mood and functioning changes: irritability, sleep shifts, withdrawal, falling grades, or increased anxiety can be signals to adjust boundaries and get support. A balanced takeaway The social media ban debate reflects a real desire to protect teens in a fast-changing digital environment. The most helpful conversations avoid extremes—neither dismissing risks nor assuming one policy can solve everything. A focus on online safety should include platform design, algorithmic accountability, and practical supports that help teens build attention, sleep, and emotional regulation skills in everyday life.

Automatic Negative Thoughts (ANTs) are those quick, reflexive interpretations that can spike anxiety, shame, anger, or hopelessness in seconds. They often arrive as a sentence in your mind (“I’m failing,” “They’re judging me,” “This will never get better”) or as a vivid image of something going wrong. In Cognitive Behavioral Therapy (CBT), we treat ANTs as hypotheses—not facts—and we learn to slow them down, test them, and replace them with more accurate, compassionate thinking. This isn’t about “positive thinking” or forcing yourself to feel fine. It’s about building a skill: noticing what your mind is doing under stress, understanding the pattern, and choosing a response that supports your well-being and your values. What are ANTs? ANTs are automatic because they show up without effort. They’re negative because they tend to tilt toward threat, loss, rejection, or inadequacy. And they’re thoughts—mental events, not objective reality. Many ANTs are shaped by past experiences, temperament, family messages, trauma, chronic stress, or perfectionistic environments. The brain is designed to scan for danger; when you’re tired, overwhelmed, or emotionally activated, it’s even more likely to default to threat-based interpretations. The tricky part is that ANTs can feel true. They often come with a body response (tight chest, racing heart, sinking stomach), and the body’s alarm can make the thought seem more believable. CBT helps you separate the thought from the fact, and the feeling from the evidence. Why ANTs matter ANTs influence emotions, behavior, and relationships. If your mind says “I’m going to mess this up,” you may procrastinate, over-prepare, avoid, or seek reassurance. If your mind says “They don’t care about me,” you may withdraw, lash out, or stop asking for what you need. Over time, these patterns can shrink your life and reinforce the original belief. The goal is not to eliminate every negative thought. The goal is flexibility: being able to notice an ANT, pause, and respond in a way that’s grounded and helpful. Common ANT patterns (cognitive distortions) CBT uses the term “cognitive distortions” to describe predictable thinking traps. Here are some of the most common ANTs: All-or-nothing thinking: “If I can’t do it perfectly, I’ve failed.” Catastrophizing: “This is going to ruin everything.” Mind reading: “They think I’m incompetent.” Fortune telling: “I already know this won’t work out.” Discounting the positive: “That doesn’t count.” Overgeneralizing: “This always happens to me.” Emotional reasoning: “I feel anxious, so something must be wrong.” Should statements: “I should be able to handle this.” How to work with ANTs: a simple CBT thought record A thought record is a structured way to slow down and examine an ANT. You can do it on paper, in a notes app, or with a worksheet. The key is to keep it specific and concrete. Situation (facts only): What happened? Who, what, when, where? Automatic thought: What did your mind say? Write it as a sentence. Emotion + intensity: What did you feel (0–100%)? (Anxiety, shame, sadness, anger, etc.) Evidence: What supports the thought? What doesn’t support it? (Aim for real evidence, not more thoughts.) Balanced thought: What’s a more accurate, fair, and helpful way to see this? If you want to go one step further, add: “What action would I take if I believed the balanced thought?” That turns insight into behavior change. Example thought record Situation: My supervisor emailed, “Can we talk later?” Automatic thought: “I’m in trouble. I’m going to get fired.” Emotion: Anxiety 85%. Evidence for: I made a mistake last week. Evidence against: My supervisor has praised my work; I’ve never been written up; “talk later” is vague and could be about scheduling or a new project. Balanced thought: “It’s possible they want to discuss the mistake, but it’s also possible it’s about something neutral. I can prepare calmly, ask for clarity, and handle feedback if it comes.” Quick tools when ANTs hit fast Sometimes you don’t have time for a full thought record in the moment. These brief tools can help you create space: Name it: “I’m having the thought that…” This simple phrase reduces the sense that the thought is a fact. Check the distortion: Is this catastrophizing, mind reading, or all-or-nothing thinking? Ask the evidence question: “What do I actually know right now?” Try a compassionate reframe: “If a friend had this thought, what would I say to them?” Common obstacles (and how to handle them) If you’ve tried reframing and it feels fake, that’s normal. A balanced thought should feel believable—not overly optimistic. Aim for “maybe” and “more likely” rather than “everything is great.” If your mind argues back (“Yes, but…”), treat that as more data. You may be bumping into a deeper core belief (for example: “I’m not safe,” “I’m not good enough,” “People leave”). In therapy, you can work at that deeper level while still practicing the day-to-day skill of catching ANTs. When to get extra support If ANTs are frequent, intense, or tied to trauma, depression, panic, or chronic pain, working with a therapist can help you build skills faster and tailor them to your nervous system and history. CBT can be especially effective when it’s personalized—identifying your most common distortions, practicing new responses, and pairing cognitive work with emotion regulation and body-based strategies when needed. With practice, ANTs become easier to spot. You may still hear them, but they won’t run the show. The win is not “never having the thought”—it’s noticing it sooner, believing it less, and choosing actions that move you toward the life you want.

Chronic pain and PTSD can shrink your world, but you are not powerless. Key points Chronic pain and PTSD often reinforce each other, but the cycle can be broken. Avoidance and catastrophic thinking make physical and psychological pain worse; active coping helps. Mindfulness and challenging unhelpful thoughts can change your pain experience. You can live a live worth living, even if pain remains part of your story. If you experience chronic pain and PTSD, you might find yourself stuck in a loop of unhelpful thinking and avoidance behaviors that backfire over time. Research shows that people with both chronic pain and PTSD have higher pain sensitivity, more psychological distress, and greater impairment than those with either condition alone (Reed et al., 2021). Often, care is siloed—physical pain managed by medical providers, psychological pain by mental health providers—missing the benefits of an integrated approach. The good news: trauma-informed strategies that address biology, thinking patterns, and avoidance together can lead to real improvements in pain, function, and quality of life. Overlap of Chronic Pain and PTSD Chronic pain and PTSD are deeply intertwined at both psychological and brain levels. Abdallah and Geha (2017) note that both conditions: Share Brain Circuits: Both involve the limbic system—especially the amygdala, hippocampus, and ventromedial prefrontal cortex, which are central to learning, memory, and emotions. Reinforce Negative Memories: Both are marked by replaying pain or trauma, reinforcing suffering. The brain overgeneralizes, warning us to avoid movement or vulnerability. Cycle of Stress and Pain: Each can trigger the other, leading to inflammation, brain changes, avoidance, and increased vulnerability. Behavioral Patterns: Avoidance, hypervigilance, and catastrophizing are common, making it harder to break the cycle. The Thoughts That Trap Us Catastrophizing—expecting or focusing on the worst—is a major risk factor in both chronic pain and PTSD. People with both conditions often feel less control, are more emotionally affected, and buy into catastrophic thinking more than those with pain or PTSD alone (Kind & Otis, 2019). Common Catastrophic Thoughts Might Include: Pain equals harm. If my pain is bad, I can’t do anything. It’s not fair! It’s my fault. It’s not safe to move. My doctors should be able to fix this—they’re failing me! I can only do what matters if I’m pain-free. When I move and it hurts, I must be damaging myself. This will always be unbearable. I am broken. There’s nothing I can do to reduce the pain. I can’t take it anymore! These thoughts are understandable, but not always accurate—and they can make symptoms worse. The Body Remembers Trauma isn’t just a memory—it’s an experience in your body. Traumatic events can leave a lasting imprint on how your nervous system processes sensations. Sometimes, pain is a re-experiencing symptom—your body’s way of remembering what your mind wants to forget. For some, symptoms like muscle tension, headaches, or gut issues are direct echoes of trauma (Kearney & Lanius, 2022). You might also feel paralyzed, unable to move or act when pain flares or memories surface. This “freeze” response is common after trauma—not a personal failure. Restoring movement, even in small ways, helps your body learn it’s no longer in danger. Kinesiophobia and Avoidance Many with chronic pain develop a fear of movement (kinesiophobia), believing activity will cause harm. This leads to less movement, more weakness, more pain, and greater disability—a vicious cycle. Avoiding movement actually increases pain and disability over time. Similarly, PTSD often leads to avoiding certain places, people, or situations, fearing they’ll trigger distress or danger. This shrinks your world, increases anxiety, and reinforces the sense you’re not safe. Avoiding trauma reminders strengthens fear and keeps symptoms alive. Harm vs. Pain: Rethinking the Connection Harm: actual tissue damage (like a broken bone or traumatic event), often accompanied by pain signals. Pain: an unpleasant sensory and/or emotional experience that could either signal harm, or reminders of harm (as in the case of chronic pain or PTSD). With chronic pain and PTSD, your body’s alarm system is stuck on high alert and is sending pain signals even when there’s no ongoing injury (Kind & Otis, 2019). Chronic pain says pain means damage; PTSD says fear means danger. Learning to distinguish between pain and harm, fear and danger, is key to reclaiming your life. Opening up to movement and experiences with low risk is called active coping. The Power of Active Coping People who use active coping—pacing activities, seeking support, facing reminders of trauma that are not actually dangerous, and challenging unhelpful thoughts—recover faster and experience less pain (Kind & Otis, 2019). Pacing is important: break tasks into manageable, time-based chunks with breaks; if pain increases, dial it down. If pain is fairly stable, see if you can gently increase over time. Gentle movement (walking, stretching, yoga) with smooth, slow breathing and self-compassion can help retrain your body and mind. Pacing is similar to exposure work in PTSD treatment. Facing safe experiences you’ve been avoiding, little by little, helps you reclaim your life. Over time, your body and mind can learn to tell the difference between danger and harm vs when fear isn’t signaling true danger and pain isn’t signaling real harm. Thoughts That Turn Down the Pain You don’t have to get rid of unhelpful thoughts—just notice them and remind yourself of what’s helpful and true. Try: This pain flare will pass. Pain isn’t always a sign of harm—sometimes my body is just scared. I can handle this moment. I’ve gotten through it before; I can do it again. I can reclaim activities, relationships, and places where I can build comfort, safety, trust, joy, and connection. I can find a pace that works for me to care for myself and maintain my health. Reflection Questions What are your most common pain-related thoughts? PTSD-related thoughts? Can you notice the exact body sensations that come with pain or trauma triggers? Are there activities you avoid because of pain? What might happen if you tried a little, safely? If chronic pain and PTSD were not calling the shots, what would you like to do? Support for Both Chronic Pain and PTSD If you are experiencing both chronic pain and PTSD, you don’t have to navigate this alone. Find a provider who understands the mind-body connection and can help you integrate your care. Look for someone willing to collaborate with your other providers and support you as a whole person. Integrated, trauma-informed care is not just possible—it’s a key step toward reclaiming your life. Jaimie L Lusk Psy.D., ABPP - website References Abdallah, C.G., & Geha, P. (2017). Chronic pain and chronic stress: Two sides of the same coin? Chronic Stress, 1, 1–10. Kind, S., & Otis, J.D. (2019). The Interaction Between Chronic Pain and PTSD. Current Pain and Headache Reports, 23:91. Kearney, B.E., & Lanius, R.A. (2022). The brain-body disconnect: A somatic sensory basis for trauma-related disorders. Frontiers in Neuroscience, 16:1015749. Reed II, D. E., Cobos, B., Nabity, P., Doolin, J., & McGeary, D. D. (2021). Comorbid chronic pain and posttraumatic stress disorder: Current knowledge, treatments, and future directions. Pain care essentials and innovations, 211-227.