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Are You Sabotaging Your Relationships?

Warning signs that you might be sabotaging a good thing

You meet someone new and happily date for a little while. The connection is great, there is chemistry, and sex is fun. You start spending more and more time together and begin considering becoming a couple. But then, you stop replying to their texts right away. You cancel dates. You avoid talking about taking things to the next level. Your partner expresses frustration, disappointment, or even anger about your behavior. Not long after, the partner breaks up the relationship.

Does this sound like something that happens to you? If so, you might be self-sabotaging your relationships.

Christiane Blanco-Oilar, Ph.D. offers compassionate psychological services for individuals and Couples Therapy Boca Raton. I enjoy working with individuals and couples going through life transitions, relationship challenges or identity exploration, or those experiencing grief and loss, depression, anxiety, postpartum depression and eating disorders. My goal is to help you recognize, understand and have compassion for how you may have developed less-than-ideal ways of dealing with specific areas of your life.

Why We Self-Sabotage

The specific reasons why someone may self-sabotage relationships are context-specific. Every person has had a different past: parenting, childhood, teenage years and first serious relationships all have an effect on how we act right now.

One of the main reasons why people sabotage their relationships is fear of intimacy. People are afraid of intimacy when they fear emotional or physical closeness with other people.

Everyone wants and needs intimacy, but in people with certain experiences, intimacy may be linked to negative rather than positive experiences, leading to a “push-and-pull”-type behavior that leads to a relationship breakup or avoidance.

Fear of intimacy typically comes from difficult or abusive parental relationships and childhood trauma (physical, sexual, emotional). The deep, embedded belief in people who fear intimacy is: “people who I am close to cannot be trusted”.

Because early trusting relationships with parents or caregivers were broken by abuse, people who fear intimacy believe that people who love them will inevitably hurt them. As children, they could not extricate themselves from these relationships; however, as adults, they have the power to end or leave them, even when they are not inherently abusive.

This fear appears in two types: fear of abandonment and fear of engulfment. In the first, people are worried that those they love will leave them when they are most vulnerable; in the second, people are worried that they will lose their identity or ability to make decisions for themselves. These two fears often exist together, leading to the “push-and-pull” behavior so typical of those with deep fears of intimacy.

Signs Of Self-Sabotage In Relationships

There are many signs that you might have a tendency to self-sabotage even the best of relationships. Here are some of the most common.

You always have an eye on the exit

You avoid anything that leads to bigger commitment: meeting parents, moving in together, etc. You’re always wondering: “if it goes wrong, how can I extricate myself easily from this relationship?” Because commitment reduces your ability to leave a relationship without financial or emotional consequences, you tend to avoid it.

You gaslight your partner

Gaslighting is a form of emotional abuse whose aim is to deny the other person’s reality or experiences. For example, if your partner says: “I’m really upset that you canceled our date”, you respond with something like: “You’re not really upset, it’s your fault I canceled and you’re just trying to blame me for it.” Gaslighting is a sign that you don’t really believe your partners’ feelings are valid or real (even though they are).

You are known as a “serial dater”

Your friends often ask you why you break up with potential partners so often or lament the fact that you never seem to “settle down” with anyone. You break up with partners on the slightest of issues, only to start dating another person right away and repeat the cycle. You don’t want to be seen as a “player” but you can’t seem to find someone who you can commit to.

You are paranoid or extremely jealous

You always worry that your partner might be seeing someone else behind your back. You demand control over every aspect of their life and require constant contact. When they spend time with other people without you, you fret, text constantly, experience jealousy, and ask for proof that they’re being faithful. They break up with you because they find you controlling.

You criticize everything they do

You constantly look for perfection in a partner, even though you know perfection is impossible. You find fault with every little thing they do, from the way they cook to the clothes they wear. You are impossible to please, and your partner eventually gives up trying and breaks up with you.

You avoid facing problems

You spend a lot of time trying to convince yourself that the relationship is perfect, even when it’s not. When your partner wants to address a problem, you avoid the topic or simply say: “I don’t think we’re having an issue; it’s going to go away.” Your partner grows resentful of your inability to face problems together and leaves.

You have sex with other people

While in some cases having sex with other people is okay when both people agree to non-monogamy, in general, going from affair to affair can be a sign of self-sabotage. You’re doing one of the most hurtful things you can do to a romantic partner in the hopes that they’ll find out and leave you.

You always tear yourself down

You always talk about yourself in self-deprecating ways: “I’m not as smart as you”, “I’m just an idiot, why are you with me?”, “You’re just with me because you pity me”, etc. This is a sign of low self-esteem, and most people do not enjoy being told that they love someone who is worthless. When, despite their constant reassurance that you are a good person, you keep tearing yourself down, they give up and break up.

These are just a few examples of how people with a fear of intimacy might sabotage their relationships. Note that many of them are abusive: things like gaslighting, paranoia and control can damage the other person. People with these patterns have childhood trauma and don’t know how else to act.

Ending Self-Sabotage

To end self-sabotage, you first need to take a good, hard look at yourself and your behavior patterns. Unless you are willing to be honest with yourself and face all the ways you may have abused or hurt other people because of your fear of intimacy, you are doomed to repeat it.

Therapy is the first step many take to end their self-sabotaging patterns. A professional can help you identify your behaviors, dig to the root of your issues, and find new, healthier ways to behave.

In general, a few things are important to uncover when ending self-sabotage.

What is your attachment style?

Attachment theory is a framework that explains patterns of behavior with intimate others. The ideal type of attachment is “secure”: this is when people feel like they can trust others and remain a distinct individual, even in close relationships.

However, childhood experiences can lead to anxious, avoidant, or disordered attachment styles: these are the ones that cause issues in adults trying to develop strong relationships and families. The good news: you can work with a therapist on developing a more secure style by facing your fears and removing false beliefs about relationships.

What are your triggers?

Fear of intimacy and self-sabotage can remain dormant until a trigger wakes them up. It might be words, actions or even places. Knowing what triggers your fears will help you either avoid them or work on them so they don’t trigger you anymore.

Do you confuse the past with the present?

One of the main problems of self-sabotaging is that we behave in the present as if the current situation was the same as one in the past. It can be childhood or past adult relationships. Learning to say: “that was then, this is now” can help you make decisions that are based on the present, rather than reacting blindly based on what happened to you in the past.

Can you talk about these issues?

One of the hallmarks of self-sabotage and fear of intimacy is the inability to talk about your feelings and your problems. You avoid talking about these things because talking means feeling, and you want to avoid feeling these things at all costs. Expressing your emotions, your fears and your needs will not only help you identify the problems but will also help others understand you better.

Get The Help You Need

Remember that it’s okay to get help. Seeking therapy, or simply a kind and friendly ear is the first step towards freeing yourself from self-sabotaging behaviors in relationships. Be kind to yourself and accept that everyone needs help once in a while.

By Anabelle Bernard Fournier

Finding Mindfulness in an Age of Depression & Anxiety – Depression Treatment Raleigh

Depression Treatment Raleigh

We live in uncertain times.

Actually, things have always felt uncertain to the people who live in those times, but these days it might feel even more heightened, with the hyperconnectivity of the internet, social media and constant messaging, comparing ourselves to everyone else, and a very tense, divisive political situation (not just in the U.S., but in many countries).

It’s enough to drive anxiety through the roof for many people and depression seems to be a huge problem for many people we work with. Anxiety & depression seem to be on the rise, or at least it can feel that way to many.

So what can we do to deal with this anxiety & depression?

There isn’t one simple solution, but there are some habits we can form to help us cope — even thrive — in the middle of chaos and uncertainty.

Depression Treatment Raleigh
Do you feel down? Have you lost interest in things you used to enjoy? Are you critical and judgmental towards yourself? We can help you find the Inner Path that can lead you out of your depression.

The Causes of Anxiety

In short, our anxiety is caused by uncertainty. It’s a feeling of alarm, of stress, of fear or even slight panic, when things feel unsettled, constantly shifting, out of control.

We feel this kind of “out-of-control”, all the time at some level which can lead to hopelessness and depression. There are times when this feeling is heightened:

  • We lose our job or feel like our job is unstable
  • We get into deep debt or feel like our finances are out of control
  • Someone we love has a crisis (like health crisis)
  • We get sick
  • There’s a death in the family
  • Someone we can’t stand gets elected to the leadership of our country (this has happened in multiple countries, I’m not talking about anyone in particular)
  • You move to a new home in a new city


You get the idea — they’re all times of heightened uncertainty, and so the feeling of anxiety starts to increase.

The thing is, if you go through just one of these things, it’ll increase stress and maybe anxiety, but then if things calm down, you have a chance to recover. But if you’re constantly going through these kinds of things, it doesn’t give you a chance to recover. You’re constantly in a fragile state, and everything becomes more stressful.

The key is not to eliminate uncertainty and stress in your life, but instead to increase your resilience by allowing yourself to feel grounded even in the middle of a stressful, uncertain event. Then things become not such a big deal. They might stress you out a bit, but they won’t be the end of the world.

Six Habits that Lead to Mindfulness

The basic habits that lead to this kind of resiliency, and a feeling of groundedness, are things you can practice every single day:

Let ourselves feel it.

When we’re feeling uncertainty, instead of rushing to solve it … or to distracting ourselves or comforting ourselves with food or shopping … we can let ourselves feel the uncertainty. I’m not talking about engaging in a narrative about what the uncertainty is like and why it’s so bad — but instead feeling it physically in your body. Where is the feeling located in your body? Can you give it some attention and curiosity? Can you stay with it for a few moments? This habit of letting ourselves feel the uncertainty and stress is transformative — every bit of anxiety becomes a place to practice, an opportunity to be present with ourselves. It becomes a chance to create a new relationship with our experience.

Learn that it’s OK to feel groundlessness.

You are feeling anxiety & depression because of the uncertainty of your situation. But that’s because uncertainty becomes a reason to freak out. What if, instead, we learned that this groundless, uncertain feeling is actually just fine? It might not be completely pleasant, but it’s nothing to panic about. In fact, it can be an opportunity to find joy and appreciation in the groundlessness — what is there to appreciate in this feeling of complete openness? Start to shift how you see and react to this groundlessness, embracing it rather than panicking about it.

Give ourselves love.

In the middle of stress and uncertainty, instead of engaging in our old habits of shutting down or avoiding, of worrying and fretting, can we try a new habit of giving ourselves love? This is a way of being compassionate and friendly with ourselves, no matter what we’re doing. It’s like giving love to a child who is in pain — the compassion and love pour out of our hearts. Can we practice this for ourselves?

Simplify by being fully present with one thing.

We have so much going on that it can all be overwhelming. Can you simplify by focusing on just one thing right now? Trust that you’ll take care of the other things when it’s needed. Instead, be fully present with this single task. It can be something important, like working on that writing that you’ve been putting off for days. Or it can be something small, like washing this one dish, or drinking this one cup of tea. Be fully with it, and savor the experience fully. This leads to a feeling of groundedness, and helps us to not feel as frazzled.

Find the joy in being fully present and savoring.

The item above, of simplifying by doing one thing, can feel like quite a shift for many of us. It might feel like sacrifice, not constantly switching tasks and being on social media and checking phones. But it can be a way of opening up to the moment, treating yourself with a little focus, joyfully savoring whatever you’ve chosen to do with this moment of your life.

Learn to love being resilient.

Resilience is a matter of saying “No Big Deal” to any kind of uncertainty that arises, of savoring and being present, of giving ourselves love and being present with whatever uncertainty is coming up for us. Resilience is not blowing everything up to End of the World level, just because it’s not under control. Resilience is feeling grounded in the middle of chaos (even if there’s stress present), and finding a joy in being in that uncertainty. Resilience is taking a breath and then savoring that breath. It can be a wonderful thing, if you learn to love it.

For Men Only – Men’s Mental Health

At A New Day Family Counseling, we understand the challenges men face today to improve their mental health.

Men typically engage in fewer health-promoting behaviors, have fewer social supports, possess less effective behavioral responses to stress, and use fewer health care services than women. Men are 4 times more likely than females to die from suicide attempts (Centers for Disease Control and Prevention, 2010). Men with depression are more likely to turn to alcohol and drugs. Men are also more likely to allow anger to be expressed freely without acknowledging other’s feelings and are not likely to ask for help in managing anger. Finally, young men engage in more risky behaviors and are increasingly likely to engage in those behaviors over time (Mahalik et al., 2013).

Untreated mental health problems tend to get worse over time and can lead to serious consequences including addiction, incarceration, destroyed relationships and damage to physical health. Fortunately, with the right treatment most mental health problems are resolved within a relatively short period of time and result in an increased ability to cope with future challenges, improve relationships and improve contentment in life.

Beginning the therapy process is a sign of strength and takes courage.

As E.E. Cummings penned, “It takes courage to grow up and become who you really are.” In recent years, I have had the experience of seeing many more men access mental health services. My heart is touched by these men, who recognize their need for help and allow themselves to take a risk to open up emotionally and be vulnerable in ways that they may never have been before. These men have accessed services for a variety of reasons including divorce or a separation, relationship problems, illness or injury, or for help with addiction, anger, trauma or anxiety and depression. Additionally, fathers have sought help with understanding their children’s needs as they develop or to adapt to the challenging task of parenting. I have also had the experience of seeing young men challenge traditional gender roles and try out new behaviors that would have been shamed or made fun of many years ago. As a result, old gender roles thankfully are changing. The new world demands equality between the sexes in the workplace, in relationships and in child rearing. I believe that these changes are helping men become more satisfied with their relationships and themselves.

A New Day Family Counseling Plainfield, IL  believes in healing not only individuals but attends to the healing of the whole family.  After all, our family relationships are the most important human connection we will have and have the power to hurt or heal us.   We take a collaborative, family-centered approach and use brief, solution-focused and evidence-based treatment methods.  Our therapists listen deeply, empathically and non-judgmentally and seek to understand your feelings and beliefs to help create a new and empowering story about who you are. We will teach you how to identify old, limiting beliefs that interfere with your relationships, your sense of purpose, and inner peace. We will work on healing that unhealthy relationship with yourself so that you may embrace a new one that is whole, genuine, and resilient.  And, we will work on restoring your family relationships with authentic, safe and healing communication, teaching the art of compromise, and restore bonding and attachment that has been challenged by difficult times, loss, trauma, emotional injuries, addiction and mental health issues.

We offer individual counseling for adults, teens and children, family counseling, couple/marital counseling.  We also offer Telehealth services.  We treat anxiety, depression, bi-polar disorder, chronic anger, personality disorders, women’s issues, trauma, grief and loss or coping with stress or inevitable changes in life that challenge us in so many ways. We will assist your family with blending, parenting, step-parenting, and coping with and addressing behavioral and emotional issues and disorders including ADHD, autism, developmental disorders, and mood disorders. We provide help to couples and families suffering from relationship problems, intimacy issues, divorce, physical and mental illness,  loss, or trauma.

We provide counseling services to Plainfield, Romeoville, Shorewood, Joliet, Oswego, Naperville, Yorkville, Bolingbrook, and Aurora and the surrounding areas in Will County, IL. Gwen Ginski, MEd, LCSW

While I have been fortunate to observe these exciting changes in men, it is still true that many men hold on to old, rigid and restrictive stereotypes. These stereotypes have a negative impact on men’s mental and physical health and can be very destructive in family relationships. Men often believe that they must handle problems by themselves and fear that they may seem weak or that others will find out that they are struggling. Boys often socialized from a very early age by their parents, peers, and teachers to “toughen up” and not cry. These norms are further shaped and reinforced by the work force, where emotions are not recognized or denied and men are expected to fulfill a variety of roles that may endanger their emotional well-being.

Some men become so enthralled in the pursuit of a “masculinity ideal” that requires that they have to continuously prove their power, strength and vitality.

These men continually practice norms in the pursuit of wealth, dominance, success, power, status and superiority. On the other end of this spectrum are the men who do not have the access to resources to prove this so-called masculinity and turn to anti-social behaviors in pursuit of this same ideal. This can lead to “Toxic Masculinity” which results in macho behavior, promiscuity, workaholism, authoritarianism and even violence. Toxic Masculinity ultimately results in a loss of internal strength, confidence and stability and leads to interpersonal and emotional problems, and even legal problems.

Men sometimes believe that the best way to handle emotions is to avoid them or bottle them up.

If a man experiences a crisis, which undoubtedly happen in life, whether it be a loss, a divorce, or another difficulty in life, he may not have the ability to process through the intense emotions that go along with these life experiences. As a man, you deserve to be happy and have satisfying healthy relationships. Seeking help for yourself is a sign of great strength. It is much easier to deny and avoid facing problems than it is to take an active step towards improving yourself and your mental health. Reach out and find a therapist that fits your needs and circumstances. Most therapists will provide a free consultation to see if they are a good fit for you. In the meantime, take care of your physical health and don’t compare yourself to others. Remember that everyone copes differently and your coping is not a reflection on your worth as a man. Allow family and friends to support you and ask for that support. Some family members or friends may not be able to be there for you, but some will. Try not to take this personally. Seek out people who can support you! Contact A New Day Family Counseling

Gwen Ginski, MEd, LCSW

Resources for Men

Headsupguys – A self-check to help men determine if they are experiencing symptoms of depression
Alcohol Use Disorders Identification Test (AUDIT) – A self-check tool to screen for unhealthy alcohol use, defined as risky or hazardous consumption or any alcohol use disorder
Anxiety Screening Tool –
ManTherapy – A public office campaign that offers information about mental health to reduce the stigma

Understanding Alcoholic Neuropathy – Addiction Counseling Westwood New Jersey

Alcoholic neuropathy is one of the most common and least recognizable consequences of heavy alcohol use. People with a long history of alcohol misuse might experience pain, tingling, weakness, numbness, or loss of balance as a result of alcoholic neuropathy.

Signs and Symptoms of Alcoholic Neuropathy

Signs and symptoms of alcoholic neuropathy can progress gradually, and they are usually subtle at first. Often, a person who drinks heavily might not recognize that the symptoms are related to alcohol or to neuropathy. For addiction counseling Westwood New Jersey. Signs and symptoms include any combination of the following:

*Deceased sensation of the toes, feet, legs, fingers, hands or arms

*Pain, tingling or other unusual feelings in the toes, feet, legs, fingers, hands or arms

*Weakness in the feet or hands

*Lack of coordination of the feet or hands

*Loss of balance/unsteadiness when walking

*Bruises, cuts, sores or skin infections on the toes, feet, or fingers

*Decreased pain from injuries, especially on the feet or hands

*Dizziness, particularly when standing with eyes closed

*Trouble walking a straight line, even without recent alcohol use

*Constipation or diarrhea

*Urinary incontinence

*Sexual dysfunction

Effects of Alcoholic Neuropathy

Alcoholic neuropathy is a nerve disease caused by excessive alcohol consumption over a long period of time. The effects of alcoholic neuropathy are caused by nerve damage and fall into four main categories; decreased sensation, pain/hypersensitivity, muscle weakness, and autonomic.

Decreased Sensation

Alcoholic neuropathy damages sensory nerves, resulting in decreased sensation of the hands and feet. This may not sound like a terrible problem, but diminished sensation actually causes very serious consequences.

Pain and Hypersensitivity

Another prominent effect of alcoholic neuropathy involves painful and uncomfortable sensations. Alcoholic neuropathy can result in hypersensitivity to touch and/or resting pain. Light touch can feel exaggerated and painful, particularly in the fingers and toes.

Constant pain in the hands or feet is one of the most bothersome aspects of alcoholic neuropathy. The pain can feel like burning, throbbing, or sharp pins and needles. As the condition progresses, the pain may vary in intensity, sometimes diminishing for months at a time before worsening again.

Muscle Weakness

For addiction counseling Westwood New Jersey, severe alcoholic neuropathy may cause motor weakness due to nerve damage. Our muscles need to receive a message from nearby nerves in order to function. When this message is interrupted due to damaged nerves, the muscles cannot function as they normally would. This most often manifests with weakness of the hands and feet.

Autonomic Neuropathy

Autonomic nerves control functions of the organs of the body, such as the bladder, stomach, and intestines.2

Alcoholic neuropathy can weaken the autonomic nerves, causing impairment of bowel and bladder function and sexual dysfunction.

Dr. Gerald Opthof has been providing addiction counseling Westwood New Jersey for individuals, couples and families for over 20 years. His practice is built on connection, relating to his clients as whole people and not just the problems they are facing. He offers strategies built on his professional knowledge, experience, and the perspective that he has gained from his own life challenges. Also specializing in Marital counseling Westwood New Jersey.


In general, it takes years for alcoholic neuropathy to develop, so a long-standing history of heavy alcohol use is typical. Some heavy alcohol users experience a faster onset and progression of alcoholic neuropathy than others. It is not completely clear why some people are more prone to this complication than others.

Alcoholic neuropathy is caused by nutritional deficiency, as well as toxins that build up in the body. Alcohol decreases absorption of nutrients, such as protein and vitamin B12, causing significant deficits that affect many areas of the body, including the nerves. Alcohol also alters the function of the stomach, liver, and kidneys in ways that prevent the body from properly detoxifying waste material, which then builds up and harms many regions of the body, including the nerves.

Nerve damage typically affects the axons, which are the projections that send electrical signals from one nerve to another, as well as the myelin, which is the fatty coating that protects the nerves. Nerves do not have a resilient ability to regenerate if they are severely damaged. The nerve damage of alcoholic neuropathy may be permanent if the damage has been taking place for a long period of time or if it persists.

Diagnosis of Alcoholic Neuropathy

The diagnosis of alcoholic neuropathy involves a combination of medical history, physical examination, and possibly blood tests or nerve tests such as electromyography (EMG) and nerve conduction studies (NCV).

Physical examination: A complete physical and neurological examination tests reflexes, muscle strength, sensation (including light touch, pinprick, vibration and position sense), and coordination. Usually, people with alcoholic neuropathy have diminished reflexes and diminished sensation. In very advanced disease, weakness may be present too.

Electromyography (EMG) and nerve conduction studies (NCV): These tests examine nerve function in detail. Characteristic patterns, such as decreased function in the hands and feet, low amplitude of nerve waves, and slowing of nerve function, are suggestive of alcoholic neuropathy. The nerve tests do not identify the cause of neuropathy, only the extent of nerve damage.

Nerve biopsy: In rare instances, a doctor may suggest a nerve biopsy, which can show a pattern of nerve damage consistent with alcoholic neuropathy.

Other tests: Additional assessments might include blood tests, urine tests, or imaging studies of the brain or spinal cord to rule out other causes of neuropathy symptoms.

Treatment of Alcoholic Neuropathy

There are several medical treatments that can be used to manage the pain of alcoholic neuropathy. These include pain medications and antidepressants. While not specifically approved for the treatment of alcoholic neuropathy, antidepressants are often prescribed to help control the pain. Similarly, anti-seizure medications: As with antidepressants are sometimes prescribed as a way to manage pain.

Since nutritional deficiencies are partly to blame for alcoholic neuropathy, supplementation with vitamin B12, folate, vitamin E, and thiamine may be recommended.

There are no medications that can help improve loss of sensation, strengthen the muscle weakness, or aid the coordination and balance problems caused by alcoholic neuropathy. However, some people notice an improvement in symptoms a few months after discontinuing alcohol intake for addiction counseling Westwood New Jersey

Sometimes alcohol causes such severe damage to the body that a liver transplant may be necessary. In that case, there may be some improvement in the symptoms of alcoholic neuropathy after the liver transplant,4 but often, the neuropathy is so advanced that there may be little, if any, improvement, even after a transplant.

Alcohol use disorder is a challenging condition. The medical community has recognized that addiction is a disease and that some individuals are born with a tendency to become addicted to substances. Thus, it is usually necessary to get medical help to managing alcohol use disorder.

Some of the symptoms of alcoholic neuropathy can be partially reversed, but if the neuropathy becomes advanced, it might not be reversible. Medication can help in reducing some of the symptoms of alcoholic neuropathy. The most important strategy against alcoholic neuropathy lies in preventing the symptoms from getting worse by decreasing alcohol consumption as soon as possible.

By Heidi Moawad, MD, and medically reviewed by Huma Sheikh, MD

Photo: Pexels

What America Can Learn from Couples Therapy

The principles of good communication for Couples Therapy Palo Alto could also apply to divided Americans.

At family gatherings, in bars and restaurants, relatives and friends are shouting at each other instead of engaging in what used to be called political discussions. These high-volume, emotionally charged exchanges are also increasingly the norm in venues ranging from local governments to national ruling bodies across the world.

These shout-fests might remind you of a bad marriage—and we think there is some truth in that. We are clinical psychologists who are couples therapists and researchers who evaluate the benefits of interventions with couples. We do not have answers to urgent questions about how to bridge political and cultural chasms, but we do know a thing or two about how to help two people reduce the conflict in their relationship. What are the principles backed up by both research and clinical experience of working with couples who have unresolved differences? How have they been useful in helping Couples Therapy Palo Alto communicate more effectively about issues on which they disagree? And can these insights be applied to healing political divisions?

We do not assume that Democrats and Republicans—or politicians attempting to negotiate Britain’s exit from the European Union, or Russians debating the power of Vladimir Putin—will suddenly pay attention to these principles. Rather, we offer these ideas with modesty, in hopes that individual readers may find them useful in de-escalating tensions with family and friends with different political and social ideas. While you can’t control what other people believe or how they behave, there are steps you can take to make your conversations more productive.

1. Try to understand their perspective
Before meeting up with someone we expect to disagree with, most of us either think about how to avoid the topic, or we act like lawyers preparing for a trial. We give a great deal of thought to presenting our point of view in a convincing way and to considering the weaknesses and absurdities in the other person’s arguments. While some of this preparation is adaptive, studies suggest that we might find such conversations less troubling and more effective if we took the time to try to understand the perspective of the other person. If the person is someone you know, you can try to reconstruct their side of an argument as best you can. If the person comes from a group with an identifiable point of view, you can examine written material or information from social media that presents the other’s point of view effectively.

Why does all this work? If you can demonstrate that you can understand accurately what the other person is saying, and if you can find some areas of agreement, the other person is more likely to feel heard. And feeling heard tends to reduce the repetition, frustration, and rise in volume that occurs when the other person concludes that you are not listening, you have misunderstood what they have been trying to say, or you are just not very clever!

A more general approach to preparing for a discussion that may get heated is to practice staying in the moment—what is now often called mindfulness. Research suggests that we can reduce the biases that often fuel disagreements by building moment-to-moment awareness of our thoughts, feelings, and surroundings through practices like meditation. Mindfulness can make us more cognizant of the mental shortcuts we take when judging others and help us react less intensely when we feel threatened or upset.

2. Try to confide, not attack or avoid
Dan Wile, a nationally known couples therapist, has pointed out that when we disagree or are upset with each other, there are typically three stances that each person can take: We can avoid, attack, or confide.

Most often when we anticipate a conflict, we tend to engage in avoidance—not raising the issue at all, or stating only a small part of the issue. This may keep the temperature from rising, but it does nothing to resolve disagreements, reduce simmering tension, or formulate actions to solve problems collaboratively.

When one person is on the attack, the most likely response from the other is to fight back or withdraw. This is understandable, but, like avoidance, it does little, if anything, to convince the other to entertain a new idea.

Robert Levenson and John Gottman have been pioneers in studying conflict between opposite-sex and same-sex partners while both are hooked up to equipment that measures their physiological arousal and distress. One of the important findings of this research is that as the disagreement escalates, both partners show sharp increases in physiological arousal, but that for one partner (more often the female), the arousal quickly returns to baseline, while for the other, arousal and distress remain high (more often the male).

This discrepancy tends to result in escalating conflict in which the high-arousal partner attempts to hide the feeling (stonewalling) while the lower-arousal partner is engaged in attempting to solve the problem. When this happens, the problem is that the stonewaller is still upset and their partner is frustrated at the lack of verbal response. Gottman further describes what he considers to be the “four horsemen of the apocalypse.” In addition to stonewalling, he points to criticism, contempt, and defensiveness as emotional nightriders that come along to destroy intimate relationships.

Wile suggests that a more productive strategy is for each person to confide rather than attack or avoid. Confiding involves letting the other person know that you are worried about raising this issue, or that you can see some of the weaknesses in your own arguments or some strengths or at least reasonableness in the other person’s point of view. This confiding style enables people to disagree while maintaining a more collaborative conversation.

For more information about Couples Therapy Palo Alto, please go to my therapist website & contact me.

3. Make it safe for people to confide in you
OK. It’s easy for us to say that a collaborative strategy will be more productive for both people than an avoidant or attacking stance. But how can we achieve this ideal when we feel passionately about our personal or political beliefs?

There are positive communication strategies we can use to encourage disclosure and collaboration and result in both parties feeling they are being heard. Some of the points we list come from the research on the “Speaker Listener Technique” by Scott Stanley, Howard Markman, and Galena Rhoades, who have shown how couples who take turns at being speaker and listener—not interrupting to get a new point across—and who follow some of the suggestions below show improvement in their relationship over time. They coach Couples Therapy Palo Alto to:

Make short statements. Arguments get out of hand when a large number of ideas are presented all at once before allowing a response.

Slow the conversation down. Especially as we get upset, we tend to talk faster and rush past points when we feel that little blip in the gut that signals hurt, anger, or anxiety.

Take time to make sure we understand what the other person is saying. We often assume that we know what the other person means and that what they are saying is either misinformed, wrong, or intentionally hurtful. Instead of walking away or attempting to contradict what sound like errors or even lies, we recommend what may be a counterintuitive step—interviewing the other person carefully to ask more about what they mean.
Use “I” statements that describe what you feel and believe, not “you” statements that characterize the other person’s intentions. (A sentence such as “I feel that you are hostile” is not an “I” statement.)

4. If conversation gets hot, take a break
No matter how well we prepare for an argument or follow good communication guidelines, sometimes our feelings or the other person’s emotions are triggered to the point where one of the four horsemen enters the scene. One or both become critical, defensive, or contemptuous—or go silent while continuing the conversation but not expressing upset. Under these circumstances, it becomes impossible to consider the other’s point of view. We want to underline the seemingly obvious point that people rarely modify their point of view when they are being criticized, shouted at, dismissed, or ignored.

Very often, one of the participants in a heated discussion wants to continue, hoping that in the end the other will see the logic of their point of view. Often the other person tries to get away by leaving the room psychologically or physically. Most couples therapists suggest that their clients agree to a “time out,” which gives both partners a chance to cool off.

But this won’t work unless both people agree on a time to resume the discussion in order to have a “recovery conversation” that is not derailed by feelings of helplessness and anger. That is, a recovery conversation can help to shift from a battle between two warriors, to an exchange between two people working together to address a difference or problem that concerns them both.

5. Don’t slide; decide
Some difficult conversations start because couples need to make an important decision. Stanley, Rhoades, and Markman report that many partners have reservations about what the other proposes, but choose not to express them. Or both partners simply slide into an option rather than struggle together toward a decision, even on important issues like moving in together, or having a baby, or basic values. It seems easier to agree to move in together rather than find two separate places after graduation. One partner may go along with the other’s desire to have a child rather than have a prolonged and difficult fight. Both may choose to keep quiet rather than discuss a serious disagreement about values or politics.

The problem is that down the road, sliders have a much harder time in their relationship than deciders do. Moving in together saves money, but may be premature in terms of the state of the relationship. The reluctant parent, having avoided a pre-baby argument, may now experience heightened levels of individual and relationship stress. Undiscussed value or political issues can lead to increased polarization and emotional distance.

Especially in facing big issues, we recommend that you take advantage of the strategies in steps one to four, rather than skirting around issues in order to avoid a stressful conversation. If you are able to tolerate listening respectfully to each other and slow things down before coming to any final conclusions, you may actually be able to discuss both of your points of view more directly. To lower the tension at the start of a discussion, we often suggest that partners take the tack that “this is a discussion, not a decision.” This often works in Couples Therapy Palo Alto and it might work for you when discussing a political issue on Facebook or at the dinner table. Who knows? Nationally, it might even help politicians and activists on opposite sides have more productive discussions with each other.

Can these steps help America talk again?
Imagine Republicans and Democrats on the floor of the United States House of Representatives or Senate arguing about a proposed new law—but this time our legislators are applying insights about how to resolve conflict between couples. A Republican speaker might address the assembled legislators this way:

I want to express my support for this bill, but I also want to acknowledge that my Democratic colleagues have some concerns about how the new law would operate. My understanding of their chief concern is that it will be difficult to enforce. Have I got it right?

Almost right. What’s missing is a specification of the administrative office that will administer enforcement. I know that my Republican colleagues are leery of creating bigger government, so how can we work together to address the enforcement problem?

And so on, toward compromise and resolution. It’s a nice thought experiment, though this is not how the current United States Congress operates. Getting members of Congress to adopt those guidelines might seem far-fetched—but we believe it is completely possible for ordinary people to follow them. The next time you find yourself disagreeing with an uncle or a neighbor about strongly held ideas and values, try taking some of these steps. You might not win the argument, but you can avoid some antagonism—while keeping your relationships strong.



Online Counseling for Work Stress New York City

Online Counseling for Work Stress New York City

What does your reflection reveal?

There are times when we see parts of our character we don’t like. The moments are often fleeting, yet can be haunting.

Did I snap too harshly on the person again?

Was I too passive in the meeting as usual?

Am I too smothering to my child as my parents were to me?

Was it only about me yet again?

We worry, obsess, can’t sleep, or have dreams about this, and can even feel the part of us is right under the surface.

The symptoms are stress, anxiety, work burnout, isolation or depression. We then have to deny, rationalize or escape.

But we can change.

There needs to be a look into character, to study our contradictions, and to minimize balms of the day such as shopping, substances, tv, eating, or social media.

The combination of understanding intellectually and also acting and behaving and experiencing is what makes a person better. You study the self, identify distractions, and challenge the given.

It is a dual process: intellect plus experience.

Without it, we continue to be haunted. With a study of the self, we gain actionable insights, build real changes, and make a more fulfilling life.

When seeing your reflections, what do you do?

Not sure why parts of your character hold you back in your work? For Stress Counseling, Kearns Group helps individuals study the gap between goals and their achievement. Through a contextual counseling we reveal the stress that gets in the way and design strategies to better reach their achievement. Conveniently located in Greenwich Village near Union Square.

Telehealth Stress Counseling: Can it help you too?

Is your stress leading to poor sleep or irritability?

Do you occasionally get down or short tempered?

Realize things about yourself you want to change but find hard to do?

If you don’t get ahead of your mental health care, anxiety can creep up and turn into a bigger deal. It can then easily become a strained life of distraction, hiding, or escaping.

With Telehealth Stress Counseling, there is now a more dynamic and effective approach for change.

As a Mental Health Counselor for working professionals, I am amazed at the accessibility and efficiency of Telehealth Counseling.

People are able to identify work and personal issues more immediately, stay ahead of their stresses more flexibly, and strategically make better choices and build lasting results.

If you are a…

banker who feels even greater pressure to perform

startup employee whose company has pivoted yet again

See unwanted patterns in your relationships again

Or feel more isolated than ever during COVID

it’s time to stop going at it alone.

Get something that sparks you, or someone you care about, in a different way. A mental health approach that is convenient, effective, and helping more and more.

Reach out and connect to Telehealth online Stress Counseling you might like the way you feel.

Can Stress Counseling work for you?

We need to find something that sparks us in a different way to fight our stress. Work on the new recipe, write in the journal, or talk with an old friend.

The spark away from the stress is an assist in helping us get through the rough patch. Finding a new interest away from the anxiety helps us remember we’re going to get through it, even when the skies are grey.

And as you work through the stress, don’t make too big a deal of the situation. If you make it too big of a deal, you don’t go near it. And if you worry all the time, it doesn’t mean you are going to approach it any better. The idea is, how bad can it be? In going through it you usually find out its not the end of the world.

As a mental health professional, Stress Counseling is a big part of my role these days. To help people feel better I emphasize the importance of a spark. I also point out responses to stresses don’t have to be perfect. The idea is to make it good but also recognize you are learning to be better. The process is really about learning to make better choices and learning to work through things.

Put the bat on the ball, return the shot, and treasure the basics. Even spell it out to yourself: is this worth that.

Further, in fighting our stresses, set limits. Limit is all. Somebody pays the piper if you don’t. Have to give attention to your well-being and by setting limits you help yourself.

So find the spark that makes you feel different, try to not make the stress too big, and your response does not have to be perfect but something where we are making better choices.

Online Counseling in Texas

The Pros of Online Therapy

Are you considering Online Counseling in Texas? The internet has opened up new avenues for mental health treatment, but there are some pros and cons you should consider before you decide if e-therapy, also known as teletherapy,1 is right for you. In the face of the social distancing measures required in our COVID-19 crisis, many in-person psychotherapies are becoming online out of necessity.

Pros of Online Therapy
Let’s explore some of the biggest advantages of online therapy.2

Good Option for Remote Areas
Online therapy offers access to mental health information and treatment to people in rural or remote areas. Those who live in such areas simply might not have access to any other form of mental health treatment because there are limited or no mental health practices in their geographic area.

Having to drive long distances and take significant time out of a busy schedule to seek therapy can be a burden on many people in need of help. If you have reliable internet access, online therapy gives you relatively quick and easy access to treatment that might not have been readily available to you otherwise.3

Accessibility for People With Physical Limitations
Online therapy provides accessibility to individuals who are disabled or housebound. Mobility can be a big issue when it comes to accessing mental health care. A therapist practicing out of their own home, for example, may not be set up to accommodate all potential clients.

Individuals who are unable to leave their home for various reasons, such as physical or mental illness, may find online therapy a useful alternative to traditional psychotherapy settings.

Convenience and Affordability of Online Counseling in Texas
Online therapy is usually fairly affordable and convenient. Since you will be attending therapy sessions online in the comfort of your own home, you can often schedule your therapy sessions for times that are the most convenient for you.

Today, many states require insurance providers to cover online therapy just as they would traditional therapy sessions. Contact your insurance company to learn more about how e-therapy treatments will be covered by your policy.

Therapists who only treat patients online likely have fewer overhead costs such as renting office space. Online therapists, therefore, can often offer affordable treatment options for those who are not covered by health insurance.

Dr. Jan Dunn provides Online Counseling in Texas to individuals, couples, and families. Telehealth
Video Therapy Sessions provides the same treatment as in person therapy sessions. Shifting the therapy office to a clients space makes therapy portable, accessible, confidential, and comfortable. In turn, clients often report feeling more at ease, less stressed, and more apt to open up and, in turn, therapy is more effective. The benefits far outweigh any concerns for most clients, as accessibility to care drastically increases and cancellations drastically decrease. Therapy is delivered in the comfort of your home – when and where you need it.

Does Health Insurance Cover Online Counseling in Texas?

Treatment Is More Accessible
The Internet makes mental health treatment more accessible.4 People may feel comfortable talking to friends and family about physical health care issues but may not feel the same discussing mental health concerns that are just as important. Online access makes it easier to overcome the stigma that has historically been attached to mental health issues.

Teletherapy can be an important tool to help people learn more about psychological health. Even if you feel like your mental well-being is strong, online therapy can help you become psychologically stronger.5 You can learn more about health behaviors and coping strategies that will lead to better psychological health.

You don’t need to have a clinically diagnosed condition to benefit from talking to a professional, and online therapy can provide an easy avenue for getting started.

Overlooks Body Language
In many cases, online therapists cannot see facial expressions, vocal signals, or body language. These signals can often be quite telling and give the therapist a clearer picture of your feelings, thoughts, moods, and behaviors.

Some delivery methods such as voice-over-Internet technology and video chats can provide a clearer picture of the situation, but they often lack the intimacy and intricacy that real-world interactions possess.

Some people may feel more comfortable undergoing Online Counseling in Texas in a digital setting, especially younger people who are more intimately familiar with such methods of communication, but others—therapists and patients alike—may get more out of therapy that utilizes more direct human contact.

Ethical and Legal Concerns
Online therapy eliminates geographic restraints, making the enforcement of legal and ethical codes difficult.8 Therapists can treat clients from anywhere in the world, and many states have different licensing requirements and treatment guidelines. It is important to understand your therapist’s qualifications and experience before you begin the treatment process.



Online Counseling in Texas

The Pros of Online Therapy

Are you considering Online Counseling in Texas? The internet has opened up new avenues for mental health treatment, but there are some pros and cons you should consider before you decide if e-therapy, also known as teletherapy,1 is right for you. In the face of the social distancing measures required in our COVID-19 crisis, many in-person psychotherapies are becoming online out of necessity.

Pros of Online Therapy
Let’s explore some of the biggest advantages of online therapy.2

Good Option for Remote Areas
Online therapy offers access to mental health information and treatment to people in rural or remote areas. Those who live in such areas simply might not have access to any other form of mental health treatment because there are limited or no mental health practices in their geographic area.

Having to drive long distances and take significant time out of a busy schedule to seek therapy can be a burden on many people in need of help. If you have reliable internet access, online therapy gives you relatively quick and easy access to treatment that might not have been readily available to you otherwise.3

Accessibility for People With Physical Limitations
Online therapy provides accessibility to individuals who are disabled or housebound. Mobility can be a big issue when it comes to accessing mental health care. A therapist practicing out of their own home, for example, may not be set up to accommodate all potential clients.

Individuals who are unable to leave their home for various reasons, such as physical or mental illness, may find online therapy a useful alternative to traditional psychotherapy settings.

Convenience and Affordability of Online Counseling in Texas
Online therapy is usually fairly affordable and convenient. Since you will be attending therapy sessions online in the comfort of your own home, you can often schedule your therapy sessions for times that are the most convenient for you.

Today, many states require insurance providers to cover online therapy just as they would traditional therapy sessions. Contact your insurance company to learn more about how e-therapy treatments will be covered by your policy.

Therapists who only treat patients online likely have fewer overhead costs such as renting office space. Online therapists, therefore, can often offer affordable treatment options for those who are not covered by health insurance.

Dr. Jan Dunn provides Online Counseling in Texas to individuals, couples, and families. Telehealth
Video Therapy Sessions provides the same treatment as in person therapy sessions. Shifting the therapy office to a clients space makes therapy portable, accessible, confidential, and comfortable. In turn, clients often report feeling more at ease, less stressed, and more apt to open up and, in turn, therapy is more effective. The benefits far outweigh any concerns for most clients, as accessibility to care drastically increases and cancellations drastically decrease. Therapy is delivered in the comfort of your home – when and where you need it.

Does Health Insurance Cover Online Counseling in Texas?

Treatment Is More Accessible
The Internet makes mental health treatment more accessible.4 People may feel comfortable talking to friends and family about physical health care issues but may not feel the same discussing mental health concerns that are just as important. Online access makes it easier to overcome the stigma that has historically been attached to mental health issues.

Teletherapy can be an important tool to help people learn more about psychological health. Even if you feel like your mental well-being is strong, online therapy can help you become psychologically stronger.5 You can learn more about health behaviors and coping strategies that will lead to better psychological health.

You don’t need to have a clinically diagnosed condition to benefit from talking to a professional, and online therapy can provide an easy avenue for getting started.

Overlooks Body Language
In many cases, online therapists cannot see facial expressions, vocal signals, or body language. These signals can often be quite telling and give the therapist a clearer picture of your feelings, thoughts, moods, and behaviors.

Some delivery methods such as voice-over-Internet technology and video chats can provide a clearer picture of the situation, but they often lack the intimacy and intricacy that real-world interactions possess.

Some people may feel more comfortable undergoing Online Counseling in Texas in a digital setting, especially younger people who are more intimately familiar with such methods of communication, but others—therapists and patients alike—may get more out of therapy that utilizes more direct human contact.

Ethical and Legal Concerns
Online therapy eliminates geographic restraints, making the enforcement of legal and ethical codes difficult.8 Therapists can treat clients from anywhere in the world, and many states have different licensing requirements and treatment guidelines. It is important to understand your therapist’s qualifications and experience before you begin the treatment process.



Online therapy in Texas

online therapy Texas

Online counseling is the provision of professional mental health counseling services through the Internet.

Services are typically offered via email, real-time chat, and video conferencing. Some clients use online counseling in conjunction with traditional psychotherapy, or nutritional counseling, and a growing number of clients are using online counseling as a replacement for office visits.

While some form of tele-psychology has been available for over 35 years, the advent of internet video chat systems and the increasing penetration of broadband has resulted in the continuing growth of online therapy. Some clients are using videoconferencing, live chat and email with professional psychologists in place of or in addition to face-to-face meetings. There is also a growing trend with online recovery coaches who can now conduct face-to-face consults with clients online.


In 1972, computers from Stanford and UCLA simulated a psychotherapy session that was considered the very beginning of online counseling. At the time the internet went public,[further explanation needed] this launch went hand in hand with the development of the first self-help groups on the internet who were, in that time, very popular.[citation needed] In 1995, Martha Ainsworth began searching for a competent therapist because she had some psychological complaints. Her travel requirements made it difficult for her to consult a face-to-face therapist, and she therefore searched for an effective alternative online, but only found a dozen webpages that offered online treatment for psychological complaints. Afterwards, Martha Ainsworth wanted to reach the general public with her experiences and founded a sort of clearinghouse for mental health websites, named Metanoia. This database seemed to be a very efficient store-room and by the year 2000, this clearinghouse contained over 250 websites of private practices, and more than 700 online clinics where a therapist could be contacted.

According to, the first service to offer online mental healthcare was “Ask Uncle Ezra”, created by staff of Cornell University in 1986 for students. By mid-1995 several fee-based online services offering mental health advice had appeared.

Between 1994 and 2002, a group of trained volunteer crisis counselors called “Samaritans”, began providing suicide prevention services via email.


online therapy Texas is filling the unmet need for clients located in areas traditionally under-served by traditional counselors. Rural residents, people with disabilities and expats, along with under-served minorities often have an easier time finding a suitable therapist online than in their local communities.

Online counseling has been shown to be effective for clients who may have difficulty reaching appointments during normal business hours, while decreasing the number of missed appointments for in-person therapy.

Kathryn McNeer, LPC provides online therapy Texas specializing in couples counseling at the McNeer Group.

Medical uses and effectiveness

Although there is some preliminary support for the possibility that online counseling may help populations that otherwise underutilize traditional in-office counseling, the question of the effectiveness and appropriateness of online therapy Texas has not been resolved.

Mental health

Research from G.S. Stofle suggests that online counseling would benefit people functioning at a moderately high level. J. Suler suggests that people functioning at a particularly high level, and who are well-educated and are artistically inclined, may benefit the most from using text-based online counseling to as a complement to ongoing psychotherapy. Severe situations, such as suicidal ideation or a psychotic episode, might be better served by traditional face-to-face methods, although further research may prove otherwise.

Cohen and Kerr conducted a study on the effectiveness of online therapy for treatment of anxiety disorders in students and found that there was no difference in the level of change for the two modes as measured by the State-Trait Anxiety Inventory.

As the main goal of counseling is to alleviate the distress, anxiety or concerns experienced by a client when he or she enters therapy, online counseling has strong efficacy under that definition. Client satisfaction surveys tend to demonstrate a high level of client satisfaction with online counseling, while the providers sometimes demonstrate lower satisfaction with distance methods.

photo: pexels

Online Counseling

Welcome back to our newsletter series addressing the question we’ve been hearing from our community of clients: Is my response to the abnormality, normal? Last time, we focused on your own thoughts and feelings. In this 3rd installment, we are focusing on what our community is noticing in their relationships with others.

Relating in Isolation

As depicted in the graphic above, our community is noticing that we are still very committed to our relationships, but there are shifts in our roles, or we may play multiple roles at once. You may also find yourself having to navigate how to absorb the reactions of others. As isolating as this situation is, our emotions are still occurring in relation to others. This can affect the entire system’s mood and mindset.

Depression Treatment Raleigh
Do you feel down? Have you lost interest in things you used to enjoy? Are you critical and judgmental towards yourself? We can help you find the Inner Path that can lead you out of your depression.

Therapist near me

144 Wind Chime CT. #1 Raleigh NC 27615-6433

Our Personal Reflections

Last week, my 4 year-old son planted “magic beans” to take us to Giant Land, where he was pretty sure “the virus isn’t going around.” He watched the magic beans (we’re not allowed to just call them beans) vigilantly, watered them 27 times a day, packed for himself and his brother, including a pillow, and waited so we could climb the thing and get out of here. When that didn’t work (shocking, I know), this week he decided to build a spaceship with a seat for each of us so we can finally get off of this blasted planet. A life-size space ship. With plywood, screws, and Styrofoam. As a play therapist, I’m seeing a lot of themes in his play, or as he would call it “work.” However, I’m sure I don’t have to explain the meaning of it to you. We all want an escape plan and are fantasizing in one way or another of an alternate life. It’s been a good reminder that kids are dealing with the same stress as adults. Their symptoms are often the same, but the way it plays out (pun intended) is different. It’s been a reminder for me to appreciate his ingenuity and be compassionate about his struggles – and to do the same for myself and others.

I’ve noticed the different needs my family members have based on their developmental stages. The toddler seems to be okay with his blissful ignorance to what’s going on. The older kids have been dealing with it based on their developmental abilities, but their personality differences also come through. My kindergartner seems satisfied socially, but needs to be held, physically and emotionally, in her moments of rage that come through. My elementary schooler has engaged in magical thinking. He has this idea about turning the light switch off and COVID turns off too. He imagines everything we will do as soon as it ends, such as vacations and time off of school (because somehow he needs even more time off). I’ve found it’s been helpful to meet them in the moment through – whether it’s imagining or holding space until they can regulate. I’ve noticed the parallel as an adult. We have these same emotions and need space for them as well.

Couples Therapy Tribeca
New York City Therapist Carolyn Ehrlich focuses on learning how we share space with each other. In therapy, both parties are given the opportunity to speak, guided by a therapist. And most importantly, both will be heard.

56 Leonard Street, Apt 17AE, New York, NY 10013

Turning Relationships into Community

The sentiment of being in this together while distancing from each other is strange. But part of what’s helping us all survive right now is how we are consciously engaging with our community. Alicia Bailey, a KCC clinician, recognizes that we are experiencing an “intensified version of the pressure we feel every day as parents, which is forming these human beings, but we have nowhere to outsource.” Not to mention managing their mental health along with our own. And meanwhile, our partnerships might either be falling by the wayside so we can function, or riddled with tension at the moment. However, she notes that this situation is increasing our collective resiliency, because we have to get creative on how to outsource, such as enlisting grandparents or neighbors for childcare.

​It’s amazing for us to see the resourceful ideas that many come up with to connect with others, such as creating “COVID families,” weekly video calls with friends and family, drive-by birthday wishes, sustaining the local economy, and normalizing the struggle so that your loved ones will not feel alone.

We are grateful to continue to be a part of your community. If someone you care about could use some help, please forward this on to them, or pass along our information.

Your support around the corner, or wherever there’s WiFi,

Psychologist Chapel Hill N.C. – Telehealth

Recent developments in the COVID-19 pandemic have motivated me to transition to an entirely virtual practice. I believe firmly that social distancing is the safest and most ethical way to ensure the well-being for everyone and protect my clients.

I use a HIPAA-compliant platform that can be accessed by phone, iPad, or computer. No set-up needed; you simply click a link sent to you prior to the session.
While the same rules of confidentiality for in-person sessions apply to virtual or phone sessions, there are some unique aspects to consider:
– Use a private Wi-Fi connection with high speed internet.
– Make sure you are in a private space so that you can ensure your privacy.
– Please be present and ready by your device at the scheduled appointment time.

Research has shown that teletherapy is equivalent in effectiveness to in-person therapy. Thanks to recent technology improvements, the differences between the experience of a video session and a face-to-face session are negligible.

Psychologist Chapel Hill N.C. – Telehealth

If you are committed to improving, you will do well regardless of whether the sessions with your therapist are held in person or remotely.

Most individuals report that they find teletherapy to be as effective as an in-person office visit. Added benefits include that you will not have to spend time commuting to my office and the lack of school and available child-care will not prevent being able to attend regular therapy sessions.

Psychologist Chapel Hill N.C. – Telehealth is an excellent option to ensure you get the help you need even during a pandemic where we need to socially distance to maintain safety. Too often, putting off treatment creates more problems. Fortunately, teletherapy is now widely available.

I am a doctoral-level licensed psychologist in North Carolina; I have expertise in various evidence-based treatments for adults and am committed to providing scientifically validated interventions. I work with a diverse population, including trauma, insomnia, mood disorders, anxiety, and relationship problems. I take my work and clinical specializations seriously and continue to devote a considerable amount of time and effort to advance my training and professional development. For your convenience, my services are provided via telehealth.

Dr. Sara Michelson
Licensed Psychologist Chapel Hill N.C.

I am a psychologist trained in evidence-based treatments.

I have particular expertise in treating psychological trauma and PTSD. I have been certified by the National Center for PTSD as a provider for Prolonged Exposure Therapy (PE) and Cognitive-Processing Therapy (CPT), both evidenced-based treatments to help reduce the symptoms of PTSD.

I also treat insomnia and sleep problems, anxiety disorders, panic attacks, mood disorders, relationship problems, anger, and other stressful life transitions. I have completed specialized training in cognitive behavioral therapy for insomnia (CBT-I), mindfulness, anger therapy, and behavioral activation for depression (BA).

I graduated with a B.A. in psychology and comparative literature from the University of Copenhagen and a Psy.D. in clinical psychology from Roosevelt University in Chicago, IL. I have received training in cognitive behavioral therapies at Northwestern University and the University of Chicago. My doctoral research focused on the effects of childhood trauma on later personality development. I completed my predoctoral internship at the VA Hudson Valley Health Care System and a post-doctoral fellowship at Yale University where I specialized in working with veterans with post-traumatic stress disorder. Since completing my graduate training, I have worked in private practice, VA hospitals, the Center for Deployment Psychology, and with public safety and law enforcement agencies in Illinois and Psychologist Chapel Hill N.C. where I have conducted pre-employment screenings, crisis evaluations, and fitness for duty evaluations.

CBT typically helps individuals address anxiety, depression, relationship problems, etc. by teaching new skills and ways of coping. For example, someone with social anxiety may work to improve the skill of tolerating being in anxiety-inducing social situations. Someone who is prone to extreme worry may work on the skill of talking themselves through their anxiety. Someone with depression may try to improve their ability to engage in behavioral activation. Research has shown that improvements of these skills, can help to alleviate significantly psychological distress.

What are some of the strategies used in CBT?

In CBT, the focus is on thoughts and behavior. Some of the strategies used include:
• Identifying problematic thoughts and thought patterns that are keeping you stuck
• Changing your relationship to the problematic thoughts by accepting their presence and challenging their accuracy
• Developing balanced alternative views to initial interpretations of events
• Learning new problem-solving and emotion regulation skills
• Building motivation and ability to engage in productive and meaningful behavior through exercises

Social Media and Suicide Among Teens

Digital media, including social media, became a centerpiece of day to day life at a seemingly exponential rate. Before I graduated high school in 2006, I remember many evenings spent on ICQ (used to chat with friends), making simple websites with shout outs to my friends which included obnoxious lists of inside jokes, and playing The Sims Online. I whiled away the hours without much consequence – at that time it was  project to upload a picture to the internet (you had to have a digital camera or a scanner), and in order to sign up for Facebook, you needed to have a college email address. These were simpler times.

Fast forward to now, and we are a world of quasi-cyborgs with our phones in our hands and our head in the Cloud. Technology is immensely helpful to us in innumerable ways – it helps us connect with others, provides us with apps that support our well-being, productivity, work, supports us to make healthier lifestyle choices, and so on. However, if this resource is not used intentionally, it may cause irreversible damage. I’m talking about the approximately 60% increase in suicide rates among individuals ages 10-24 between the year 2007 and 2018.1 While we cannot explicitly say that this increase in suicide among young people is mostly due to the growth in use of social media, there seems to be a pretty obvious connection.

Build your self-care skills through Online Counseling in New Jersey

Do you want to improve your self-care skills? Contact me to learn more about working together through online counseling in New Jersey.

I now also offer Online Counseling in Pennsylvania, contact me to learn more.

Take, for instance, the 2017 death of Sadie Riggs from Pennsylvania. Her peers were merciless with their bullying, targeting her in the hallways at school but also through social media, and telling her to kill herself. Her parents, once they discovered what was happening, went to the police and to her school – neither did anything, and they eventually took their daughter’s phone. Unfortunately, it was too late and Sadie completed suicide about a week after her phone was taken.2 Cyberbullying is a type of bullying that extends beyond the boundaries of school; it follows kids home and can infiltrate their life as often as they choose to check their phone, which is at least a couple hours a day for most teens.

What are some of the ways that social media is influencing the increase in suicide among young people? Prosuicidal behavior may be cultivated online in some of the following ways:

  1. Cyberbullying. This refers to when someone is targeted online and repeatedly tormented and harassed. It’s bullying, but online. A study found that victims of cyberbullying were twice as likely to attempt suicide, and the individuals perpetrating the bullying were 1.5 times as likely to have attempted suicide.3
  2. Media Contagion Effect. This refers to the increase in a particular activity that occurs when the media covers it, for instance: mass shootings. One study found that, out of 719 people between the ages of 14-24 years old, almost 60% reported being exposed to suicide related content through internet sources.3; There is also a growing trend of posting suicide notes online, which may influence the decisions of vulnerable individuals.3
  3. Normalizing/disinhibiting suicide or self-harm. Through sharing online, anyone has access to content that may normalize suicide or non-suicidal self harming behavior. Vulnerable individuals who may find extreme chat rooms where others idolize or encourage suicide.3

While there are dangers lurking on the internet, there is also help. If you or someone you know is struggling with suicidal ideation or self harming behaviors, make sure you reach out for help immediately. Here are some resources:

The National Suicide Prevention Lifeline: 800-273-8255

Crisis Text Line:

Society for the Prevention of Teen Suicide:

The Trevor Project, a resource for LGBTQ individuals:

Sarah Tronco, LCSW, provides online counseling in New Jersey and works to develop a strong therapeutic relationship with her clients, which helps to create a secure place where individuals can achieve meaningful change.

Sarah Tronco, LCSW, now also provides Online Counseling in Pennsylvania, contact her to learn more.




Photo by Danilo Rios on Unsplash

Couples Therapy Palo Alto: Relationships in the Tech World.

Being a Marriage and Family Therapist in the Bay Area specializing in Couples Therapy Palo Alto, means I have the privilege to meet clients from very diverse backgrounds. One of them is the Silicon Valley background which is a culture in and of itself. Clients and couples with this background share some distinct characteristics: high achieving, hard working, intelligent, ambitious, and long working hours. Some people work so hard and long that they don’t even dare to get into any intimate relationship. While a small number of people are content with life without being in a significant relationship, many of us have the innate desire to want to connect with a partner. Because of the demand from work for time, it often creates a lot of challenges for those who work in the Silicon Valley culture to have successful and fulfilling relationships.

Palo Alto, being the heart of Silicon Valley, is one of those cities in which many couples struggle to have a healthy work life balance. Over the years of working with couples from that region, I’ve identified a few helpful ways to create and maintain a fulfilling and loving relationship in the long term.

1: Be Honest and Realistic with Yourself and Your Partner.
More often than not, working in Silicon Valley is a long term and heavy commitment. That’s true for the people working in the industry, as well as for the significant others. So it’s critical that couples be realistic about what they’re committing to professionally and how that will have a direct impact on their personal and relationship life. Otherwise, resentment and bitterness often become the natural by product.

2: Know Your End Game.
I’ve had clients complain about how “cut throat” and brutal the lifestyle working in Silicon Valley is. Working 80 hour weeks often is the norm rather than exception. Naturally it’s not a sustainable lifestyle, especially for those that are more family oriented. So if your goal is to experience that culture and get that on your resume, be concrete about your timeline. On the other hand, if your goal is to take companies public, then you must recognize that you need a partner that believes in your vision as well as is willing to make the necessary sacrifices. In the meantime, you also need to be work extra hard on the relationship to maintain a healthy and happy balance.

For more information about Couples Therapy Palo Alto, please go to my therapist website & contact me.

3: Communication (DUH…)
Literally 100% of the couples that I work with have some level of communication issues. For relationships to thrive in the Silicon Valley culture, having great communication is part of the successful equation. That’s because when time is the scarce commodity, it is crucial that the couple knows how to be effective and efficient in their communication to avoid tension, misunderstanding, and resentment building. One tip that I often give to couples is to over communicate. The reason being that I believe 95% of the time, conflicts arise from misunderstanding. And the best antidote to misunderstanding is over communication.

4: Define a Balanced Relationship with Your Partner.
When you’re unable to fully provide the essential currency in a relationship, TIME, you need to understand how you can still meet your partner’s needs in a straight forward manner. Talk with your partner about how you’d like to define and create a healthy relationship with them despite having less than the ideal amount of time. When there’s a genuine gesture to improve and the desire care for your partner, it tends to create a positive chain reaction in the relationship.

Kin Leung, MFT – Individual and Couples Therapy Palo Alto


Family Stress Test

Family Stress Test

Stress is a natural and normal “by-product” of every family’s life. In fact, family stress can bring out the best of us: as we stretch to meet the challenges we face, we become better parents, our children blossom and our families grow. But too much stress can spiral our families in the other direction. Take this Thriving test to see how your family fares.

Set 1

1. There is a lot of bickering in our house. Someone is always angry at someone else.

2. There’s never enough time to sit down together, either to talk or to eat. There’s always too much to do.

3. My spouse and I argue a lot about how to raise the children.

4. It’s like pulling teeth to get the kids to help around the house.

5. Our family has experienced a lot of significant change recently (divorce, death, blending family, job loss, illness, other trauma).

6. Money is very tight. My partner and I have constant conflicts about how to spend it.

7. My child has been having behavioral problems at school.

8. The children get upset when they hear us arguing.

9. I work too much, and it’s really getting to me.

10. We don’t really talk about hard issues; we just try to hold our breath, wait and let them go away.

Counseling Plainfield Illinois, my goal as a therapist offering, is to find solutions that work for you on an individual basis, helping you to discover the true potential of your life, so everyday can be a celebration, and feel like a real ‘breath of fresh air.’ There may be no magic button or quick-fix solution when it comes to changing things from the past that have been difficult, but what we can do is work together to find comfort and resolve in the difficult areas of your life, and the challenges you have to face. Read more about Gwen Ginski, MEd, LCSW.

Set 2

1. We acknowledge feelings, encourage their expression and allow time for dealing with the issues these feelings raise.

2. We plan time for family activities. And we eat together at least once every day.

3. If a blended family, we maintain and nurture original parent-child relationships and let new relationships develop in their own time.

4. I feel confident in my role as parent.

5. Our family easily maintains a sense of humor and playfulness.

6. Family priorities take precedence over work.

7. I know what’s important to my kids.

8. When issues arise that we get stuck on, we ask for help from other family members, support groups, community-based programs, clergy and/or a therapist.

9. We have enough money for the important things.

10. Everyone in the family has responsibilities around the house and does them without being nagged.

If you answered true more often in the first set than in the second set, you may want to seek help lowering the stress level of your family. Families that communicate about problems, who face issues as they arise, who support one another and seek help when it is needed, can build strong bonds among themselves, nurture a healthy and loving family and have a lot more fun doing it!

Author’s content used  under license, © 2008 Claire Communications

Disorganized Attachment

Mary Ainsworth’s work on attachment identified three attachment categories (secure, insecure avoidant, and insecure ambivalent/resistant). The development of the disorganized/disoriented classification evolved as a part of Mary Main’s doctoral research in which she noticed that approximately 10% of infants in Ainsworth’s Strange Situation Procedure were difficult to classify.1 Disorganized attachment is an additional attachment category that was identified in 1986 by Mary Main and Judith Solomon at the University of California, Berkeley.

Explore your attachment style through Online Counseling in New Jersey

Are you curious about your attachment style and how it may be impacting the quality of your life and relationships? Contact me to learn more about working together through online counseling in New Jersey.

I now also offer online counseling in Pennsylvaniacontact me to learn more.

The three attachment styles identified by Ainsworth are considered organized because they present behaviors that are consistent.2 In the Strange Situation Procedure, behaviors that were classified as disorganized/disoriented include:

-Obvious displays of fear of the caregiver
-Sequential or simultaneous behaviors or affects that are contradictory
-Movements that are asymmetric, misdirected, stereotypic, or jerky
-Apparent dissociation or freezing 1

These behaviors would typically happen for a moment until an infant’s behaviors returned to those that could more easily be classified into one of Ainsworth’s categories. Disorganized attachment can be seen as coexisting among the other three categories instead of being a replacement category, as disorganized infants were always coded into a second organized category.2

Caregiver Behaviors Associated with Disorganized Attachment

The following parental behaviors have been associated with disorganized/disoriented behavior in infants studied in the Strange Situation Procedure:

-Frightened or frightening parental behavior
-Dissociative, withdrawing, or helpless behavior
-Experiencing a persistent anxiety disorder
-Social and economic disadvantage
-Lack of regulation of the caregiving environment 1

Additional behaviors that can cause disorganized attachment behavior in infants, identified by Main and Hesse, include threatening gestures or expressions from the caregiver toward the infant, submissive behavior of a caregiver, sexual or romantic behavior toward the infant, mocking or teasing the infant, role confusion, and withdrawing (being silent during interaction). 2

The Impact of Disorganized Attachment

Disorganized attachment in infancy can impact the development of the amygdala. Components of maternal and infant disorganized attachment are linked to a larger left amygdala volume in adulthood, which is associated with limbic irritability and dissociation.3 Limbic irritability can result in aggression, violence directed at the self or others, and dysphoria.4 Unresolved trauma contributes to disorganized attachment in adults, with unresolved loss being easier to resolve than abuse that is unresolved.5

Check out my previous post to get a general overview of the different attachment styles.

Sarah Tronco, LCSW, provides online counseling in New Jersey and works to develop a strong therapeutic relationship with her clients, which helps to create a secure place where individuals can achieve meaningful change.

Sarah Tronco, LCSW, now also provides online counseling in Pennsylvaniacontact her to learn more.


  6. Photo by Allef Vinicius on Unsplash

How Well Are You Listening to Your Children and Others?

When our children come to us with a problem, we usually want to help them. So we console, interpret, advise, distract or praise. Other times, we feel we must teach our children, and so we interrogate, lecture, moralize or order. And probably more often than we’d like, we respond angrily—blaming, criticizing, ridiculing, shaming or withdrawing.

However, all of these responses are problematic—whether with our children, or with the important adults in our lives. They often serve to stop the communication of real feelings and the development of individual solutions. Take the quiz below, adapted from the classic Parent Effectiveness Training, by Dr. Thomas Gordon, to assess your listening skills.

1. I let my children feel their difficult feelings, knowing that comments such as “Everyone goes through this” deny the strength of their feelings.

2. I try to listen for the need beneath the words and respond to that.

3. I make it a point to check in to see if I’ve understood something in the way my child intended it. When I do, I try to keep my own feelings, opinions and guidance out of it.

4. When my child tells me something, I try to respond with either noncommittal phrases (such as “I see” or “Is that so”) or with an invitation to say more (such as “Tell me more” or “Go ahead, I’m listening”).

5. I notice that when I listen to my children’s problems, rather than make suggestions or give advice, my children often come up with their own excellent solutions.

Counseling Plainfield Illinois, my goal as a therapist offering, is to find solutions that work for you on an individual basis, helping you to discover the true potential of your life, so everyday can be a celebration, and feel like a real ‘breath of fresh air.’ There may be no magic button or quick-fix solution when it comes to changing things from the past that have been difficult, but what we can do is work together to find comfort and resolve in the difficult areas of your life, and the challenges you have to face. Read more about Gwen Ginski, MEd, LCSW.

6. When I hear my child out fully, my child is often much more willing to listen to my thoughts and ideas.

7. When I let my children express their feelings openly and completely, the feelings often seem to disappear quickly.

8. I really want to hear what my child has to say; if I don’t have the time to listen right at that moment, I say so and make time for it later.

9. I’ve learned to trust that my children can find perfectly good solutions to their problems on their own.

10. I understand that my children are separate, unique individuals, and that their feelings and perceptions are not necessarily the same as mine.

11. When I stay away from moralizing, interpreting, ordering and advising, I find that I learn a lot more about my children. Sometimes, I even learn from my children.

12. I know that just listening doesn’t always bring about immediate change and that it’s sometimes OK to leave things on an inconclusive or incomplete note.

13. I understand that listening to children express their feelings can help them accept a situation they know they cannot change.

Authentic communication with our children (and friends) has rewards more valuable than a pot of gold. Real listening may be the rainbow bridge we need to get there. If you scored fewer “true” answers than false, you could probably benefit from improving your listening skills. Don’t hesitate to call.

Author’s content used under license, © 2008 Claire Communications

Photo Credit: Jason Rosewell,

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Your Reaction to “The New Normal”: Are My Thoughts And Feelings Normal?

How Are You? No, Really, How are you?

The answer to this question is often a resounding, “Eh.” As therapists, we see the silver lining in this: emotional honesty (we can see your eye roll). We have found that because we are in a difficult common experience, we have been able to connect more quickly with one another around difficult emotions. This seems more authentic than the old standard, “I’m fine.”

Am I Normal?

We’ve all been hearing a lot about “the new normal,” but what does that even mean during a time when everything has been upended? It’s our first time going through a global pandemic too, but we know there is comfort in learning that you are not alone in your experience. Here are some common thoughts and feelings from our community (and ourselves) you might relate to:

I kind of like this.

No commute. More quality time with family. Working from home full time. Simple living. It makes sense that you like parts of this change. Soak in any positives you can to help get through this. Engage in self-care so you’re able to be present with your family, or take a moment to be present with little things you used to rush past during your stressful commute.

I feel guilty about liking it.

It also makes sense that you notice your privilege about enjoying aspects of staying home. Others definitely have it worse. You might also feel guilty about the struggles you’re having for the same reason. Something we’ve been pointing out to you, though, is your life is undoubtedly more difficult now than it was before, which is stressful. It’s okay to have complex feelings right now – and any time (but you knew therapists would say that)

I’m super anxious.

Of course you are. About getting sick. About your loved ones. The economy. The news. Food. Keeping the kids busy. And about the many changes you are experiencing. We could go on, and so could you. The DSM-V (Diagnostic & Statistical Manual for Mental Health Diagnoses) requires 6 months of anxiety symptoms, but some of them may sound familiar right now: difficulty controlling worry, feeling on edge, irritability, sleep disturbances. Some of your anxiety might be new, but it might also tie back to older issues as well. Send yourself some compassion, and consider making this a time to do some deeper emotional work.

I’m feeling hopeless about the future.

We don’t know how long this will go on, other than a long time. A symptom of depression is not looking forward to the future. Well, when we all have our picture of the future ripped out from under us, it makes sense that we feel a little depressed. We think that just about everyone might relate to some of the symptoms of depression right now: depressed mood most of the day, loss of interest in activities (especially when you have so few options, right?), significant weight change, loss of energy every day. As The New York Times points out, there is research showing that many aspects of social isolation lead to loneliness and depression. What’s our therapeutic advice about this one? You guessed it: self-care. Starting with therapy, of course :) It’s not just coming from us though – even The Washington Post suggests that therapy could ease your coronavirus stress.

We are finding ourselves doing some very meaningful work with you as these feelings have been coming up. As a result, we have been able to witness some relief and growth.

Depression Treatment Raleigh
Do you feel down? Have you lost interest in things you used to enjoy? Are you critical and judgmental towards yourself? We can help you find the Inner Path that can lead you out of your depression.

Therapist near me

144 Wind Chime CT. #1 Raleigh NC 27615-6433

Your Reaction to “The New Normal”: Connecting Virtually

We are privileged to be trusted with your emotional wellbeing right now, so we want to share what we’ve been learning about the human condition during this time, beginning with the virtual connection.

Most of our human “contact” now happens virtually. By now, you’ve heard our kids and dogs, and we’ve witnessed your family members seeking your attention, including Whiskers stealthily gliding by the camera. We’ve been hearing that people are both surviving on and exhausted by virtual interaction. It seems the key to preventing ‘virtual burnout’ might be similar to your in-person interactions: when you’re able, choose the connections which are fulfilling rather than draining. We’ve also heard that sometimes you just need a break from video calls. You can always empathically shout at your neighbor from 6 feet away instead.

Virtual Therapy

We are honored to find that therapy is one of the fulfilling types of virtual interactions. We’ve been thinking carefully about how to keep it this way for you, such as incorporating mindfulness, being flexible, and taking care of ourselves so we are present for you. Many clients have shared that it is more natural than expected. We are missing being in the room with you, but are so grateful for the ability to virtually connect with you.

​At this point, most of us are searching for humor to get us through this situation (one of our favorite coping mechanisms). Here are Hamilton cast members performing “The Zoom Where It Happened.”

Couples Therapy Tribeca
New York City Therapist Carolyn Ehrlich focuses on learning how we share space with each other. In therapy, both parties are given the opportunity to speak, guided by a therapist. And most importantly, both will be heard.

56 Leonard Street, Apt 17AE, New York, NY 10013

Counseling for women – Infidelity

According to The New York Times, the most consistent data on infidelity comes from the University of Chicago’s General Social Survey (GSS). Interviews with people in non-monogamous relationships since 1972 by the GSS have shown that approximately 12% of men and 7% of women admit to having had an extramarital relationship. Results, however, vary year by year, and also by age-group surveyed. For example, one study conducted by the University of Washington, Seattle found slightly, or significantly higher rates of infidelity for populations under 35, or older than 60. In that study which involved 19,065 people during a 15-year period, rates of infidelity among men were found to have risen from 20 to 28%, and rates for women, 5% to 15%. In more recent nationwide surveys, several researchers found that about twice as many men as women reported having an extramarital affair. A survey conducted in 1990 found 2.2% of married participants reported having more than one partner during the past year. In general, national surveys conducted in the early 1990s reported that between 15–25% of married Americans reported having extramarital affairs. People who had stronger sexual interests, more permissive sexual values, lower subjective satisfaction with their partner, weaker network ties to their partner, and greater sexual opportunities were more likely to be unfaithful. Studies suggest around 30–40% of unmarried relationships and 18–20% of marriages see at least one incident of sexual infidelity.

Rates of infidelity among women are thought to increase with age. In one study, rates were higher in more recent marriages, compared with previous generations; men were found to be only “somewhat” more likely than women to engage in infidelity, with rates for both sexes becoming increasingly similar. Another study found that the likelihood for women to be involved in infidelity reached a peak in the seventh year of their marriage and then declined afterward; whereas for married men, the longer they were in relationships, the less likely they were to engage in infidelity, except for the eighteenth year of marriage, at which point the chance that men will engage in infidelity increases.

One measure of infidelity is covert illegitimacy, a situation that arises when someone who is presumed to be a child’s father (or mother) is in fact not the biological parent. Frequencies as high as 30% are sometimes assumed in the media, but research by sociologist Michael Gilding traced these overestimates back to an informal remark at a 1972 conference. The detection of unsuspected illegitimacy can occur in the context of medical genetic screening, in genetic family name research, and in immigration testing. Such studies show that covert illegitimacy is, in fact, less than 10% among the sampled African populations, less than 5% among the sampled Native American and Polynesian populations, less than 2% of the sampled Middle Eastern population, and generally 1–2% among European samples.

When working with couples in person or online, it is Kathryn’s direct yet non-judgmental approach to any and all issues a couple is facing that provides a safe place for them to do the deep work of counseling and ultimately thrive. She helps couples determine which patterns in their life and relationships are keeping them “stuck” and then helps them establish new, more productive patterns whether in person or online therapy all over Texas. Kathryn works with couples on trust, intimacy, forgiveness, and communication. She has seen it all, and her couples appreciate her no-nonsense approach to helping to sort through the tough stuff. Kathryn provides premarital counseling in addition to couples counseling, marriage counseling, and individual counseling for women & counseling for men.

Counseling for women – Gender

Differences in sexual infidelity as a function of gender have been commonly reported. It is more common for men compared to women to engage in extra-dyadic relationships. The National Health and Social Life Survey found that 4% of married men, 16% of cohabiting men, and 37% of dating men engaged in acts of sexual infidelity in the previous year compared to 1% of married women, 8% of cohabiting women, and 17% of women in dating relationships. These differences have been generally thought due to evolutionary pressures that motivate men towards sexual opportunity and women towards commitment to one partner. In addition, recent research finds that differences in gender may possibly be explained by other mechanisms including power and sensations seeking. For example, one study found that some women in more financially independent and higher positions of power, were also more likely to be more unfaithful to their partners. In another study, when the tendency to sensation seek (i.e., engage in risky behaviors) was controlled for, there were no gender differences in the likelihood to being unfaithful. These findings suggest there may be various factors that might influence the likelihood of some individuals to engage in extra-dyadic relationships, and that such factors may account for observed gender differences beyond actual gender and evolutionary pressures associated with each.

Counseling for women – Emotional

Infidelity causes extreme emotions to occur between males and females alike. Emotions have been proven to change through this process. Below, the three phases of infidelity (beginning, during and after) are explained.

The “Before” Stage:

Infidelity is the biggest fear in most romantic relationships and even friendships. No individual wants to be cheated on and replaced by another, this act usually makes people feel unwanted, jealous, angry and incompetent. The initial stage of the infidelity process is the suspicious beginning; the stage in which it has not been proven, but warning signs are beginning to surface. While suspicion is not hard evidence in infidelity and cannot prove anything, it does affect a person’s affective emotions and cognitive states. Jealousy, the feeling of incompetence, and anger can all be felt in both the affective and cognitive states of emotions; infidelity has a different impact in each of those connected states.

Affective emotions and response are a primary factor in the initial stages of infidelity on both sides. Affective behaviors are how we deal with emotions that we do not anticipate. An affective response immediately indicates to an individual whether something is pleasant or unpleasant and whether they decide to approach or avoid a situation.

To begin, affective emotions and the effect infidelity has on affective jealousy. Both men and women alike feel some kind of jealousy when they suspect their significant other is being unfaithful. If some individual suspects that he or she is being cheated on they begin to question their partner’s actions and may possibly act in more frustrated ways towards them than they normally would. The affective use of jealousy in a seemingly unfaithful relationship is caused by the accusing partner anticipating the infidelity from the other.

Another affective emotion in this beginning stage is incompetence. Feeling incompetent can spring from multiple things in a relationship, but during the initial stages of infidelity, a person can experience this on an increased level. When someone is having incompetent feelings due to someone else’s actions they begin to resent them, creating a build-up and eventually an affective emotion outburst over something small. The faithful partner is not normally aware that their suspicion is the reason they feel incompetent in the relationship and do not expect to be so irritated by the change of simple things; making it an affective response in this stage of infidelity. These unanticipated emotions could lead to more and multiple responses such as this one within the future of the initial stage of infidelity.

An additional affective response or emotion seen in initial infidelity is anger. Anger is an emotion that is felt in all stages of infidelity, but in different ways and at different calibers. In the initial stages of infidelity anger is an underlying emotion that is usually exposed after the buildup of other emotions such as jealousy and Resentment. Anger is noticed to be a key emotion within a situation like infidelity, it takes on many roles and forms throughout the process but in the initial stage of cheating, anger can be an affective emotion because of how unpredictable and rapid it can happen without thinking of one’s actions and feelings before doing so.

Cognitive emotions and states tend to be felt in the initial stages of infidelity whenever the faithful partner is alone or left alone by the suspected unfaithful one. Cognitive emotions and responses are that of those in which an individual anticipates them. Once couples begin to anticipate the actions and emotions of their partners, even if evidence have not been set forth, the emotions of infidelity enter a cognitive state.

To begin with cognitive responses in infidelity, individuals who have been cheated on experience jealousy cognitively for many reasons. They may feel that their partner has lost interest in them and feel that they cannot compare to the persons with whom they are being cheated on with. Therefore, they anticipate the loss of their partner’s emotional interest in them and become jealous for more clear reasons. The anticipation of jealous feelings towards an individual’s significant other causes a cognitive response, even without the burden of proof.

Some more cognitive responses in the young stages of infidelity are incompetence and resentfulness. In the initial stages of infidelity, the feeling of incompetence can lead to cognitive resentment. The partner being cheated on will begin to feel that anything and everything they do is not enough, they may feel incompetent in the ways of love, affection, or sex. Whenever an individual suspects that they are being cheated on they try to change their behavior in hopes of keeping or getting their partner’s attention back onto themselves instead of on the person whom they are having another relationship with. People cheat for many reasons and each of those can cause a faithful person to believe they are not competent enough to be in a romantic relationship. This feeling leads to the resentment of the unfaithful partner’s actions and becomes an ongoing emotion throughout the stages of infidelity instead of simply being a quick and immediate response to a partner’s actions.

Counseling for women – Anger

Anger in infidelity is quite inevitable. In the initial stage of infidelity, anger is not as apparent as it is seen in stage two, because there is not hard facts or evidence supporting one’s suspicions. As previously talked about, the accuser most likely feels jealous and incompetent in the first stage of cheating. These emotions can contract into anger and provide a cognitive state of anger because the accusing person anticipates his or her anger. Unlike jealousy and resentment, it is hard to identify the purpose or cause of the individual’s anger because in reality there is nothing yet to be angry about, there is no proof of their romantic partner’s unfaithfulness. It is hard to pinpoint the anger emotion in the initial stages due to ambiguity; therefore, it begins to take on other emotions turning into a cognitive state of emotional turmoil. The individual knows they are angry and anticipates it, but cannot logically explain it to their partner because of the lack of evidence they have.

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What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a multifactorial neurobiological disorder (Curatolo, Paloscia, D’Agati, Moavero, & Pasini, 2009) that affects between 3% and 7% of school aged children in the United States and is the most prevalent neurobehavioral condition among this population in many countries (Findling, 2008).  Although it may be the most studied condition in child psychiatry worldwide, its exact causes  and the exact mechanisms underlying this disorder are still unknown (Cortese, 2012).  It appears to be caused by the confluence of many genetic and environmental risk factors, each having a small effect on increasing vulnerability to the disorder (Curatolo et al., 2009).

This chronic disorder impairs function at both home and at school since it affects attentional and cognitive functions including problem solving, planning, orienting, alerting, cognitive flexibility, sustained attention, response inhibition, and working memory.  Other areas such as motivation and delay aversion are also affected. These impairments create a negative impact on social interactions and adolescents with ADHD are at high risk for low self-esteem and poor peer relationships (Curatolo et al., 2009).   ADHD frequently exists with other neuropsychiatric and neuro-developmental disorders, including oppositional defiant disorder, conduct disorder, anxiety and depressive disorders, developmental coordination disorder, sleep disorders, learning difficulties and substance abuse disorder (Cortese, 2012).

ADHD is a highly inheritable condition with documented brain abnormalities and its symptoms persist into adolescence and adulthood in 37% to 85% of children, according to the National Comorbidity Survey (Findling, 2008).

2.  Historical Perspective of ADHD (How Has Our Understanding Of ADHD Changed Over Time?)

ADHD was first described over 100 years ago by George Still in the Coombs lectures of 1902.  He described this condition as an ‘‘abnormal defect in moral control in children’’.  Encephalitis lethargica, or sleeping sickness appeared as an epidemic during World War I, spread throughout the world, and disappeared in 1927.  After this epidemic, many children showed hyperkinetic behavioral symptoms including hyperkinesis, impulsivity, learning disability, and short attention span and were labeled as “minimal brain damaged” and later as “minimal brain dysfunction”.  In the 1950s, this label was modified to ‘‘hyperactive child syndrome’’.  In 1968 the disorder was renamed in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-II as ‘‘hyperkinetic reaction of childhood’’. (Spencer, Biederman, & Mick, 2007).      During the 1960s and 1970s the focus on what is now ADHD was on motoric hyperactivity and overt impulsivity (Curatolo et al., 2009).

The DSM-III which was published in 1980 represented a paradigm shift in the diagnosis and treatment of ADHD because it began to emphasize inattention as a significant component of the disorder.  The DSM-III also recognized developmental variability in the disorder at different ages and allowed for a residual type if the remaining symptoms caused significant impairment (Spencer et al., 2007).  The DSM-III marked the beginning of attention deficit disorder with or without hyperactivity (Curatolo et al., 2009).  This definition was further defined in the DSM-IV which included three subtypes of ADHD:  predominantly inattentive, predominantly hyperactive-impulsive, and a combined subtype (Spencer et al., 2007).  The clarification of three subtypes led to new theories about the etiology and pathophysiology of ADHD within a more specific brain localization area (Curatolo et al., 2009).

3.  Diagnosis (How Do You Know If You Have ADHD?)

A child with ADHD displays a considerable degree of distractibility, impulsivity, inattentiveness and other hyperactivity that is inappropriate for the child based on the developmental stage of the child.  The diagnosis of ADHD is made after careful examination of the clinical history.  Although ADHD is often observed in early childhood, the current guidelines for diagnosis begin at the age of four years, partly because many overactive toddlers will not develop ADHD.  Children with ADHD may have other common symptoms including low frustration tolerance, shifting activities frequently, difficulty organizing, and daydreaming.  Often these symptoms are pervasive but they may not occur in all settings (Spencer et al., 2007).

The three subtypes of ADHD:  predominantly inattentive, predominantly hyperactive-impulsive, and a combined subtype determine where children struggle the most.  Those children with predominantly inattentive ADHD may have more problems in school and struggle with homework and fewer problems with peers and family.  Since children with this subtype do not display as many behavior problems and are more likely to be female, they often are not diagnosed until late adolescence.  In contrast, children with excessive hyperactive or impulsivity symptoms may do better at school but they struggle more at home and in other less structured environments.  Children with combined subtype have the most co-occurring psychiatric and substance abuse disorders and are most impaired overall (Spencer et al., 2007).

As these children reach adulthood, many of their problems persist.  Previously, it was thought that symptoms would largely go away in adolescence, but research supports the persistence of the disorder and/or associated impairment in the majority of cases.  Although individuals may no longer meet all of the diagnostic criteria of ADHD, they may still suffer from significant impairment.  Diagnosing ADHD in older patients is more complicated for a number of reasons.  First, the original model of ADHD is the DSM-IV was a childhood disorder.  Field trials on children were used to determine the diagnostic criteria (Lahey et al., 1994) and major studies on children were used to confirm the model (Scholte, van Berckelaer-Onnes, & van der Ploeg, 2001) which is why some researchers have hesitated to apply the diagnostic criteria of the DSM-IV to adults (Stein, Fischer, & Szumowski, 1999).  A further complication of diagnosing ADHD in older patients is that evidence suggests that manifestation of symptoms may become more subtle with age (Riccio et al., 2005) although recent work has found that the lack of inhibitory control is the primary characteristic of adult ADHD (Amen, Hanks, & Prunella, 2008; Bekker et al., 2005).

Currently in order for an adult to be diagnosed with ADHD they must have childhood-onset, persistent, and current symptoms of ADHD.  Symptoms in adults often present with marked inattention, distractibility, organization difficulties, and poor efficiency.  These persistent traits often lead to life histories of academic and occupational failure (Spencer et al., 2007).   In addition, adults with ADHD can have serious emotional, relational, and work related consequences including higher prevalence of other medical and behavioral disorders and higher medical costs (Amen et al., 2008).

The most significant and consistent structural imaging findings in children with ADHD include smaller total brain volumes and reduced volumes, in the right frontal lobe, caudate nucleus, the cerebellar hemisphere and posterior inferior lobules of the cerebellar vermis. These early abnormalities of regional brain volumes have also been shown to change over time in children and adolescents with ADHD. Developmental trajectories study showed that volumetric abnormalities in the cerebrum and cerebellum persisted with increasing age, whereas caudate differences versus normal subjects disappeared. Cortical development in children with ADHD shows a marked delay in brain maturation; the gray matter peaks were about 3 years later than in healthy controls. The delay is most prominent in prefrontal regions important for control of cognitive processes including attention and motor planning (Curatolo et al., 2009)

Dr. Jan Dunn provides Online Counseling in Texas to individuals, couples, and families. Telehealth Video Therapy Sessions provides the same treatment as in person therapy sessions. Shifting the therapy office to a clients space makes therapy portable, accessible, confidential, and comfortable. In turn, clients often report feeling more at ease, less stressed, and more apt to open up and, in turn, therapy is more effective. The benefits far outweigh any concerns for most clients, as accessibility to care drastically increases and cancellations drastically decrease. Therapy is delivered in the comfort of your home – when and where you need it.

4.  Physical Differences in the Brain (Are the Brains of Children with ADHD Different?)

Advances in brain imaging studies have significantly contributed to the biological understanding of ADHD.  Although many differences have been identified in the brain structures of children with ADHD, some of these differences are more consistent and more significant than others.  These findings include smaller total brain volumes and reduced volumes in the right frontal lobe, caudate nucleus, the cerebellar hemisphere and posterior inferior lobules of the cerebellar vermis.  These abnormalities change over time in children and adolescents with ADHD.  Studies have shown that although volumetric abnormalities in the cerebrum and cerebellum persist with advancing age, those in the caudate region disappear and are consistent with subjects without ADHD.  Another important finding is that children with ADHD show marked delay in the cortical development of the brain.  The gray matter peaks approximately three years later than subjects with ADHD and the delay is most prominent in the frontal regions which focus on control of cognitive processes including attention and motor planning (Curatolo et al., 2009)

This is the first study to establish neural effects of a cognitive training program in ADHD. Our findings provide preliminary evidence that training of cognitive functions targets critical syndrome-associated structures, and indicate it may improve cognitive performance by enhancing dysregulated fronto-cerebellar circuits. Interestingly, similar results have been demonstrated following methylphenidate administration, suggesting that cognitive training may mimic the effects of psychostimulant medication on the brain. On the whole, our results postulate a neural account for the potency of cognitive training in ADHD patients, and hold clinical implications, supporting the pertinence of training programs as part of standard ADHD-treatment (Hoekzema et al., 2010)

General Guidelines

There is no doubt about it, ADHD is one of the more complex disorders that people suffer.  It impacts how one thinks, how one lives and how one develops relationships in one’s life.  It is highly complex and requires more than just medication.  In fact, the most recent research states that this disorder is a “chronic brain disorder”.  Which means that it is a life long disorder, people are born with it and they die with it.  It impacts a person for their entire life.

It is important to see a provider who truly understands the complexity of ADHD and how best to help.  It is important for the provider to take a multi-interventional approach to helping the individual and/or couple with ADHD.

1.   Medication is certainly important and finding the right medication for you can be challenging; however, very important if you want to have better control of your symptoms.

2.   It is also important to eat a diet high in proteins since the person with ADHD requires more than the average individual.

3.  Exercise intensively at least 20 minutes daily (more if possible).  It has been proven that intense exercise changes the chemistry of the brain, making the brain function better.  Sounds like a good idea for folks who have ADHD!!

4.  There is also a growing body of knowledge that support taking vitamins and minerals to help boost what the ADHD brain needs nutritionally.

Therapy plays a critical part in helping the ADHD individual, parent and/or couple because this disorder is often misunderstood.  It can create so many problems in a marriage that often the ADHD individual has difficulty remaining in a long term relationship.  It takes skills and understanding for marriages to cope with this disorder.  Parents often do not understand the complexity of this disorder, wondering why their child is having so many problems after starting medication.  Medication is only part of the solution.  Specialized parenting skills are needed to help the parent who has an ADHD child.  I call this training the “graduate course” for parents.  Adults with ADHD need assistance because they often have years of failed attempts at relationships, school, work.  These failures result in negative “self talk” which often leads to mood disorders.  It is not uncommon to see young adults with ADHD also suffering from anxiety and/or depression.  They need to learn more about their brains and how best to navigate life to create successes versus failures.

Amy Tuteur M.D.

Photo pexels

What is Anxiety?


Anxiety is an emotion characterized by an unpleasant state of inner turmoil, often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination. It is the subjectively unpleasant feelings of dread over anticipated events.

Anxiety is a feeling of uneasiness and worry, usually generalized and unfocused as an overreaction to a situation that is only subjectively seen as menacing.[3] It is often accompanied by muscular tension,[4] restlessness, fatigue and problems in concentration. Normally considered to be appropriate, when anxiety is experienced regularly the individual may suffer from an anxiety disorder.[4] Anxiety is closely related to fear, which is a response to a real or perceived immediate threat; anxiety involves the expectation of future threat.[4] People facing anxiety may withdraw from situations which have provoked anxiety in the past.[5]

A job applicant with a worried facial expression

Anxiety is distinguished from fear, which is an appropriate cognitive and emotional response to a perceived threat.[6] Anxiety is related to the specific behaviors of fight-or-flight responses, defensive behavior or escape. It occurs in situations only perceived as uncontrollable or unavoidable, but not realistically so.[7] David Barlow defines anxiety as “a future-oriented mood state in which one is not ready or prepared to attempt to cope with upcoming negative events,”[8] and that it is a distinction between future and present dangers which divides anxiety and fear. Another description of anxiety is agony, dread, terror, or even apprehension.[9] In positive psychology, anxiety is described as the mental state that results from a difficult challenge for which the subject has insufficient coping skills.[10]

Fear and anxiety can be differentiated in four domains: (1) duration of emotional experience, (2) temporal focus, (3) specificity of the threat, and (4) motivated direction. Fear is short lived, present focused, geared towards a specific threat, and facilitating escape from threat; anxiety, on the other hand, is long-acting, future focused, broadly focused towards a diffuse threat, and promoting excessive caution while approaching a potential threat and interferes with constructive coping.[11]

Joseph E. LeDoux and Lisa Feldman Barrett have both sought to separate automatic threat responses from additional associated cognitive activity within anxiety.[12][13]

Therapist Anxiety Newport Beach psychologist Dimitra Takos, PsyD a therapist specializing in treating anxiety in young adults in college, adolescent teens in school, and adults in general.

Anxiety Symptoms

Anxiety can be experienced with long, drawn out daily symptoms that reduce quality of life, known as chronic (or generalized) anxiety, or it can be experienced in short spurts with sporadic, stressful panic attacks, known as acute anxiety.[14] Symptoms of anxiety can range in number, intensity, and frequency, depending on the person. While almost everyone has experienced anxiety at some point in their lives, most do not develop long-term problems with anxiety.

Anxiety may cause psychiatric and physiological symptoms.

The risk of anxiety leading to depression could possibly even lead to an individual harming themselves, which is why there are many 24-hour suicide prevention hotlines.[17]

The behavioral effects of anxiety may include withdrawal from situations which have provoked anxiety or negative feelings in the past.[5] Other effects may include changes in sleeping patterns, changes in habits, increase or decrease in food intake, and increased motor tension (such as foot tapping).[5]

The emotional effects of anxiety may include “feelings of apprehension or dread, trouble concentrating, feeling tense or jumpy, anticipating the worst, irritability, restlessness, watching (and waiting) for signs (and occurrences) of danger, and, feeling like your mind’s gone blank”[18] as well as “nightmares/bad dreams, obsessions about sensations, déjà vu, a trapped-in-your-mind feeling, and feeling like everything is scary.”[19]

The cognitive effects of anxiety may include thoughts about suspected dangers, such as fear of dying. “You may … fear that the chest pains are a deadly heart attack or that the shooting pains in your head are the result of a tumor or an aneurysm. You feel an intense fear when you think of dying, or you may think of it more often than normal, or can’t get it out of your mind.”[20]

The physiological symptoms of anxiety may include:

Neurological, as headache, paresthesias, fasciculations, vertigo, or presyncope.
Digestive, as abdominal pain, nausea, diarrhea, indigestion, dry mouth, or bolus.
Respiratory, as shortness of breath or sighing breathing.
Cardiac, as palpitations, tachycardia, or chest pain.
Muscular, as fatigue, tremors, or tetany.
Cutaneous, as perspiration, or itchy skin.
Uro-genital, as frequent urination, urinary urgency, dyspareunia, or impotence, chronic pelvic pain syndrome. Stress hormones released in an anxious state have an impact on bowel function and can manifest physical symptoms that may contribute to or exacerbate IBS.

Painting entitled Anxiety, 1894, by Edvard Munch

There are various types of anxiety. Existential anxiety can occur when a person faces angst, an existential crisis, or nihilistic feelings. People can also face mathematical anxiety, somatic anxiety, stage fright, or test anxiety. Social anxiety and stranger anxiety are caused when people are apprehensive around strangers or other people in general.[citation needed]


Further information: Angst, Existential crisis, and Nihilism
The philosopher Søren Kierkegaard, in The Concept of Anxiety (1844), described anxiety or dread associated with the “dizziness of freedom” and suggested the possibility for positive resolution of anxiety through the self-conscious exercise of responsibility and choosing. In Art and Artist (1932), the psychologist Otto Rank wrote that the psychological trauma of birth was the pre-eminent human symbol of existential anxiety and encompasses the creative person’s simultaneous fear of – and desire for – separation, individuation, and differentiation.[citation needed]

The theologian Paul Tillich characterized existential anxiety[21] as “the state in which a being is aware of its possible nonbeing” and he listed three categories for the nonbeing and resulting anxiety: ontic (fate and death), moral (guilt and condemnation), and spiritual (emptiness and meaninglessness). According to Tillich, the last of these three types of existential anxiety, i.e. spiritual anxiety, is predominant in modern times while the others were predominant in earlier periods. Tillich argues that this anxiety can be accepted as part of the human condition or it can be resisted but with negative consequences. In its pathological form, spiritual anxiety may tend to “drive the person toward the creation of certitude in systems of meaning which are supported by tradition and authority” even though such “undoubted certitude is not built on the rock of reality”.[21]

According to Viktor Frankl, the author of Man’s Search for Meaning, when a person is faced with extreme mortal dangers, the most basic of all human wishes is to find a meaning of life to combat the “trauma of nonbeing” as death is near.[22]

Depending on the source of the threat, psychoanalytic theory distinguishes the following types of anxiety:


Test and performance

Main articles: Test anxiety, Mathematical anxiety, Stage fright, and Somatic anxiety
According to Yerkes-Dodson law, an optimal level of arousal is necessary to best complete a task such as an exam, performance, or competitive event. However, when the anxiety or level of arousal exceeds that optimum, the result is a decline in performance.[24]

Test anxiety is the uneasiness, apprehension, or nervousness felt by students who have a fear of failing an exam. Students who have test anxiety may experience any of the following: the association of grades with personal worth; fear of embarrassment by a teacher; fear of alienation from parents or friends; time pressures; or feeling a loss of control. Sweating, dizziness, headaches, racing heartbeats, nausea, fidgeting, uncontrollable crying or laughing and drumming on a desk are all common. Because test anxiety hinges on fear of negative evaluation,[25] debate exists as to whether test anxiety is itself a unique anxiety disorder or whether it is a specific type of social phobia.[26] The DSM-IV classifies test anxiety as a type of social phobia.[27]

While the term “test anxiety” refers specifically to students,[28] many workers share the same experience with regard to their career or profession. The fear of failing at a task and being negatively evaluated for failure can have a similarly negative effect on the adult.[29] Management of test anxiety focuses on achieving relaxation and developing mechanisms to manage anxiety.[28]

Stranger, social, and intergroup anxiety

Main articles: Stranger anxiety and Social anxiety
Humans generally require social acceptance and thus sometimes dread the disapproval of others. Apprehension of being judged by others may cause anxiety in social environments.[30]

Anxiety during social interactions, particularly between strangers, is common among young people. It may persist into adulthood and become social anxiety or social phobia. “Stranger anxiety” in small children is not considered a phobia. In adults, an excessive fear of other people is not a developmentally common stage; it is called social anxiety. According to Cutting,[31] social phobics do not fear the crowd but the fact that they may be judged negatively.

Social anxiety varies in degree and severity. For some people, it is characterized by experiencing discomfort or awkwardness during physical social contact (e.g. embracing, shaking hands, etc.), while in other cases it can lead to a fear of interacting with unfamiliar people altogether. Those suffering from this condition may restrict their lifestyles to accommodate the anxiety, minimizing social interaction whenever possible. Social anxiety also forms a core aspect of certain personality disorders, including avoidant personality disorder.[32]

To the extent that a person is fearful of social encounters with unfamiliar others, some people may experience anxiety particularly during interactions with outgroup members, or people who share different group memberships (i.e., by race, ethnicity, class, gender, etc.). Depending on the nature of the antecedent relations, cognitions, and situational factors, intergroup contact may be stressful and lead to feelings of anxiety. This apprehension or fear of contact with outgroup members is often called interracial or intergroup anxiety.[33]

As is the case the more generalized forms of social anxiety, intergroup anxiety has behavioral, cognitive, and affective effects. For instance, increases in schematic processing and simplified information processing can occur when anxiety is high. Indeed, such is consistent with related work on attentional bias in implicit memory.[34][35][36] Additionally recent research has found that implicit racial evaluations (i.e. automatic prejudiced attitudes) can be amplified during intergroup interaction.[37] Negative experiences have been illustrated in producing not only negative expectations, but also avoidant, or antagonistic, behavior such as hostility.[38] Furthermore, when compared to anxiety levels and cognitive effort (e.g., impression management and self-presentation) in intragroup contexts, levels and depletion of resources may be exacerbated in the intergroup situation.


Anxiety can be either a short-term ‘state’ or a long-term personality “trait”. Trait anxiety reflects a stable tendency across the lifespan of responding with acute, state anxiety in the anticipation of threatening situations (whether they are actually deemed threatening or not).[39] A meta-analysis showed that a high level of neuroticism is a risk factor for development of anxiety symptoms and disorders.[40] Such anxiety may be conscious or unconscious.[41]

Personality can also be a trait leading towards anxiety and depression. Through experience many find it difficult to collect themselves due to their own personal nature.[42]

Choice or decision

Anxiety induced by the need to choose between similar options is increasingly being recognized as a problem for individuals and for organizations.[43] In 2004, Capgemini wrote: “Today we’re all faced with greater choice, more competition and less time to consider our options or seek out the right advice.”[44]

In a decision context, unpredictability or uncertainty may trigger emotional responses in anxious individuals that systematically alter decision-making.[45] There are primarily two forms of this anxiety type. The first form refers to a choice in which there are multiple potential outcomes with known or calculable probabilities. The second form refers to the uncertainty and ambiguity related to a decision context in which there are multiple possible outcomes with unknown probabilities.[45]

Panic Disorder

Panic disorder may share symptoms of stress and anxiety, but it is actually very different. Panic disorder is an anxiety disorder that occurs without any triggers. According to the U.S Department of Health and Human Services, this disorder can be distinguished by unexpected and repeated episodes of intense fear.[46] Someone who suffers from panic disorder will eventually develop constant fear of another attack and as this progresses it will begin to affect daily functioning and an individual’s general quality of life. It is reported by the Cleveland Clinic that panic disorder affects 2 to 3 percent of adult Americans and can begin around the time of the teenage and early adult years. Some symptoms include: difficulty breathing, chest pain, dizziness, trembling or shaking, feeling faint, nausea, fear that you are losing control or are about to die. Even though they suffer from these symptoms during an attack, the main symptom is the persistent fear of having future panic attacks.[47]

Anxiety disorders

Main article: Anxiety disorder
Anxiety disorders are a group of mental disorders characterized by exaggerated feelings of anxiety and fear responses.[48] Anxiety is a worry about future events and fear is a reaction to current events. These feelings may cause physical symptoms, such as a fast heart rate and shakiness. There are a number of anxiety disorders: including generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism. The disorder differs by what results in the symptoms. People often have more than one anxiety disorder.[48]

Anxiety disorders are caused by a complex combination of genetic and environmental factors.[citation needed] To be diagnosed, symptoms typically need to be present for at least six months, be more than would be expected for the situation, and decrease a person’s ability to function in their daily lives.[citation needed] Other problems that may result in similar symptoms include hyperthyroidism, heart disease, caffeine, alcohol, or cannabis use, and withdrawal from certain drugs, among others.[citation needed]

Without treatment, anxiety disorders tend to remain.[48][49] Treatment may include lifestyle changes, counselling, and medications. Counselling is typically with a type of cognitive behavioural therapy.[50] Medications, such as antidepressants or beta blockers, may improve symptoms.[49]

About 12% of people are affected by an anxiety disorder in a given year and between 5–30% are affected at some point in their life.[50][51] They occur about twice as often in women than they do in men, and generally begin before the age of 25.[48][50] The most common are specific phobia which affects nearly 12% and social anxiety disorder which affects 10% at some point in their life. They affect those between the ages of 15 and 35 the most and become less common after the age of 55. Rates appear to be higher in the United States and Europe.[50]

Short- and long-term anxiety

Anxiety can be either a short-term “state” or a long-term “trait”. Whereas trait anxiety represents worrying about future events, anxiety disorders are a group of mental disorders characterized by feelings of anxiety and fear.[48]


Anxiety disorders often occur with other mental health disorders, particularly major depressive disorder, bipolar disorder, eating disorders, or certain personality disorders. It also commonly occurs with personality traits such as neuroticism. This observed co-occurrence is partly due to genetic and environmental influences shared between these traits and anxiety.[52][53]

Anxiety is often experienced by those with obsessive–compulsive disorder and is an acute presence in panic disorder.

Risk factors

A marble bust of the Roman Emperor Decius from the Capitoline Museum. This portrait “conveys an impression of anxiety and weariness, as of a man shouldering heavy [state] responsibilities”.[54]
Anxiety disorders are partly genetic, with twin studies suggesting 30-40% genetic influence on individual differences in anxiety.[55] Environmental factors are also important. Twin studies show that individual-specific environments have a large influence on anxiety, whereas shared environmental influences (environments that affect twins in the same way) operate during childhood but decline through adolescence.[56] Specific measured ‘environments’ that have been associated with anxiety include child abuse, family history of mental health disorders, and poverty.[57] Anxiety is also associated with drug use, including alcohol, caffeine, and benzodiazepines (which are often prescribed to treat anxiety).


Neural circuitry involving the amygdala (which regulates emotions like anxiety and fear, stimulating the HPA Axis and sympathetic nervous system) and hippocampus (which is implicated in emotional memory along with the amygdala) is thought to underlie anxiety.[58] People who have anxiety tend to show high activity in response to emotional stimuli in the amygdala.[59] Some writers believe that excessive anxiety can lead to an overpotentiation of the limbic system (which includes the amygdala and nucleus accumbens), giving increased future anxiety, but this does not appear to have been proven.[60][61]

Research upon adolescents who as infants had been highly apprehensive, vigilant, and fearful finds that their nucleus accumbens is more sensitive than that in other people when deciding to make an action that determined whether they received a reward.[62] This suggests a link between circuits responsible for fear and also reward in anxious people. As researchers note, “a sense of ‘responsibility’, or self-agency, in a context of uncertainty (probabilistic outcomes) drives the neural system underlying appetitive motivation (i.e., nucleus accumbens) more strongly in temperamentally inhibited than noninhibited adolescents”.[62]

The gut-brain axis

The microbes of the gut can connect with the brain to affect anxiety. There are various pathways along which this communication can take place. One is through the major neurotransmitters.[63] The gut microbes such as Bifidobacterium and Bacillus produce the neurotransmitters GABA and dopamine, respectively.[64] The neurotransmitters signal to the nervous system of the gastrointestinal tract, and those signals will be carried to the brain through the vagus nerve or the spinal system.[63][64][65] This is demonstrated by the fact that altering the microbiome has shown anxiety- and depression-reducing effects in mice, but not in subjects without vagus nerves.[66]

Another key pathway is the HPA axis, as mentioned above.[65] The microbes can control the levels of cytokines in the body, and altering cytokine levels creates direct effects on areas of the brain such as the hypothalmus, the area that triggers HPA axis activity. The HPA axis regulates production of cortisol, a hormone that takes part in the body’s stress response.[65] When HPA activity spikes, cortisol levels increase, processing and reducing anxiety in stressful situations. These pathways, as well as the specific effects of individual taxa of microbes, are not yet completely clear, but the communication between the gut microbiome and the brain is undeniable, as is the ability of these pathways to alter anxiety levels.

With this communication comes the potential to treat anxiety. Prebiotics and probiotics have been shown to reduced anxiety. For example, experiments in which mice were given fructo- and galacto-oligosaccharide prebiotics[67] and Lactobacillus probiotics[66] have both demonstrated a capability to reduce anxiety. In humans, results are not as concrete, but promising.[68][69]


Genetics and family history (e.g. parental anxiety) may put an individual at increased risk of an anxiety disorder, but generally external stimuli will trigger its onset or exacerbation.[57] Estimates of genetic influence on anxiety, based on studies of twins, range from 25–40% depending on the specific type and age-group under study. For example, genetic differences account for about 43% of variance in panic disorder and 28% in generalized anxiety disorder.[citation needed] Longitudinal twin studies have shown the moderate stability of anxiety from childhood through to adulthood is mainly influenced by stability in genetic influence.[70][71] When investigating how anxiety is passed on from parents to children, it is important to account for sharing of genes as well as environments, for example using the intergenerational children-of-twins design.[72]

Many studies in the past used a candidate gene approach to test whether single genes were associated with anxiety. These investigations were based on hypotheses about how certain known genes influence neurotransmitters (such as serotonin and norepinephrine) and hormones (such as cortisol) that are implicated in anxiety. None of these findings are well replicated,[citation needed] with the possible exception of TMEM132D, COMT and MAO-A.[73] The epigenetic signature of BDNF, a gene that codes for a protein called brain derived neurotrophic factor that is found in the brain, has also been associated with anxiety and specific patterns of neural activity.[citation needed] and a receptor gene for BDNF called NTRK2 was associated with anxiety in a large genome-wide investigation.[74] The reason that most candidate gene findings have not replicated is that anxiety is a complex trait that is influenced by many genomic variants, each of which has a small effect on its own. Increasingly, studies of anxiety are using a hypothesis-free approach to look for parts of the genome that are implicated in anxiety using big enough samples to find associations with variants that have small effects. The largest explorations of the common genetic architecture of anxiety have been facilitated by the UK Biobank, the ANGST consortium and the CRC Fear, Anxiety and Anxiety Disorders.[74][75][76]

Medical conditions

Many medical conditions can cause anxiety. This includes conditions that affect the ability to breathe, like COPD and asthma, and the difficulty in breathing that often occurs near death.[77][78][79] Conditions that cause abdominal pain or chest pain can cause anxiety and may in some cases be a somatization of anxiety;[80][81] the same is true for some sexual dysfunctions.[82][83] Conditions that affect the face or the skin can cause social anxiety especially among adolescents,[84] and developmental disabilities often lead to social anxiety for children as well.[85] Life-threatening conditions like cancer also cause anxiety.[86]

Furthermore, certain organic diseases may present with anxiety or symptoms that mimic anxiety.[15][87] These disorders include certain endocrine diseases (hypo- and hyperthyroidism, hyperprolactinemia),[87][88] metabolic disorders (diabetes),[87][89][90] deficiency states (low levels of vitamin D, B2, B12, folic acid),[87] gastrointestinal diseases (celiac disease, non-celiac gluten sensitivity, inflammatory bowel disease),[91][92][93] heart diseases, blood diseases (anemia),[87] cerebral vascular accidents (transient ischemic attack, stroke),[87] and brain degenerative diseases (Parkinson’s disease, dementia, multiple sclerosis, Huntington’s disease), among others.[87][94][95][96]


Several drugs can cause or worsen anxiety, whether in intoxication, withdrawal or as side effect. These include alcohol, tobacco, cannabis, sedatives (including prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs like heroin), stimulants (such as caffeine, cocaine and amphetamines), hallucinogens, and inhalants.[97] While many often report self-medicating anxiety with these substances, improvements in anxiety from drugs are usually short-lived (with worsening of anxiety in the long term, sometimes with acute anxiety as soon as the drug effects wear off) and tend to be exaggerated. Acute exposure to toxic levels of benzene may cause euphoria, anxiety, and irritability lasting up to 2 weeks after the exposure.[98]


Poor coping skills (e.g., rigidity/inflexible problem solving, denial, avoidance, impulsivity, extreme self-expectation, negative thoughts, affective instability, and inability to focus on problems) are associated with anxiety. Anxiety is also linked and perpetuated by the person’s own pessimistic outcome expectancy and how they cope with feedback negativity.[99] Temperament (e.g., neuroticism)[40] and attitudes (e.g. pessimism) have been found to be risk factors for anxiety.[97][100]

Cognitive distortions such as overgeneralizing, catastrophizing, mind reading, emotional reasoning, binocular trick, and mental filter can result in anxiety. For example, an overgeneralized belief that something bad “always” happens may lead someone to have excessive fears of even minimally risky situations and to avoid benign social situations due to anticipatory anxiety of embarrassment. In addition, those who have high anxiety can also create future stressful life events.[101] Together, these findings suggest that anxious thoughts can lead to anticipatory anxiety as well stressful events, which in turn cause more anxiety. Such unhealthy thoughts can be targets for successful treatment with cognitive therapy.

Psychodynamic theory posits that anxiety is often the result of opposing unconscious wishes or fears that manifest via maladaptive defense mechanisms (such as suppression, repression, anticipation, regression, somatization, passive aggression, dissociation) that develop to adapt to problems with early objects (e.g., caregivers) and empathic failures in childhood. For example, persistent parental discouragement of anger may result in repression/suppression of angry feelings which manifests as gastrointestinal distress (somatization) when provoked by another while the anger remains unconscious and outside the individual’s awareness. Such conflicts can be targets for successful treatment with psychodynamic therapy. While psychodynamic therapy tends to explore the underlying roots of anxiety, cognitive behavioral therapy has also been shown to be a successful treatment for anxiety by altering irrational thoughts and unwanted behaviors.

Evolutionary psychology

An evolutionary psychology explanation is that increased anxiety serves the purpose of increased vigilance regarding potential threats in the environment as well as increased tendency to take proactive actions regarding such possible threats. This may cause false positive reactions but an individual suffering from anxiety may also avoid real threats. This may explain why anxious people are less likely to die due to accidents.[102]

When people are confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes, PET-scans show increased blood flow in the amygdala.[103][104] In these studies, the participants also reported moderate anxiety. This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors.


Social risk factors for anxiety include a history of trauma (e.g., physical, sexual or emotional abuse or assault), early life experiences and parenting factors (e.g., rejection, lack of warmth, high hostility, harsh discipline, high parental negative affect, anxious childrearing, modelling of dysfunctional and drug-abusing behaviour, discouragement of emotions, poor socialization, poor attachment, and child abuse and neglect), cultural factors (e.g., stoic families/cultures, persecuted minorities including the disabled), and socioeconomics (e.g., uneducated, unemployed, impoverished although developed countries have higher rates of anxiety disorders than developing countries).[97][105] A 2019 comprehensive systematic review of over 50 studies showed that food insecurity in the United States is strongly associated with depression, anxiety, and sleep disorders.[106] Food-insecure individuals had an almost 3 fold risk increase of testing positive for anxiety when compared to food-secure individuals.

Ref text and photo: Wikipedia & Pexels

Psychology Articles, Therapy News, and Mental Health Topics

A great resource for Psychology Articles, Therapy News, and Mental Health Topics.

The Panelist is valuable place to find articles on health and mental health as well as current events. A recent article that was featured spoke about flouride added to the water, and it’s negative effects. This article also spoke about the possible links of water flouridation to ADD and ADHD, which is such a current topic among therapy professionals.

Grief: Have We Moved Beyond the Five Stages?

At first thought, you may associate grief with death and losing someone close to you. Grief over the loss of a loved one is specifically referred to as bereavement. However, if you’ve experienced any kind of significant loss, such as the loss of a relationship, career, health status, or any other loss that triggered strong emotional distress, then you are no stranger to grief. In this post I am going to explore a popular model for processing grief, and why that may no longer be the best way to approach the experience of loss.

Work through your loss with me through online counseling in New Jersey

I have experience working with individuals dealing with different sources of grief. I’ve spent time as a hospice social worker helping patients and their loved ones process the emotional and practical aspects of death, as well as years in long term care helping people adjust to changes in lifestyle and health status. In my counseling practice, grief shows up in many ways, whether it’s the result of death, divorce, change in health status, career loss, and so on.

In helping you to process your loss, I partner with you to explore and make sense of your unique emotional reactions. Together, we navigate your grief and find ways to process, heal, and move forward in light of the changes that have been created by your loss. Contact me to learn more about working together through online counseling in New Jersey.

The truth about the five stages

You may have heard of the 5 stages of grief as identified by Elizabeth Kübler-Ross, which are denial, anger, bargaining, depression, and acceptance. However, these stages were actually intended to apply to the emotional process that a patient experiences as they adjust to being diagnosed with a terminal illness.1 The grieving processes appeared to be similar for the loved ones experiencing the loss of their loved one, and so Kübler-Ross also applied them to the bereaved as well.

The 5 stages model continues to be widely popular despite major concerns about the theory. An article in OMEGA-Journal of Death and Dying from 2017 by Margaret Stroebe, Henk Schut, and Kathrin Boerner2 identifies issues with the way the stages model represents grief. Here are some of the concerns they identify:

1. Oversimplification – reactions to grief are as diverse and varied as each person who experiences loss. The 5 stages model does not account for this variability.

2. The stages model is passive, meaning that although it describes what a bereaved person experiences, it doesn’t address the struggle of coming to terms with the loss.

3. Stages include concepts that incorporate imprecise and broad terms. Some stages are identified by emotions, while others are cognitive processes.

4. It implies that stages have a smooth progression. This does not accurately represent that we actually know about the experience of grief, like someone may experience only some stages, the stages may be experienced out of order, stages can be re-experienced, and people may have experiences not included in the stage model.

5. Stages are presented in a prescriptive way. For instance, anger is identified as a necessary stage, and although it’s a common symptom, it’s not experienced by everyone.

6. It doesn’t take into account secondary stressors, such as the necessary adaptations that occur following a loss like changes in identity, roles, life changes, etc.

These are some of the concerns noted by Margaret Stroebe, Henk Schut, and Kathrin Boerner2 who feel that the stage theory should be abandoned and that the use of stage theory could potentially be harmful. Here are some examples of how the stage model could be detrimental to a grieving individual:

• If an individual is not experiencing grief in the stages indicated by Kübler-Ross, it could result in someone feeling that they are grieving incorrectly, potentially creating even more emotional distress for an individual.

• Since the stages could be interpreted as prescriptive, someone could end up relying more on the stages than on their own emotional experiences. This could create tension between the way grief is actually presenting vs. the stage of grief someone believes they should be experiencing.

• Mental health practitioners who adhere to the 5 stage model could inadvertently complicate someone’s grieving process by reinforcing the idea that grief must be experienced in these separate stages.

Sarah Tronco, LCSW, provides Online Counseling in New Jersey and works to develop a strong therapeutic relationship with her clients, which helps to create a secure place where individuals can achieve meaningful change.




3. Photo by Danielle MacInnes on Unsplash

Couples Therapy for Rekindling Romance

Romance fades. However, that doesn’t mean that you’re doomed to a life of the doldrums after the honeymoon phase has worn off. Instead, it means that you need to reinvent your meaning of romance. More importantly, it means getting on the same page as your partner about what romance looks like as your marriage grows. Couples counseling can provide you with a terrific space for figuring that out.

From Romance to Roommates and Back Again

Most relationships follow a common arc in that they start hot and heavy and then fade into something less lusty but steadier. However, if you’re not careful, the romance can slip so far away that it starts to feel like you’re just roommates. When that happens, one or both of you are likely to become dissatisfied.

Unfortunately, you can’t go back to before when you barely knew each other. You can finish each other’s sentences. You know exactly how to push each other’s buttons. And you can’t stop engaging in the mundane details of everyday life. However, you can still get the romance back. It just looks a little different than when you first met. There’s nothing wrong with that. In fact, it gives you the opportunity to get creative, which can be wonderful.

Is There a Problem?

Sometimes romance fades just because of circumstance. You have a few children, you get busy with your careers, you deal with illness … and the romance just kind of slips away. However, sometimes a lack of romance is a sign of an underlying issue in the relationship. Couples counseling can help you come together to communicate about exactly what’s going on. You can figure out if there’s a bigger problem at play, and if so, how you want to address it.

For example, sometimes a lack of romance is due to a series of built-up resentments that you’ve failed to deal with over time. Couples therapy can help you air those resentments, communicate about them in a healthy way, and find methods of moving forward. Once you feel more connected again, the romance issue might resolve itself. If not, couples counseling can help with that too.

Rekindle the Spark in Your Relationship

Couples therapy can also simply serve as a catalyst to rekindle romance. Simply setting aside one hour per week to talk about your relationship is a strong show of commitment. While in therapy, you can communicate about ideas that you might have to rekindle romance. Sometimes you’re shy or afraid about doing that on your own but become empowered to do so in the therapy office.

Your therapist might also offer counseling exercises, therapeutic homework, or simply suggestions for how to find ways to rekindle romance at home. You might learn new techniques for practicing mindfulness in the relationship. You might set goals that help you get romance back on track. Alternatively, you might just find that you’re more committed to date nights and weekend getaways since you feel a bit accountable for reporting back to your therapist.

Rekindling romance can be as simple as adding more handholding and deep kisses to your daily life. Or it can be much more in-depth and creative. The trick is to start somewhere. Couples counseling can help you both start on the same page.

Kathryn McNeer, LPC specializes in Couples Counseling Dallas with her sound, practical and sincere advice. Kathryn’s areas of focus include individual counseling, relationship and couples counseling Dallas. Kathryn has helped countless individuals find their way through life’s inevitable transitions; especially that tricky patch of life known as “the mid life crisis.” Kathryn’s solution-focused, no- nonsense counseling works wonders for men and women in the midst of feeling, “stuck,” or “unhappy.” Kathryn believes her fresh perspective allows her clients find the better days that are ahead. When working with couples, it is Kathryn’s direct yet non-judgmental approach that helps determine which patterns are holding them back and then helps them establish new, more productive patterns. Kathryn draws from Gottman and Cognitive behavioral therapy. When appropriate Kathryn works with couples on trust, intimacy, forgiveness, and communication.

Overcoming Fear of Flying in the Bumpy Skies

Turbulence is a natural occurrence and should be expected — not dreaded. The trick is to learn to go with the flow.

Lately, at airport gates and security lines, I’m increasingly hearing other frequent fliers share stories of spilled coffee and sudden drops on planes. Threaded through nearly every conversation are questions about whether there has been an upswing in air turbulence, and whether climate change is to blame.

Turbulence was never a concern for Ashwin Fernandes, who takes more than 200 flights per year as regional director to the Middle East, North Africa and South Asia for Quacquarelli Symonds (QS) World University Rankings, until a bad flight in 2013 left him spooked.

“We were over the Bay of Bengal during monsoon season and the plane started shaking violently and then dropped suddenly,” he recounts. “I didn’t know what to do, except wonder how much worse it would get and when it would end.”

Since then, Mr. Fernandes has followed a strict set of self-imposed rules, which includes taking daytime flights whenever possible. Red-eye flights, he says, can be more anxiety-provoking because of fatigue. But one question continues to haunt him: Is global warming making the skies less friendly?

Maybe, but only at certain altitudes, said Paul D. Williams, professor of atmospheric science at the University of Reading, who is the co-developer of a turbulence-forecasting algorithm that has helped make flight travel more comfortable by avoiding rough air and greener by reducing carbon dioxide emissions via “low turbulence” routes.

“Climate change is altering temperature patterns and wind speeds in the upper atmosphere,” he says. “The main consequence for aviation is an increase in clear-air turbulence, or in-flight bumpiness at high altitudes in regions devoid of significant cloudiness or nearby thunderstorms, as the jet stream becomes more unstable.”

But severe turbulence, the kind that causes passengers who aren’t wearing their seatbelts to defy gravity and lift up from their seats, remains a very rare occurrence.

“Only around 0.1 percent of the atmosphere at flight cruising levels contains severe turbulence, so even if that figure were to double or treble because of climate change, severe turbulence will still be very rare,” Dr. Williams says, also offering grounds for optimism. “Hopefully, a combination of improved turbulence forecasts and better technology will reduce the number of aircraft encountering turbulence in the future, despite the effects of climate change.”

The takeaway is to remain buckled throughout the flight, as is routinely instructed by the cockpit crew before takeoff. Airlines want passengers to be comfortable throughout the journey, which is the main reason for avoiding turbulence. Cargo planes, filled with packages instead of people, on the other hand, tend to stay the course even when the air is rough.

“No matter how scary it might feel, our pilots are in control and there is no question of structural integrity,” explains Rich Terry, a captain and managing director of fleet support for Delta Air Lines. “Modern aircraft are developed and tested to sustain any level of conceivable turbulence.”

Captain Terry says the easiest way to make sense of turbulence is to think about ocean waves cresting and falling. “That same movement happens in the air, so now picture those same movements throughout the atmosphere. When airplanes intersect those waves, you have turbulence.”

In other words, it’s a natural occurrence and should be expected — not dreaded. Learn to go with the flow.

“Expect, accept, allow” is the self-regulating advice offered by Martin N. Seif, a psychologist with private practices in New York and Connecticut who co-founded the Anxiety and Depression Association of America and is a co-author of “What Every Therapist Needs to Know About Anxiety Disorders” and “Overcoming Unwanted Intrusive Thoughts.”

When experiencing turbulence, Dr. Seif suggests replacing “what if” thoughts with “what is” thoughts. “Stay present,” he advises. “Anxiety is fueled by catastrophic thoughts and is maintained by attempts to avoid it.”

Ashley Nicholls, who frequently flies around the Northeast with her Vermont-based marketing and communications firm, says that when the going gets rough, she distracts herself with math — subtracting from 100 by three’s. “By the time I get to 1, the bumps are done. If they aren’t, I start over.”

What about preparing in advance for turbulence by monitoring weather reports and checking the latest phone apps for flight conditions? Both Mr. Fernandes and Ms. Nicholls believe that this may help to keep the element of surprise at bay, but Dr. Seif disagrees.

“All that stuff reinforces anxiety and puts the focus on the need to avoid turbulence,” he warns. “The best thing you can do is nothing.”

Adam Bluestein, a freelance journalist, grew weary of his worries over weather and decided to rewrite the script in his head. Previously reliant on an array of spiritual talismans — a Ganesh necklace, a tiny Buddha statue, a pouch of crystals, and 36 cents wrapped in a piece of aluminum foil as a Jewish blessing for life — Mr. Bluestein found a better way to check in and zone out.

He embarked on a cognitive behavioral therapy of his own design, which included educating himself in the laws of space and physics, and then flying to Thailand to re-establish his sense of courage. The outcome was a complete reset of his mental state. He no longer obsesses about what’s out of his control. Letting go, he knows, is the biggest obstacle for anxious fliers.

“Now I go up with a calmer state of mind. I observe what’s happening, I don’t react. When I see the wings bend, I know that’s what they are meant to do,” he says, also crediting yoga for helping him “muster of a sense of detachment” even in turbulence.

“Recently, I was on a 747 from Amsterdam, in a middle seat, when out of nowhere, the plane dropped by what seemed like 100 feet and my arms flew up,” he says. “When things like that happen now, it causes me to feel a greater calm because I’ve spent so much time working on it. I like when there’s stuff going on. It’s almost reassuring.

Ultimately, Mr. Bluestein landed on what could be the most grounding response to turbulent skies I’ve encountered: “It’s not about me.”

By Nancy Stearns Bercaw

Kin Leung is a Marriage & Family Therapist, MFT practicing in the San Francisco Bay area. Kin specializes in helping couples overcome struggles related to infidelity, intimacy, miscommunication, mistrust, and parenting. Kin’s kind, thoughtful and compassionate approach to marriage counseling San Francisco helps guide couples to a calmer and safer space to explore issues and move forward in a more productive manner.

In Search of Secure Attachment

Escaping the trap of push-and-pull relationships.

Attachment styles are formed in childhood, when the early relationship between child and parent begins to take shape. Researchers have found that attachment patterns established during childhood tend to manifest themselves again adult relationships.

In short, the attachment pattern you form with your parents is replicated later in your romantic relationships.
Ever heard that we each crave the love that we know?
Attachment styles

About 60% of people have a secure attachment style, meaning their parents represented a safe touch-base from which they set out to explore the world when they were children.

As adults, this lucky bunch is able to form secure relationships, meaning they are attuned to their partner’s needs as well as their own, and are also able to set healthy boundaries inside the relationship. Relationships between people with secure attachment styles will have their ups and downs, but those relationships are usually what we reference as healthy.
The rest of us are divided between anxious and avoidant (about 20% each).

Lisa Firestone Ph.D. explains how anxious and avoidant patterns are formed:

Anxious: “[…]when a parent is available and attuned at times and insensitive or intrusive at others, the child is more likely to experience an anxious ambivalent attachment pattern. An anxiously attached child can feel like they have to cling to their parent to get their needs met.”

In other words, an anxious attachment style is formed whenever a child’s emotional needs is not consistently met. The child is never sure about how her requests for emotional support will be received, since the response from her parents tends to be unreliable.
Avoidant: “This pattern of attachment develops when a child does not consistently feel safe, seen, or soothed by their parent and therefore becomes pseudo-independent.”

When it comes to forming an avoidant attachment pattern, the parents in this scenario are described by Dr. Lisa Firestone as “emotional deserts,” meaning they’re not very responsive. The result is a child who feels she has to either ignore her own emotional needs (since they’re inconvenient to her parents), or take care of them herself (since she can’t count on anyone else to help her with that).

The good news for those of us with a maladaptive attachment patterns (anxious or avoidant) is that it’s possible to work on changing towards secure. Therapy and self-reflection help a lot.

The bad news is that people with maladaptive attachment patterns tend to attract each other, especially when they’re not aware of which attachment pattern they have, or what that means in practical terms.

The match between someone who’s anxious and someone who’s avoidant doesn’t usually form the healthiest relationships.

How the anxious and the avoidant find each other

When they first get together, the anxious and the avoidant feel like the perfect match.

The anxious partner needs frequent validation. She needs to check with her partner constantly that he still loves her, cares for her, and considers her a priority. She sees it as investing in the relationship, as being all-in.

She blows the relationship out of proportion in her head. Love is everything, and doing everything together, texting all the time when you’re apart, and having long conversations about your feelings is what love is.

After they break up, he calls her needy.

The avoidant partner represents the other extreme. He’s too busy, he can’t be bothered. He’ll call later — maybe.

He takes care of his own emotional needs (or so he thinks), after all, so he doesn’t understand how someone could need that much reassurance that often.
After they break up, she tells her friends he was cold, self-centered, and immature.

(I’m using “him” and “her” because it reflects my personal experience, but gender doesn’t actually matter in determining anyone’s attachment pattern.)

I admit, I have first-hand experience on the (im)perfect combination between an anxious attachment style and a dismissive-avoidant attachment style.

When in a relationship, the avoidant partner’s elusiveness confirms the anxious partner’s need to push harder, to insist. The more the anxious partner insists, the more the avoidant partner feels his need for space is justified.

For a while, their characteristic behaviors justify each other, and they’re happy in their little dance — until they’re not.

My mind-blown moment

Identifying my attachment pattern as anxious-preoccupied has opened my eyes to my behavior in relationships. Understanding how someone with an avoidant attachment style can be so attractive to someone like me simply put my past relationships under a completely new light.

I can’t say it explains everything, because people are a bit more complex than their attachment styles, but I feel like it explains a lot.

I would get into relationships with a need to feel emotionally satisfied before I could do anything else — study, pursue a career, and even care for myself.

Feeling secure, to me, meant that I needed constant validation that the relationship mattered as much to my partner as it did to me. In other words, I needed to feel like it mattered more to him than anything else.

That meant that the more I needed my partner, the more he pulled away. The more he pulled away, the more I felt alone, empty, and insecure.

Whenever I fell into a relationship with an avoidant, I ended up subsisting on scraps of emotional attention, while expecting a full meal that would never come.

In the words of Dr. Lisa Firestone, the avoidant partner:

“[…] can appear to be more focused on themselves and to value their priorities above their partner’s. They can seem cool and removed, often showing annoyance or even disdain when their partner is expressing feelings or needs, believing their partner is being “childish” or “dramatic.” These reactions mimic the emotional desert in which they grew up.”

We’re not broken

Having a maladaptive attachment style doesn’t mean anyone’s broken.

It only means that some work is required in order to progress towards a secure attachment style, and to avoid the pain and heartbreak of a mismatch such as the ones I experienced.

Anxious and avoidants don’t always end up together, but knowing they are very likely to attract each other — and make each other very miserable — is reason enough to seek deeper knowledge of your attachment style.

In order to correct a maladaptive attachment style, self-awareness is the first step. By understanding your emotional needs and how you seek to fulfill them, you can make major progress in avoiding a push-and-pull type of relationship in favor of a more secure, well-balanced one.

Seeking the guidance of a qualified therapist is also an important step.

By Rae Gomes

Benu Lahiry is an Associate Marriage and Family Therapist in San Francisco specializing in Couples Counseling Pacific Heights. Her work is especially helpful for people experiencing anxiety, depression, self-doubt, lack of motivation, and for couples with intimacy issues. She is experienced in many evidence-based therapy modalities, including attachment theory, cognitive behavioral therapy, psychodynamic principles, mindfulness practices, and solution-focused therapy. Her therapeutic style is best described as warm, direct, and collaborative.

In Romantic Relationships, People Do Indeed Have a ‘Type’

Researchers show that people do indeed have a ‘type’ when it comes to dating, and that despite best intentions to date outside that type — for example, after a bad relationship — some will gravitate to similar partners.

If you’ve ever come out of a bad relationship and decided you need to date someone different from your usual “type,” you’re not alone.

However, new research by social psychologists at the University of Toronto (U of T) suggests that might be easier said than done. A study published today in Proceedings of the National Academy of Sciences shows people often look for love with the same type of person over and over again.

“It’s common that when a relationship ends, people attribute the breakup to their ex-partner’s personality and decide they need to date a different type of person,” says lead author Yoobin Park, a PhD student in the Department of Psychology in the Faculty of Arts & Science at U of T. “Our research suggests there’s a strong tendency to nevertheless continue to date a similar personality.”

Using data from an ongoing multi-year study on couples and families across several age groups, Park and co-author Geoff MacDonald, a professor in the Department of Psychology at U of T, compared the personalities of current and past partners of 332 people. Their primary finding was the existence of a significant consistency in the personalities of an individual’s romantic partners.

“The effect is more than just a tendency to date someone similar to yourself,” says Park.

Participants in the study along with a sample of current and past partners, assessed their own personality traits related to agreeableness, conscientiousness, extraversion, neuroticism, and openness to experience. They were polled on how much they identified with a series of statements such as, “I am usually modest and reserved,” “I am interested in many different kinds of things” and “I make plans and carry them out.” Respondents were asked to rate their disagreement or agreement with each statement on a five-point scale.

Park and MacDonald’s analysis of the responses showed that overall, the current partners of individuals described themselves in ways that were similar to past partners.

“The degree of consistency from one relationship to the next suggests that people may indeed have a ‘type’,” says MacDonald. “And though our data do not make clear why people’s partners exhibit similar personalities, it is noteworthy that we found partner similarity above and beyond similarity to oneself.”

By examining first-person testimonials of someone’s partners rather than relying on someone’s own description of them, the work accounts for biases found in other studies.

“Our study was particularly rigorous because we didn’t just rely on one person recalling their various partners’ personalities,” said Park. “We had reports from the partners themselves in real time.”

The researchers say the findings offer ways to keep relationships healthy and couples happy.

“In every relationship, people learn strategies for working with their partner’s personality,” says Park. “If your new partner’s personality resembles your ex-partner’s personality, transferring the skills you learned might be an effective way to start a new relationship on a good footing.”

On the other hand, Park says the strategies people learn to manage their partner’s personality can also be negative, and that more research is needed to determine how much meeting someone similar to an ex-partner is a plus, and how much it’s a minus when moving to a new relationship.

“So, if you find you’re having the same issues in relationship after relationship,” says Park, “you may want to think about how gravitating toward the same personality traits in a partner is contributing to the consistency in your problems.”

The data for the research comes from the German Family Panel study launched in 2008, an ongoing longitudinal study on couple and family dynamics with a nationally representative sample of adolescents, young adults, and midlife individuals in Germany.

Story Source:
Materials provided by University of Toronto. Note: Content may be edited for style and length.

Journal Reference:
Yoobin Park, Geoff MacDonald. Consistency between individuals’ past and current romantic partners’ own reports of their personalities. Proceedings of the National Academy of Sciences, June 10, 2019; DOI: 10.1073/pnas.1902937116

Kathryn McNeer, LPC specializes in Couples Counseling Dallas with her sound, practical and sincere advice. Kathryn’s areas of focus include individual counseling, relationship and couples counseling Dallas. Kathryn has helped countless individuals find their way through life’s inevitable transitions; especially that tricky patch of life known as “the mid life crisis.” Kathryn’s solution-focused, no- nonsense counseling works wonders for men and women in the midst of feeling, “stuck,” or “unhappy.” Kathryn believes her fresh perspective allows her clients find the better days that are ahead. When working with couples, it is Kathryn’s direct yet non-judgmental approach that helps determine which patterns are holding them back and then helps them establish new, more productive patterns. Kathryn draws from Gottman and Cognitive behavioral therapy. When appropriate Kathryn works with couples on trust, intimacy, forgiveness, and communication.

Hoarding: Symptoms and Treatment Options

Hoarding is not simply a behavior. It is a mental health condition. In fact, there are different types of hoarding disorders. Oftentimes, hoarding is a subset of OCD, which itself is an anxiety disorder.

What Is Hoarding?

Hoarding is a condition in which a person keeps things that most other people would say are not valuable. Of course, it’s true that “one’s man junk is another man’s treasure.” However, if a person collects items to the point where it interferes with their lives in some significant way, and they are still unable to get rid of those items, then they are hoarding.

Some examples of hoarding negatively impacting someone’s life include:

Their home because difficult to live in due to clutter. They may be unable to cook, shower, sleep in a bed, or move around properly.
They can’t have people in to do normal home repairs because of the “stuff.”
The hoard leads to home damage such as rotting, mold, sagging foundations, etc.
Neighbors and/or city officials complain or take action against the home because of the hoard.
Hoarding limits emergency personnel’s access to the home and its occupants.
The hoard causes physical illness due to contamination, filth, dust, etc.
Animals in the hoard aren’t receiving proper care including medical treatment.
The hoard affects the person’s relationships with loved ones.
Inability to maintain steady employment due to conditions related to the home and/or to shopping to add to the hoard.

People with hoarding disorders often become extremely distressed at the idea of losing their stuff. If someone, such as loved one, comes in and cleans, they get very anxious and angry.

Hoarding and OCD

Compulsive hoarding is a form of obsessive-compulsive disorder (OCD), which is one type of anxiety disorder. Generally speaking, people with hoarding tendencies have high levels of anxiety and the hoarding behaviors helps soothe those anxieties. It’s important to note that although compulsive hoarding is very common among people with OCD, not all hoarding before is OCD-related.

Types of Hoarding

People can truly hoard almost anything. However, there are some common themes that relate to different types of hoarding. They include:

Paper Hoarding

Many hoarders have great anxiety about letting go of any little bit of paper. They worry that they will need the information on that paper and therefore can’t let it go. Their homes get overwhelmed with paper clutter. This can include:

Medical forms
Tax forms
Pay stubs
Printed-out copies of online conversations
Report cards
Children’s drawings
Notes, cards, and letters
Mail including coupons and junk mail
Magazines and books

Of course, we all keep some kind of paper clutter in our lives. However, hoarders won’t let go of anything. They often can’t find what they want in the mess. If asked to let go of something such as their child’s third grade report card, they may panic or get angry.

Animal Hoarding

There are laws in most areas limiting the number of pets a person is allowed to have. Those who go above that number may be animal hoarding. However, there’s more to it than this.

Animal hoarding means that, regardless of the law, the person has more animals than they can take care of. They physically, mentally, and financially do not have the means to provide for the animals. Therefore, the animals are undernourished and ill, often dying from unknown causes.

Despite this, the hoarder continues to believe that they love the animals and are even helping them. They don’t want to let any of them animals go to other homes. In fact, they keep acquiring more animals. They may put food out on the porch to encourage strays or even drive to various areas with traps to collect animals. They don’t spay or neuter the animals, so they breed prolifically.

Food Hoarding

Some people have a huge fear of running out of food or running out of the money to buy food. They stockpile. Their cupboards, refrigerator, freezer, pantry, and basement overflow with food and yet they keep buying more. Food hoarders rarely pay attention to expiration dates. They don’t want to throw out any food, even if it’s expired or clearly rotting.

Trash Hoarding AKA Hoarding Everything

There are some people whose hoarding is so generalized that they absolutely don’t want to get rid of anything. They’re sometimes called garbage hoarders because they keep things that other clearly consider to be trash. They don’t ever “take out the garbage.” They may see potential use in everything. Alternatively, throwing something out might just give them too much anxiety. People may keep empty containers and boxes, the plastic wrap off of opened products, or even things like toilet paper and dirty diapers if the hoarding has gotten so extreme.

Dr. Jan Dunn provides Online Counseling in Texas to individuals, couples, and families. Telehealth Video Therapy Sessions provides the same treatment as in person therapy sessions. Shifting the therapy office to a clients space makes therapy portable, accessible, confidential, and comfortable. In turn, clients often report feeling more at ease, less stressed, and more apt to open up and, in turn, therapy is more effective. The benefits far outweigh any concerns for most clients, as accessibility to care drastically increases and cancellations drastically decrease. Therapy is delivered in the comfort of your home – when and where you need it.

Hoarding with Compulsive Shopping

People with compulsive shopping disorders don’t necessarily hoard. However, the two conditions can go hand-in-hand. The person shops impulsively and compulsively, often going into great debt but feeling unable to stop themselves. They never get rid of the items that they purchase; that’s the hoarding part. If they became unable to continue shopping because they lose all access to funds, then they may go “shop” in untraditional places such as dumpsters.

Symptoms of Hoarding

Each form of hoarding is a little bit different from the others. Individuals may experience hoarding to varying degrees. However, here are some common symptoms to look for:

The feeling that you just can’t throw something away
Justifying to others why you can’t get rid of things
High anxiety when asked to try to throw something away
Retrieving items from the trash after throwing them away
Inability to make decisions about what to keep and what to discard
Feeling overwhelmed by “stuff” but unable to do anything to change it
Stress when other people are near your things; worry that people will get rid of your items
Constant fear of not having enough, needing more, or losing something important

Of course, all of the examples described above of how hoarding can negatively impact someone’s life are also warning signs to look out for.

Treatment Options for Hoarding Disorder

Although not all compulsive hoarding is part of an OCD diagnosis, it’s often treated in the same way as OCD. Cognitive Behavioral Treatment and Exposure Response Prevention are two of the most common treatments to help people overcome hoarding. Oftentimes, the therapist will come to the individual’s home to help them work on their thoughts and behaviors in the hoarding environment.

How the Body and Mind Talk To One Another

Have you ever been startled by someone suddenly talking to you when you thought you were alone? Even when they apologise for surprising you, your heart goes on pounding in your chest. You are very aware of this sensation. But what kind of experience is it, and what can it tell us about relations between the heart and the brain?

When considering the senses, we tend to think of sight and sound, taste, touch and smell. However, these are classified as exteroceptive senses, that is, they tell us something about the outside world. In contrast, interoception is a sense that informs us about our internal bodily sensations, such as the pounding of our heart, the flutter of butterflies in our stomach or feelings of hunger.

The brain represents, integrates and prioritises interoceptive information from the internal body. These are communicated through a set of distinct neural and humoural (ie, blood-borne) pathways. This sensing of internal states of the body is part of the interplay between body and brain: it maintains homeostasis, the physiological stability necessary for survival; it provides key motivational drivers such as hunger and thirst; it explicitly represents bodily sensations, such as bladder distension. But that is not all, and herein lies the beauty of interoception, as our feelings, thoughts and perceptions are also influenced by the dynamic interaction between body and brain.

The shaping of emotional experience through the body’s internal physiology has long been recognised. The American philosopher William James argued in 1892 that the mental aspects of emotion, the ‘feeling states’, are a product of physiology. He reversed our intuitive causality, arguing that the physiological changes themselves give rise to the emotional state: our heart does not pound because we are afraid; fear arises from our pounding heart. Contemporary experiments demonstrate the neural and mental representation of internal bodily sensations as integral for the experience of emotions; those individuals with heightened interoception tend to experience emotions with greater intensity. The anterior insula is a key brain area, processing both emotions and internal visceral signals, supporting the idea that this area is key in processing internal bodily sensations as a means to inform emotional experience. Individuals with enhanced interoception also have greater activation of the insula during interoceptive processing and enhanced grey-matter density of this area.

So what is enhanced interoception? Some people are more accurate than others at sensing their own internal bodily sensations. While most of us are perhaps aware of our pounding heart when we are startled or have just run for the bus, not everyone can accurately sense their heartbeats when at rest. Interoceptive accuracy can be tested in the lab; we monitor physiological signals and measure how accurately these can be detected. Historically, research has focused on the heart, as these are discrete signals that can easily be quantified. For example, a typical experiment might involve the presentation of a periodic external stimulus (eg, an auditory tone) that is time-locked to the heartbeat, such that each tone (‘beep’) occurs when the heart is beating, or in between heartbeats. Participants state whether this external stimulus is synchronous or asynchronous with their own heart. An individual’s interoceptive accuracy is an index of how well they are able to do this.

It is also possible to measure subjective indices of how accurate people think they are at detecting internal bodily sensations, ascertained via questionnaires and other self-report measures. My work shows that individuals can be interoceptively accurate (ie, good at these heartbeat-perception tests) without being aware that they are. In this way, interoceptive signals can guide and inform without fully penetrating conscious awareness.

Individual differences in interoception can also be investigated using brain-imaging methods, such as through brain representation of afferent signals (eg, heartbeat-evoked potentials expressed in a neural EEG signal). Functional neuroimaging (fMRI) can also be used to investigate which areas of the brain are more active when focusing on an interoceptive signal (eg, the heart) relative to an exteroceptive signal (eg, an auditory tone).

Our hearts do not beat regularly and, while we can identify that our hearts race with fear or exercise, we might not fully appreciate the complexity of the temporal structure underlying our heartbeats. For example, cardiac signatures are also associated with states such as anticipation. Waiting for something to happen can cause our heartrate to slow down: this will happen at traffic lights, when waiting for them to go green. These effects of anticipation, potentially facilitating the body and mind to adopt an action-ready-state, highlight the meaningful composition of internal bodily signals.

Dr. Jan Dunn provides Online Counseling in Texas to individuals, couples, and families. Telehealth Video Therapy Sessions provides the same treatment as in person therapy sessions. Shifting the therapy office to a clients space makes therapy portable, accessible, confidential, and comfortable. In turn, clients often report feeling more at ease, less stressed, and more apt to open up and, in turn, therapy is more effective. The benefits far outweigh any concerns for most clients, as accessibility to care drastically increases and cancellations drastically decrease. Therapy is delivered in the comfort of your home – when and where you need it.

Internal bodily signals can be deeply informative, which is why sensing them can provide an extra channel of information to influence decision making. Gut instinct or intuition during a card game can also be guided by interoception. Bodily signatures (heart rate, skin-conductance response) can signal which cards are good (ie, more likely to be associated with a positive outcome) even in the absence of conscious knowledge that a card is good. Thus, the heart ‘knows’ what the mind does not yet realise, and access to this bodily signature can guide intuitive decision making to a better outcome. In a real-world extrapolation of this, I visited the London Stock Exchange to work with high-frequency traders. These traders claimed that their decisions were often driven by gut instinct, when faced with fast-coming information that the conscious brain could not yet fully process. My colleagues and I demonstrated that interoceptive accuracy was enhanced in those traders who were most adept at trading, potentially grounding their intuitive instincts in a capacity to sense informative changes in internal bodily signals.

An appreciation that bodily signals can guide emotion and cognition provides potential interoceptive mechanisms through which these processes can be disrupted. Alexithymia, defined as an impaired ability to detect and identify emotions, is associated with reduced interoceptive accuracy. Autistic individuals, who often have difficulty in understanding emotions, have also been shown to have impaired interoceptive accuracy. Neural representation of bodily signatures are altered in borderline personality disorder (also known as emotionally unstable personality disorder), and interventions designed to focus on the body, such as mindfulness, have been shown to reduce anxiety. Insight into the nature of these embodied mechanisms opens up potential avenues for further understanding and targeted intervention.

As well as telling us about our own emotions, our bodies respond to the joy, pain and sadness of others. Our hearts can race as loved ones experience fear, and our pupils can adopt a physiological signature of sadness in response to the sadness of others. If you pay attention to your heart and bodily responses, they can tell you how you are feeling, and allow you to share in the emotions of others. Interoception can enhance the depth of our own emotions, emotionally bind us to those around us, and guide our intuitive instincts. We are now learning just how much the way we think and feel is shaped by this dynamic interaction between body and brain.

Sarah Garfinkel is professor of neuroscience and psychiatry at the University of Sussex. Her work has been published in the Harvard Review of Psychiatry and Brain: A Journal of Neurology, among others. She lives in Brighton.


Serving Norwalk – Darien – Westport – New Canaan, Connecticut. Helping balance career demands with emotional needs of our families. As a behavioral therapist with training in DBT and CBT, I focus on cognitive distortions and maladaptive behaviors that damage relationships and sabotage personal and professional goals. Relationship Counseling Norwalk therapist Dennis McAllister LCSW, Employing DBT skills of mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, I help clients learn new strategies for addressing life’s challenges.

The Intersection of Chronic Illness and Sex

According to the Centers for Disease Control and Prevention, chronic diseases affect 133 million Americans, representing more than 40% of the population of this country. By 2020, that number is projected to be an estimated 157 million, with 81 million having multiple conditions. Chronic illness can have profound negative effects on a relationship and sexual satisfaction. More Americans are living with not just one chronic illness, such as diabetes, heart disease or depression, but with two or more conditions. Almost a third of the population is now living with multiple chronic conditions.

Many chronic diseases can cause problems with sexual function. These conditions can include diabetes, heart and vascular diseases, neurological, and autoimmune diseases. Recent research suggests that sexual dysfunction in couples may be one of the least talked about symptoms of chronic illness.

Experiencing a chronic illness can be earth-shattering. Individuals who are chronically ill often experience emotional distress. This includes the person’s ability to engage in occupational, social, and recreational activities. But what is its impact on sex and the couple? Sex can involve a mix of feelings and emotions when battling a chronic illness. Life becomes uncertain and you both feel at a loss. Your partner feels overwhelmed because you feel shame. You may feel less attractive, less confident, and concerned about how your body works and adapts to an illness. You both become plagued with anxiety due to the worry of sexual activity, and with desire and arousal issues.

When experiencing a chronic illness, some changes may be physical, such as the changes with your body, side effects from medication, sexual dysfunction, fatigue, and pain. You may experience psychological changes such as depression and anxiety. Most of all, there is constant fear around your sexual ability and your sexual performance. We all know that physical intimacy is paramount to the quality of life, and it is still important if you are living with a chronic illness.

Your relationship as a couple can affect the development and management of a chronic illness in a variety of ways. When the both of you are at the optimal balance between intimacy and autonomy, your boundaries touch yet remains distinct. It is critical that both of you are aware of each other’s needs and emotions. Why is this so important? Because this will drive and determine the sexual intimacy in your relationship. It is important to note that your previous success in resolving sexual intimacy concerns will determine how well the both of you will cope with an illness.

Since general coping skills and sexual function are linked in the chronically ill, it is important to identify and foster strengths in your relationship that can mitigate the stress of illness. Even during an illness, relationships should not be neglected. Illness can make each partner vulnerable to fear and loss and to loneliness. Taking time to communicate and to reduce the impact of the illness on intimacy is the key to maintaining happiness despite health problems. One part of that intimacy is sexuality. What people don’t know is that with a life restricted by pain and illness, sex can be a powerful source for comfort, pleasure and intimacy. You and your partner can learn what is possible as opposed to what was once achievable by enhancing their sexual awareness, communication, and sexual styles.

Here are my tips:

Communicate your needs to your partner and have them communicate their needs. Problem-solve together by making it a team approach. State your emotional needs around sexual intimacy and the other factors in your relationship.

Consider couples psychotherapy. I recommend you see a sex therapist. I say this because they will have the knowledge and skill set in helping you and your partner with sexual problems such as the issues related to sexual functioning. They will also provide you with other suggestions to engage in if there is sexual dysfunction (i.e., desire and arousal issues, erectile dysfunction, and sexual pain).

Read up on your condition and share this with your partner. Having knowledge on the illness can bring you closer together. This can build intimacy!
Check in with each other. For the partner who does not have a chronic illness, watch for depression in them and keep an eye on their health as well. The goal here is to be lover not a caregiver, but we find at times, the partner may take on this role. They may want to seek individual counseling. This is healthy!

Acknowledge your loss and build a relationship with the illness. This can help the both of you develop the “new normal” in your relationship. With acceptance, the issue isn’t whether or not you can come to some profound insight about the nature of the illness and your experience with the illness, but rather, it is about how to live your life day to day. The ultimate goal is to accept condition and learn to live well with it. Of course, this is not easy. I watch couples experience this all the time in my practice and when they finally decide to work as a team instead of opponents or avoiders, there is this sense of hope that emerges. This hope promotes what is possible instead of what is achievable. They also report a healthier sex life.

Address stress as much as possible. I would not avoid the stress. Avoidance can make the pain worse or it cause a flare up. I see this all the time with my clients with fibromyalgia. I know this is easier said than done, but try to address the financial issues and the divisions of family responsibilities. Addressing these stressors can help promote the desire in being physically intimate.

Try to be sociable. Socially isolating is common for people with a chronic illness. Try to find a balance where you can be sociable because this can make you feel more positive about life.

Being kind is great. Doing something for your partner can build what is needed for sexual intimacy.


Enzlin, P. (2014). Sexuality in the context of chronic illness. In Y. Binik & K. Hall (Eds), Principles and practices of sex therapy (5th ed., pp. 436-456). New York, NY: The Guilford Press.

Schover, L.R., & Jensen, S. B. (1988). Sexuality and chronic illness: A comprehensive approach. New York, NY: The Guilford Press.

By Dr. Lee Phillips

Jennifer Josey LPC LMFT CSAT of Intuitive Pathways Recovery specializes in Sex Addiction Counseling Houston Texas, love addiction, recovery for couples from sex and love addiction, trauma resolution for partners of sex addicts and group therapy. Sexual addiction is a serious problem that affects people of all socioeconomic status, educational status, both males and females and even teenagers and preadolescent children.

Common Relationship Challenges

Like most interpersonal relationships, most romantic couples experience some challenge at some point in their relationship. Some of these common challenges may include infidelity, loss of intimacy, communication difficulties, coping with stress challenges, financial pressures, boundary violations, difficulty balancing individual and couple expectations, divorce, separation and breaking up. Whatever the challenge, it is important to note that all dyadic relationships will experience some kind of distress at some point. We will examine some of the more common romantic relationship challenges below.


Infidelity is increasingly becoming one of the most common relationship challenges in romantic relationships. The acts of infidelity or cheating can have devastating consequences on those involved. Having been cheated on can result in anguish, depression, fury and humiliation (Brand, Markey, Mills & Hodges, 2007). It has been suggested that infidelity is one of the leading causes of divorce and romantic relationship breakdown (Brand, Markey, Mills & Hodges, 2007).

Generally, infidelity is a violation of trust by one or both members of a monogamous romantic relationship that involves a third party individual, with whom one member has an improper relationship. Zola (2007) defines infidelity as an act of emotional and/or physical betrayal characterised by behaviour that is not approved by the other partner and that has contributed to considerable ongoing distress in the non offending partner. Infidelity can be in the form of an emotional affair, a sexual affair or a combination of both. Traditionally, men are considered to be primarily interested in sexual infidelity and women are considered to be primarily interested in emotional infidelity (Zola, 2007).

Zola (2007) suggests that there has always been a greater emotional need or tie when it comes to women and affairs, while men tend to have an affair primarily for sex. One of the reasons given for women’s preference to emotional affairs is to “mate switch”. This refers to the quest of finding a partner without giving up the security derived from the current partner (Brand, Markey, Mills & Hodges, 2007). Infidelity prevalence rates vary according to gender with female incidents reported to be 10% to 15% lower than those of their male counterparts (Zola, 2007).

In resolving this matter, women are found to be more likely to forgive a sexual infidelity where as men find it the most difficult to forgive (Zola, 2007). In support for this argument, Long and Young (2007) suggest that men are more approving of affairs for sexual reasons where as women are more approving of affairs of emotional justification. It is not uncommon that couples who have experienced infidelity in their relationships experience challenges in their attempts to resolve relational problems associated with it. As such, infidelity is considered one of the most challenging issues to treat in couple therapy (Zola, 2007; Brand, Markey, Mills & Hodges, 2007).


The word intimacy has taken on sexual connotations. But it is much more than that. It includes all the different dimensions of our lives. It involves the physical, social, emotional, mental and spiritual aspects as well as sexual components that can enhance the feelings of togetherness between the romantic couple (Larson, Hammond & Harper, 1998). According to Sternberg’s theory of love, intimacy includes emotional bonding and feelings of connectedness. Sternberg suggests that intimacy develops during the course of the relationship and will usually include decisions of loyalty to the relationship (Long & Young, 2007).

Intimacy has also been conceptualised as a sense of self disclosure, sharing of one’s self and feeling closer to one’s partner. Intimacy is maintained by engagement in intimate conversation (Brunell, Pilkington & Webster, 2007; Kirby, Baucom & Peterman, 2005) and is considered a major part of romantic relationships. It is also an important factor for psychological wellbeing and is linked to positive and satisfying relationships (Brunell, Pilkington & Webster, 2007; Long & Young, 2007).

It is fair to assume that the quality of the romantic relationship will often be judged by the frequency of intimate interactions as perceived by each individual. It is these unmet intimacy expectations that can often affect the relationship negatively and pose challenges for the couple (Kirby, Baucom & Peterman, 2005). Therapists dealing with loss of intimacy in romantic relationships should help clients develop trust and communication skills that can help to overcome barriers to intimacy.


Conflict is part of any interpersonal relationship and occurs as a result of differences in opinions. People differ in values, dreams, desires and perceptions. Therefore, we are all bound to encounter conflict at some point in our lives (Long & Young, 2007). Conflict can range from less serious mild disagreements to more intensely heated arguments. Previous research has found that marital conflict often stems from unmet needs, wants, and desires. From this perspective, marital conflict is defined as a process of interaction in which one or both partners feel discomfort about some aspect of their relationship and try to resolve it in some manner (Hamamci, 2005).

When one person needs or wants something badly enough, and the other person is unwilling or unable to meet that need, resentment will often grow. Then, if one were to add the power of an unruly tongue, the situation will usually become ripe for very destructive forms of conflict. To look at it pragmatically, romantic relationship conflict will often happen when one member of the couple perceives inequity or experiences an imbalance in rewards or benefits from being in the relationship whereby it is perceived by one member of the couple that the other only cares about his/ her individual needs (Long & Young, 2007).

The negative consequences of conflict are probably familiar to all of us. Conflict can cause psychological pain that manifests in withdrawal and distance, depression, anxiety and/or aggression. Not only between the couple but also with those who are living around them (Choi, 2008). However, there are also constructive outcomes to conflict in romantic relationships. For instance, people who continue to relate to one another despite their conflict may build greater trust and confidence in each another and become more apt in their ability to resolve their problems (Johnson, 2007). However, reoccurring conflict is usually a symptom of a problem in the romantic relationship and therefore should be addressed intentionally by the couple. The role of the counsellor, when dealing with couples who are experiencing conflict, is to help them identify the source of such conflict and its style to assist them in implementing skills to resolve the disagreements (Relationships Australia, 2009).


A good healthy romantic relationship is often characterised by good communication. Healthy couples speak openly and directly with congruent non verbal cues allowing them to convey the intended message accurately. Communication in romantic relationships connects and reassures partners and allows them to discuss and solve problems and share important information and views (Long & Young, 2007). Challenges occur when the messages we send to the other are misunderstood or misinterpreted.

It is not uncommon when a couple experiences problems in their relationship, communication becomes broken (Long & Young, 2007). Healthy, productive and effective communication is viewed as the binding tool for any romantic relationship. Problems and challenges in intimate relationships are often resolved through developing healthy, productive and effective communication. Therefore, the goal of enhancing communication skills may be a great starting point for the couple therapist.

Sexual Problems

Sexual intimacy is one of the most important factors in romantic relationships. It is one of the factors that differentiate a romantic relationship from any other interpersonal relationship. Sexual problems like all other problems in romantic relationships often develop as a result of an imbalance in the partner’s styles of loving (Long & Young, 2007). In the early stages of the relationship, it is common for couples to experience intense feelings of love, affection and a strong desire for one another. As the relationship grows, external factors such as children and busy schedules can begin to have an impact on the sexual intimacy of the couple, often resulting in frustrations experienced by at least one member of the relationship. As the frustrations develop over time, problems may begin to surface.

Sometimes sexual challenges may occur as a result of sexual dysfunction. Sexual dysfunctions are characterised by psychosocial disturbances in sexual desire resulting in distress and interpersonal difficulty (APA, 2000). According to the DSM- IV-TR, some of the common sexual dysfunction disorders include sexual desire disorder, sexual arousal disorder, and orgasmic disorders. It is crucial for the therapist to differentiate sexual problems from sexual dysfunctions in order to determine the appropriate referral when necessary. If sexual problems are an issue the therapist can help clients explore options for achieving emotional and sexual intimacy in their relationships.

Substance Abuse

While substance abuse, particularly alcohol, has been associated with financial problems and health problems that contribute to relational distress, many people use it as a way of coping with the problems in their relationships. The first issue, of course, is money. Alcohol is expensive. Spending a great deal of money each day on alcoholic beverages is a serious problem that can put a great deal of strain on relationships. Alcohol can cause people to become less sensitive to the feelings of others too. Alcohol can make it difficult for people to distinguish between the other person’s emotions, and thus they may make incorrect judgments that negatively impact their relationship with their partner (Sharf, 2001).

Time is an issue as well. Drinking is not a “one and done” type of activity. It can take hours out of the day, hours that could have been spent as a couple. The imposition on couple time from excessive drinking can cause partners to emotionally drift apart often resulting in problems within the dyadic relationship. Because of these and other factors, alcohol abuse has been singled out as a contributing factor to divorce, physical abuse and lowered marital satisfaction (Long & Young, 2007).

Divorce and Breaking Up

Divorce rates are increasing at an alarming rate. In Australia, 40% of marriages end up in divorce where as in USA, 50% of marriages end up in divorce ( For romantic relationships that continuously experience high distress, low satisfaction and low relationship quality, at some point one partner or both come to a decision to end or terminate the relationship, if such challenges are not resolved. According to ideas derived from social exchange theory, termination of marriages and romantic relationships will often occur as a result of costs exceeding rewards. If the individual perceives that they are not getting more than what they have invested in the relationship, this may lead to dissatisfaction with the relationship (Amato & Hohmann-Marriott, 2007).

Divorce and break up can be a difficult and painful experience for many. The termination of a relationship or divorce can affect an individual financially, socially, emotionally and psychologically (Long & Young, 2007). Feelings of depression, anxiety and other psychiatric disorders are often experienced during this time (Williams & Dunee-Bryant, 2006). The role of the therapist is to assist clients through this life changing transition.


American Psychiatric Association, (2000). Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Text Revision. Washington, DC: American Psychiatric Association.

Brand, R.J., Markey, C.M., Mills, A., & Hodges, S.D. (2007). Sex differences in self reported infidelity and its collates. Sex Roles , 57, 101-109.

Brunell, A.B., Pilkington, C.J., & Webster, D.G. (2007). Perceptions of risk in intimacy in dating couples: conversation and relationship quality. Journal of Social and Clinical Psychology. 26, 92-119.

Choi, H. (2008). Marital Conflict, depressive symptoms and functional impairment. Journal of Marriage and Family, 70, 377-390

Hamamci, Z. ( 2005). Dysfunctional relationship beliefs in marital conflict. Journal of Relational Emotive and Cognitive Behavioural Therapy, 23, 245-261.

Kirby, J.S., Baucom, D.H., & Peterman, M.A. (2005). An investigation of unmet intimacy needs in marital relationships, Journal of Marital and Family Therapy, 31, 313-325.

Long, L.L., & Young, M.E. (2007). Couselling and Therapy for Couples. (2nd ed.). Belmont, CA: Thompson.

Johnson, S.M. (2007). The emotionally focused couples therapy. Journal of Contemporary Psychotherapy. 37, 47-52.

Zola, M.F. (2007). Beyond infidelity related impasse: an integrated, systematic approach to couples therapy. Journal of Systematic Therapies, 26, 25-41.


Christiane Blanco-Oilar, Ph.D. offers compassionate psychological services for individuals and Couples Therapy Boca Raton. I enjoy working with individuals and couples going through life transitions, relationship challenges or identity exploration, or those experiencing grief and loss, depression, anxiety, postpartum depression and eating disorders. My goal is to help you recognize, understand and have compassion for how you may have developed less-than-ideal ways of dealing with specific areas of your life.

Can CBD Oil Help Anxiety?

Cannabidiol is a compound derived from cannabis plants. It may help people with anxiety reduce their symptoms with few or no side effects.

Research on cannabidiol oil (CBD oil) is still in its infancy, but there is mounting evidence to suggest that some people can get relief from anxiety. In this article, we examine what CBD oil is and how it may help reduce anxiety symptoms.

What is CBD oil?

Cannabidiol is extracted from cannabis plants and can be used as an oil. CBD oil is rich in chemicals called cannabinoids that bind to specialized receptors in the brain.

The best-known cannabinoid is tetrahydrocannabinol (THC), which causes the “high” people feel after using marijuana.

THC, however, is just one of many cannabinoids. Cannabidiol also binds to these receptors but does not produce a high. Proponents argue that cannabidiol oil has many health benefits, ranging from slowing the growth of cancer to improved mental health.

CBD oil is edible and can be used as a cooking oil or added to food. People may also take it as a medication by consuming a few drops. CBD oil should not be smoked, and there is no evidence that smoking it offers any benefits.

Does CBD produce a high?
CBD oil derived from hemp will not produce a “high.” Hemp is a type of cannabis plant grown for industrial use, such as making paper and clothing. Unlike other cannabis plants, hemp has not been specially bred to produce high levels of THC.

Cannabidiol may be sold as a type of hemp oil with trace amounts of THC. So, someone using cannabidiol might still test positive for THC on a drug test, even though they will not experience any alterations of mental state after using the oil.

CBD oil and anxiety

Much of the research on cannabis products has looked at the use of marijuana rather than at CBD oil as a standalone product.

Some studies have found that cannabis might help anxiety. Others suggest that having anxiety is a risk factor for recreational marijuana use, or that using marijuana can make a person more vulnerable to anxiety.

People interested in managing their anxiety with CBD oil should look exclusively at research on cannabidiol, not generalized studies of medical marijuana. Although there are fewer studies on cannabidiol specifically, the preliminary research is promising.

A small 2010 study found that cannabidiol could reduce symptoms of social anxiety in people with social anxiety disorder (SAD). Brain scans of participants revealed changes in blood flow to the regions of the brain linked to feelings of anxiety.

In this study, cannabidiol not only made participants feel better but also changed the way their brains responded to anxiety.

A 2011 study also found that cannabidiol could reduce social anxiety. For that study, researchers looked specifically at cannabidiol to treat anxiety associated with public speaking.

Research published in 2014 found that CBD oil had anti-anxiety and antidepressant effects in an animal model.

A 2015 analysis of previous studies concluded that CBD oil is a promising treatment for numerous forms of anxiety, including social anxiety disorder, panic disorder, obsessive-compulsive disorder, generalized anxiety disorder, and post-traumatic stress disorder.

The report cautioned, however, that data on long-term use of CBD oil is limited. While research strongly points to the role of cannabidiol in treating short-term anxiety, little is known about its long-term effects, or how it can be used as a prolonged treatment.

A 2016 case study explored whether cannabidiol could reduce symptoms of post-traumatic stress disorder (PTSD) and anxiety-provoked sleep disorder in a child with a history of trauma. Researchers found that cannabidiol reduced the child’s anxiety and helped her sleep.


Research on the use of cannabis suggests that it may have negative health effects, particularly when smoked.

Research specifically on cannabidiol, however, has found few or no negative side effects. This means CBD oil may be a good option for people who do not tolerate the side effects of other medications for anxiety, including addiction.

Not all states in the United States have specifically legalized CBD oil, although some have legalized it for only specific purposes.

A person should educate themselves about the potential risks of purchasing or using it. While CBD oil is not listed on the Controlled Substances Act (CSA), a person should consult their doctor before using it to treat anxiety.

Because CBD oil is not regulated as a medical treatment for anxiety, it is unclear what dosage a person should use, or how frequently they should use it. A person should consult a doctor who has experience with CBD oil to determine the right dosage for their needs.

By Zawn Villines

Dr. Jeffrey Ditzell is a Psychiatrist in New York City and specializes in issues involving anxiety depression and adult ADHD. Medical Marijuana is one of the many treatments Dr. Ditzell offers to treat a variety of mental health issues.

Ketamine Used As An Antidepressant

Long used as an anaesthetic and analgesic, most people familiar with ketamine know of it for this purpose. Others know it as a party drug that can give users an out-of-body experience, leaving them completely disconnected from reality. Less well known is its growing off-label use in the USA for depression, in many cases when other options have been exhausted.

David Feifel, a professor of psychiatry at the University of California, San Diego, was one of the first clinicians to use ketamine off-label to treat depression at UCDS’s Center for Advanced Treatment of Mood and Anxiety Disorders, which he recently founded. “Currently approved medications for depression all have about the same, very limited efficacy. A large percentage of patients with depression do not get an adequate level of relief from these antidepressants even when they have tried several different ones and even when other drugs known to augment their effects are added to them”, Feifel tells The Lancet Psychiatry. “The stagnation in current antidepressant medication on the one hand, and the tremendous number of treatment-resistant patients, has propelled me to explore truly novel treatments like ketamine.”

Compelling published study results and case reports exist of patients’ depression—in some cases deeply entrenched depression that has lasted months or even years—alleviating within hours of use of ketamine. However, critics have warned that the drug has not been studied sufficiently (at least outside clinical trials), and also emphasied the cost. Patients can pay more than $1000 per session for treatment that must usually be repeated several times. That cost is rarely covered by the patient’s medical insurance.

The balance between prescribing ketamine off-label to patients with depression (who have exhausted other options) against making all patients wait until ketamine or a derivative is licensed for depression is the key ethical dilemma, says Dominic Sisti, an assistant professor in the Department of Medical Ethics and Health Policy at the Perelman School of Medicine, University of Pennsylvania, PA, USA. “I don’t think patients who have exhausted all options should have to wait, but I worry that off-label use is not being properly monitored”, says Sisti. “If patients are fully competent and informed, they should have the right to access ketamine—but we have to be sure they understand it is basically an experimental treatment. This is a vulnerable patient population.”

Another criticism is that patients who have exhausted treatment options might be willing to try anything. “This implies that patients with treatment-resistant depression (TRD) may be so desperate for relief that their ability to perform an appropriate calculation of the risks and benefits of trying ketamine is impaired. This insinuation infuriates many TRD patients in my experience”, says Feifel. “The other assumption is an implicit one that somehow using ketamine for depression is highly risky or fraught with many side effects. Both are simply wrong.”

Advocates of ketamine use in depression are excited because it has a different mechanism of action to standard antidepressants, which affect signalling by monoamine neurotransmitters such as serotonin, noradrenaline, or dopamine. Ketamine is thought to act by blocking N-methyl-d-aspartate (NMDA) receptors in the brain, which interact with the aminoacid neurotransmitter glutamate. The resultant chemical changes in the brain caused by ketamine are not yet fully understood, but could involve ketamine-induced gene expression and signalling cascades that act long after the drug has been eliminated from the body. Meanwhile, critics say that the adverse effects of the drug, including the emergence reactions (hallucinations, dreams, and out-of-body experiences) sought after by recreational users, need further study before long-term use of ketamine can be approved for depression. Feifel states that he has patients who have been receiving ketamine treatments every 2–4 weeks for long periods, some for around 3 years, and has not yet seen any safety issues arise.

Pharmaceutical companies are entering this exciting arena by attempting to develop new drugs based on ketamine without similar side-effects. Naurex, situated in Evanston, IL, USA, recently reported results from a phase 2 study of its drug GLYX-13, which reduced depression in around half of the 400 patients in the study without any psychotic side-effects. The drug is given by injection once every 1–2 weeks, and should enter phase 3 trials later in 2015. Other pharmaceutical companies are developing drugs with other modes of administration. Johnson & Johnson (New Brunswick, NJ, USA) are developing a nasal spray containing a ketamine derivative, Crecicor (Baltimore, MD, USA) is developing a once-daily oral pill, and Naurex is also developing an oral version of GLYX-13. However, Feifel dismisses the notion that the dissociative so-called trip induced by ketamine is actually an important negative side-effect. “I have not had a single patient discontinue treatment due to the dissociative psychedelic experience”, he explains. “Although I have had a couple patients have unpleasant ‘trips’, it’s exceedingly rare, usually dose related, and very transitory due to ketamine’s rapid metabolism.” Feifel says that, more often than not, patients find the trip to be positive, or even spiritual, and believe it is an important component of the antidepressant effect they experience afterwards. “There is no doubt the dissociative effect represents a logistical issue, requiring monitoring—and this should be addressed in any approval given for ketamine”, he adds.

In the UK, ketamine has been used in two clinical trials for treating depression. Rupert McShane is the lead consultant for the local electroconvulsive therapy (ECT) service based at Oxford Health NHS Foundation Trust, Oxford, UK. His clinic took part in a UK National Institute for Health Research study (REDKITE) in which ketamine was administered for TRD in a series of 28 cases. These patients were largely referred by secondary care psychiatrists, but some contacted McShane’s team following advertising or after reading about the study on the internet. Some patients had been actively looking for somewhere where they could receive ketamine treatment.

“Our team used one of the beds in the recovery bay of the ECT suite to administer ketamine during sessions where other patients—not those receiving ketamine infusions—were receiving ECT”, explains McShane. “This had the advantage of having a team present which is familiar with treating resistant depression, and also an anaesthetist. Despite evidence of the efficacy of ECT, many patients are unwilling to try it. Thus, ketamine or similar compounds may have a role in those who would otherwise have had ECT.”

McShane adds that his team is “exploring what options there may be for providing a ketamine service for people with treatment resistant depression”. He explains that intravenous infusions seemed to clearly establish whether someone was a responder or not. “Our experience was that a second infusion was necessary in order to be able to decide whether someone was a responder, but if they have not responded by then, then they will not respond to further infusions at the same dose”, explains McShane. “Its effect in those people who respond is dramatic. However, it is hardly surprising that a single dose does not usually have an enduring effect—one would not expect that of a single dose of any antidepressant.” He adds, however, that “a few people seem to have much more prolonged responses—for several months. So far, the only way we know of to create a sustained effect in someone who has a brief response is to give it repeatedly, and also through co-prescription of conventional antidepressants which may also prolong the effect. I cannot see a future in which we will not be harnessing the use of ketamine in some way.”

In terms of the safety profile of ketamine, McShane believes that adverse effects of long-term ketamine use on the bladder, which have been reported in people who misuse it recreationally, are strongly dose and frequency related, and have not occurred in the context of medical use. “The dissociative side-effects are clearly dose related. Some patients will get benefit from ketamine at doses which do not cause them, but there is likely to be a trade-off”, he explains. “Ketamine is safe enough, and there has been so much experience of it, that it is on the WHO essential drugs list. Tolerance may develop, especially if used very frequently, but this would only be problematic if ad libitum use was proposed. Routes such as intranasal, oral, intramuscular, and sublingual all have potential advantages and disadvantages in this regard. Yet whether alternative related compounds will have real safety advantages over ketamine would require formal study: it will be expensive to show that, for a dose of equivalent efficacy, their long-term safety is as good as ketamine.”

Sisti cautions that any clinicians giving ketamine for depression should be fully trained in ketamine administration. “Many are but some may not be”, he says. “Clinics should be outfitted with appropriate emergency equipment, and staff trained on its use. The FDA should set up a voluntary reporting system to track outcomes or adverse events so that some data can be gathered in the field on the safety and efficacy of ketamine for depression.”

Feifel says that it is not for him, but for his patients to decide where the balance of risks and benefits lies in trying ketamine to treat their depression. “I live in a different world from my patients and each one of them in turn lives in a different world from each other”, he explains. “We each place a different value on things, have different priorities, have differing notions of what makes life worthwhile but most importantly, unlike many of the people who come to see me, I am not experiencing the perpetual misery that makes every waking moment a struggle not to end my life. So it is much easier for me to place more weight on the unlikely negative possibilities of a treatment than the more likely potential benefits —this is the trap pundits who decry this off-label use are falling into. One could make a compelling argument that it’s unethical to withhold ketamine treatments from someone who has chronic, severe treatment resistant depression. But I know this from the patients who tell me they would not be in this world right now if it were not for the ketamine.”

Feifel concludes that it is straightforward to talk to TRD patients about ketamine. “I tell them all the relevant information. The efficacy rates, time to onset of benefits, duration limitations, alternatives, lack of insurance coverage, and other information. My job is to make sure they understand the parameters of the treatment, not to decide whether they should do it.”

By Tony Kirby for The Lancet

Dr. Jeffrey Ditzell is a Psychiatrist in New York City and specializes in issues involving anxiety depression and adult ADHD. Ketamine for Depression is one of the many treatments Dr. Ditzell offers to treat a variety of mental health issues.

Communicating & Taking Responsibility

Your significant other is not a mind reader. Well, they’re most likely not a mind reader. Unless your significant other possesses some kind of mythical powers that allow them to tap into your deepest thoughts and feelings, if you don’t say how you feel, they really won’t have any idea. Despite the practice of proper communication being difficult at first, explicitly explaining to your partner how you’re feeling is the cornerstone of a healthy relationship.

Taking responsibility for your feelings is the best way to ensure that your needs are being met and you’re consistently happy in your relationship. Need some tips on how to make that happen? Keep reading to learn how Couples Counseling Costa Mesa can help you learn this valuable skill.

If you and your partner aren’t communicating properly, it can be a difficult, lonely and painful road to be on. By taking responsibility for your relationship and working on your communication skills, you can work towards a strong relationship built on mutual trust and respect.

Communication is a two-way street-If you and your partner are having trouble communicating; it is necessary that you both work towards a resolution. If both people in a relationship aren’t talking and listening effectively, it simply doesn’t work. Communication is also a delicate balance. Both partners need to do equal amounts of listening and speaking. Doing too much of one and too little of the other is almost as dangerous as not communicating at all.

Take responsibility

If you missed an important deadline at work could you tell your boss “I didn’t open my email so I didn’t know I should be working on something”? Probably not. Most likely, you’d never think about being so irresponsible at work, so why should it be allowed in your relationship? If you aren’t being an active participant in your relationship by listening, speaking, and being proactive, don’t be surprised if your significant other is starting to get frustrated.

Be forgiving

Strong communication is hard work, and it takes a while to master. Being (or having) a forgiving partner to encourage you along the way is incredibly important to your overall well being. Being forgiving also breaks down resentment and stops the incessant “blame game” that often occurs when commutation breaks down. Being a forgiving person also helps you forgive yourself, which is a great overall skill to master.

Know that this isn’t easy

Communicating and taking responsibility for yourself and your feelings take some getting used to and at the least, a little bit of work for both you and your partner. If you need some help to start in the right direction, Couples Counseling Costa Mesa can help. Couples Counseling Costa Mesa provides premier couples counseling services that can help your relationship flourish. I have years of experience necessary to help you work on your communication issues both now and in the future. Contact Couples Counseling Costa Mesa today and start working on your happily ever after.

Patrice Hooke, LMFT uses practical honest feedback and focus on the strengths of my clients to help them reach their goals. I believe that with honesty, compassion and understanding, we can all find healing and have a more fulfilling life. She is especially passionate about couples counseling Costa Mesa.

The Cerebral Mystique

Neuroscience gives us invaluable, wondrous knowledge about the brain – including an awareness of its limitations

More than 2,000 years ago, the semi-mythical father of medicine, Hippocrates of Kos, challenged the spiritualists of his time with a bold claim about the nature of the human mind. In response to supernatural explanations of mental phenomena, Hippocrates insisted that ‘from nothing else but the brain come joys, delights, laughter and sports, and sorrows, griefs, despondency, and lamentations’. In the modern age, Hippocrates’ words have been distilled into a Twitter-friendly pop-neuroscience slogan: ‘We are our brains.’ This message resonates with recent trends to blame criminality on the brain, to redefine mental illness as brain disease and, in futuristic-technological circles, to imagine enhancing or preserving our lives by enhancing or preserving our brains. From creativity to drug addiction, there is barely an aspect of human behaviour that has not been attributed to brain function. To many people today, the brain seems like a contemporary surrogate for the soul.

But lost in the public’s romance with the brain is the most fundamental lesson neuroscience has to teach us: that the organ of our minds is a purely physical entity, conceptually and causally embedded in the natural world. Although the brain is required for almost everything we do, it never works alone. Instead, its function is inextricably linked to the body and to the environment around it. The interdependence of these factors is masked however by a cultural phenomenon I call the ‘cerebral mystique’ – a pervasive idealisation of the brain and its singular importance, which protects traditional conceptions about differences between mind and body, the freedom of will and the nature of thought itself.

The mystique is expressed in multiple forms, ranging from ubiquitous depictions of supernatural, ultra-sophisticated brains in science fiction and the popular media to more sober, scientifically supported conceptions of cognitive function that emphasise inorganic qualities or confine mental processes to neural structures. This idealisation is almost reflexively adopted by laypeople and scientists alike (including me!) and it is compatible with both materialist and spiritual world views. The cerebral mystique might help to increase enthusiasm for neuroscience – a valued consequence – but it drastically limits our ability to analyse human behaviour and address important social problems.

The widespread analogy of the brain to a computer contributes powerfully to the cerebral mystique by distancing the brain from the rest of the biology. The contrast between a machine-like brain and the wet, chaotic mess we have throughout the rest of our bodies sets up a brain-body distinction that parallels the historical mind-body distinction drawn by early philosophers such as René Descartes. In keeping with Western religious notions of the soul, Descartes in the 17th century postulated that the mind is an ethereal entity that interacts with the body but does not join with it. With his timeless axiom ‘I think, therefore I am’ Descartes placed the mind in its own universe, autonomous of the material world.

To the extent that the brain resembles a machine, we can more easily imagine removing it from our heads, preserving it for eternity, cloning it or sending it through space. The digital brain thus seems separable from the body in both its substance and causal relations, much like Descartes’s detached spirit. It might be no accident that some of the most influential inorganic analogies to the brain were introduced by physical scientists who in their later years took to the problem of consciousness in the way that elderly people sometimes take to religion. John von Neumann, the computer pioneer, was the best-known of these; he wrote the influential book The Computer and the Brain (1958) shortly before his death in 1957, inaugurating this enduring analogy at the very dawn of the digital age.

Brains are undoubtedly somewhat computer-like – computers, after all, were invented to perform brain-like functions – but brains are also much more than bundles of wiry neurons and the electrical impulses they are famous for propagating. The function of each neuroelectrical signal is to release a little flood of chemicals that helps to stimulate or suppress brain cells, in much the way that chemicals activate or suppress functions such as glucose production by liver cells or immune responses by white blood cells. Even the brain’s electrical signals themselves are the products of chemicals called ions that move in and out of cells, causing tiny ripples that can spread independently of neurons.

Also distinct from neurons are the relatively passive brain cells called glia (Greek for glue) that are roughly equal in number to the neurons but do not conduct electrical signals in the same way. Recent experiments in mice have shown that manipulating these uncharismatic cells can produce dramatic effects on behaviour. In one experiment, a research group in Japan showed that direct stimulation of glia in a brain region called the cerebellum could cause a behavioural response analogous to changes more commonly evoked by stimulation of neurons. Another remarkable study showed that transplantation of human glial cells into mouse brains boosted the animals’ performance in learning tests, again demonstrating the importance of glia in shaping brain function. Chemicals and glue are as integral to brain function as wiring and electricity. With these moist elements factored in, the brain seems much more like an organic part of the body than the idealised prosthetic many people imagine.

Stereotypes about brain complexity also contribute to the mystique of the brain and its distinction from the body. It has become a cliché to refer to the brain as ‘the most complex thing in the known Universe’. This saying is inspired by the finding that human brains contain something on the order of 100,000,000,000 neurons, each of which makes about 10,000 connections (synapses) to other neurons. The daunting nature of such numbers provides cover for people who argue that neuroscience will never decipher consciousness, or that free will lurks somehow among the billions and billions.

But the sheer number of cells in the human brain is unlikely to explain its extraordinary capabilities. Human livers have roughly the same number of cells as brains, but certainly don’t generate the same results. Brains themselves vary in size over a considerable range – by around 50 per cent in mass and likely number of brain cells. Radical removal of half of the brain is sometimes performed as a treatment for epilepsy in children. Commenting on a cohort of more than 50 patients who underwent this procedure, a team at Johns Hopkins in Baltimore wrote that they were ‘awed by the apparent retention of memory after removal of half of the brain, either half, and by the retention of the child’s personality and sense of humour’. Clearly not every brain cell is sacred.

If one looks out into the animal kingdom, vast ranges in brain size fail to correlate with apparent cognitive power at all. Some of the most perspicacious animals are the corvids – crows, ravens, and rooks – which have brains less than 1 per cent the size of a human brain, but still perform feats of cognition comparable to chimpanzees and gorillas. Behavioural studies have shown that these birds can make and use tools, and recognise people on the street, feats that even many primates are not known to achieve. Within individual orders, animals with similar characteristics also display huge differences in brain size. Among rodents, for instance, we can find the 80-gram capybara brain with 1.6 billion neurons and the 0.3-gram pygmy mouse brain with probably fewer than 60 million neurons. Despite a greater than 100-fold difference in brain size, these species live in similar habitats, display similarly social lifestyles, and do not display obvious differences in intelligence. Although neuroscience is only beginning to parse brain function even in small animals, such reference points show that it is mistaken to mystify the brain because of its sheer number of components.

Playing up the machine-like qualities of the brain or its unbelievable complexity distances it from the rest of the biological world in terms of its composition. But a related form of brain-body distinction exaggerates how the brain stands apart in terms of its autonomy from body and environment. This flavour of dualism contributes to the cerebral mystique by enhancing the brain’s reputation as a control centre, receptive to bodily and environmental input but still in charge.

Contrary to this idea, our brains themselves are perpetually influenced by torrents of sensory input. The environment shoots many megabytes of sensory data into the brain every second, enough information to disable many computers. The brain has no firewall against this onslaught. Brain-imaging studies show that even subtle sensory stimuli influence regions of the brain, ranging from low-level sensory regions where input enters the brain to parts of the frontal lobe, the high-level brain area that is expanded in humans compared with many other primates.

Many of these stimuli seem to take direct control of us. For instance, when we view illustrations, visual features often seem to grab our eyes and steer our gaze around in spatial patterns that are largely reproducible from person to person. If we see a face, our focus darts reflexively among eyes, nose and mouth, subconsciously taking in key features. When we walk down the street, our minds are similarly manipulated by stimuli in the surroundings – the honk of a car’s horn, the flashing of a neon light, the smell of pizza – each of which guides our thoughts and actions even if we don’t realise that anything has happened.

Even further below our radar are environmental features that act on a slower timescale to influence our mood and emotions. Seasonal low light levels are famous for their correlation with depression, a phenomenon first described by the South African physician Norman Rosenthal soon after he moved from sunny Johannesburg to the grey northeastern United States in the 1970s. Colours in our surroundings also affect us. Although the idea that colours have psychic power evokes New Age mysticism, careful experiments have repeatedly linked cold colours such as blue and green to positive emotional responses, and hot red hues to negative responses. In one example, researchers showed that participants performed worse on IQ tests labelled with red marks than on tests labelled with green or grey; another study found that subjects performed better on computerised creativity tests delivered on a blue background than on a red background.

Signals from within the body influence behaviour just as powerfully as influences from the environment, again usurping the brain’s command and challenging idealised conceptions of its supremacy. A particularly powerful pathway for reciprocal brain-body interactions is the so-called hypothalamic-pituitary-adrenal (HPA) axis, named for a set of structures both inside and outside the brain that together coordinate the storied fight-or-flight response. Activation of the HPA axis is often triggered by fear-related brain signals that lead to secretion of cortisol and adrenalin from a gland that sits on top of the kidneys. These hormones lead to a range of bodily changes that affect breathing, heartrate, sensory acuity and many other variables, providing feedback to the brain and closing a circuit of mutual brain-body interaction. In some cases, the HPA axis can be engaged from outside the brain, as in pregnancy, when a surge of cortisol originates on its own from the placenta.

The HPA axis provides one of the routes by which our emotional states more generally are coupled to body-wide changes that extend far beyond the brain. Monitoring of externally observable physiological parameters such as skin conductance and respiration has long supported the idea that various emotions produce distinct responses relevant to how emotions are perceived. In a 2014 study, a group of researchers led by Lauri Nummenmaa at Aalto University in Finland asked participants to describe bodily sensations that they associate with 14 distinct emotions. The result was a stunning set of ‘bodily maps’ of the emotions, revealing variegated patterns of increased and decreased sensitivity associated with feelings of anger, fear, happiness, depression, love and so on. The subjects’ ability to report their sensations emphasises that bodily changes are part of how the emotions are experienced, and not just passive, downstream consequences of emotion-related brain activity.

An amazing finding of recent years is the fact that microbes living in the intestines are also part of the physiological network that determines our emotions. Changing the gut microbial population by eating bacteria-rich foods or undergoing an off-putting procedure called a faecal transplant can alter characteristics such as anxiety and aggression. A key experiment was performed in mice, where a two-way exchange of gut microbes between the normally shy BALB/c mouse strain and the more outgoing NIH Swiss strain was enough to flip the two personalities. In human organ-transplant patients, both cognitive and emotional effects are also commonplace. Some of these have to do with correcting the medical condition that required the transplant in the first place. For instance, liver or kidney failure causes a buildup of toxins such as ammonia in the blood; this in turn causes cognitive difficulties that can be corrected by replacing the diseased organ. But even procedures such as stomach stitching, which does not cure a disease, are said to cause personality shifts in about 50 per cent of patients.

Such examples illustrate the extent to which what happens in the brain is interwoven with what goes on in the body and the environment. There is no causal or conceptual boundary between the brain and its surroundings. Aspects of the cerebral mystique – idealised views of the brain as inorganic, hypercomplex, self-contained and autonomous – fail when we look more closely at what the brain is made of and how it operates. The integrated involvement of brain, body and environment is precisely what makes having a biological mind different from having a soul, and the implications of this difference are tremendous.

Most importantly, the cerebral mystique fosters a misleading sense that the brain is the prime mover of our thoughts and actions. As we seek to understand human conduct, the mystique prompts us to think first of brain-related causes, and pay less attention to factors outside the head. This leads us to overemphasise the role of individuals and underemphasise the role of contexts across a range of cultural phenomena.

In the arena of criminal justice, for instance, some writers suggest that the perpetrator’s brain should be blamed for transgressions. This argument often invokes the case of Charles Whitman, who in 1966 committed one of the first mass shootings in the US, at the University of Texas. Whitman had reported psychological disturbances in the months leading up to the crime, and an autopsy later revealed that a large tumour had been growing near a part of his brain called the amygdala, which is involved in stress and emotional regulation. But although advocates of blaming the brain would argue that Whitman’s brain tumour might have caused his crime, the larger reality is that Whitman’s act occurred against a background of many other predisposing factors: growing up with a violent father, the recent divorce of his parents, Whitman’s repeated career rejection and court martial from the army, his substance abuse, great physical stature, and access to high-powered weaponry. Even the high temperature on the day of the crime – 99 degrees Fahrenheit (37 degrees Celsius) – might have contributed to Whitman’s aggressive behaviour on the fateful day.

Blaming the brain for criminal behaviour offers an escape from outmoded principles of morality and retribution, but it still neglects the extended network of influences likely to contribute to any given situation. In the current discussion about the causes of violence in the US, it is more important than ever to maintain a broad view of how multiple factors work together in and around each individual; mental problems, gun access, media influences and social alienation can all play their parts. In other contexts, we miss analogous factors when we attribute drug addiction or adolescent misbehaviour to the brain, or when we credit the brain for creativity and intelligence. In each case, an idealised view that simply locates good and bad personal qualities in the brain is remarkably similar to old-fashioned perspectives that assigned virtue and vice to the metaphysical soul. An updated view should instead accept that any act of brilliance or depravity arises from a combination of brain, body and environment working together.

The cerebral mystique has particular significance for the way that our society grapples with the problem of mental illness. This is because of the widespread drive to redefine mental illnesses as brain disorders. Proponents argue that doing this places psychological problems in the same category as influenza or cancer – sicknesses that don’t evoke the social stigma commonly associated with psychiatric disorders. There is some evidence that using the language of brain disorders in fact lowers the barrier for mental-health patients to seek treatment, an important benefit.

In other respects, however, reclassifying mental illnesses as brain disorders can be highly problematic. For patients, attributing mental problems to intrinsic neurological defects incurs a stigma of its own. Although people with ‘broken brains’ might not be held morally accountable or told to ‘just get over it’, the sense that they are irredeemably flawed can be just as damaging. Biological flaws can be harder to fix than moral lapses, and people with brain dysfunction can be seen as dangerous or even less than fully human. This attitude reached extremes under the Nazis, who murdered thousands of mental-health patients as part of their ‘euthanasia’ programme during the Second World War, but it persists in more subtle forms today. A large analysis of changing attitudes to mental illness in 2012 found that there was no increase in social acceptance of patients with depression or schizophrenia, despite increasing awareness of neurobiological contributions to these conditions.

Regardless of its social implications, blaming the brain for mental illnesses might be scientifically inaccurate in many cases. Although all mental problems involve the brain, the underlying causal factors can be elsewhere. In the 19th century, the sexually transmitted bacterial disease syphilis and the vitamin-B deficiency pellagra were among the greatest contributors to insane-asylum populations in Europe and the US. A more recent study estimated that as many as 20 per cent of psychiatric patients have a bodily disorder that might be producing or worsening their mental condition; the maladies include heart, lung and endocrine problems, all of which have cognitive side effects. Epidemiological surveys have found remarkable correlations between incidence of mental illness and factors such as ethnic minority status, being born in a city, and being born at certain times of year. Although these correlations are not well-explained, they emphasise the likely role of environmental factors well beyond the brain in bringing about psychiatric problems. We must be sensitive to such factors if we want effective treatment and prevention of mental disorders.

At an even deeper level, cultural conventions circumscribe the notion of mental illness in the first place. Just 50 years ago, homosexuality was classified as a pathology in the American Psychiatric Association’s authoritative compendium of mental disorders. In Soviet Russia, political dissidents were sometimes confined on the basis of psychiatric diagnoses that would horrify most observers today. Nevertheless, sexual preference or failure to bow to authority in pursuit of a righteous cause are both psychological traits for which we could imagine finding biological correlates. That does not mean that homosexuality and political dissidence are brain diseases. Society rather than neurobiology ultimately defines the bounds of normality that determine mental-health categories.

The cerebral mystique exaggerates the brain’s contribution to human behaviour, and for some it also prompts remarkable visions of the brain’s role in the future of humanity itself. In technophilic circles, there is increasing talk of ‘hacking the brain’ to improve human cognition. This notion evokes the kind of sophisticated but semi-subversive intervention one might make into a fancy smartphone or a government server, but the reality is usually more like the type of hacking one would perform with a machete. Some of the earliest brain hacks involved the purposeful destruction of parts of the brain, famously as part of the now-extinct psychosurgery procedures that inspired Ken Kesey’s novel One Flew Over the Cuckoo’s Nest (1962). The most advanced of today’s brain hacks involve surgically implanting electrodes for direct stimulation or recording of brain tissue. These interventions can restore basic function to patients with severe movement disorders or paralysis – an incredibly impressive feat, but still a world away from enhancements to normal abilities. This distance has not stopped entrepreneurs such as Elon Musk or the US defence agency DARPA from investing heavily in technology that they hope will one day routinely hardwire healthy human brains to computers.

But this exuberance is largely the product of an artificial distinction between what goes on inside versus outside the brain. The philosopher Nick Bostrom of the Future of Humanity Institute in Oxford points out that ‘most of the benefits you could imagine achieving through [brain implants] you could achieve by having the same device outside of you, and then using your natural interfaces like your eyeballs, which can project 100 million bits per second straight into your brain’. Indeed, most of us are familiar with the kind of cognitive-enhancement aids that live in our desks, pockets and handbags, boosting our memory and communication capabilities without touching a neuron. It is debatable whether connecting smartphone-like devices more directly to brains would add much except annoyance and distraction.

In the medical realm, early efforts to restore vision in blind people using brain implants quickly gave way to much less invasive approaches involving retinal prostheses, which leverage the body’s natural physiology for early processing of visual information. Cochlear implants that restore hearing in deaf patients rely on the similar strategy of interfacing with the auditory nerve in the ear, rather than the brain itself. Except in the most impaired patients, prostheses for restoring or enhancing movement also benefit from interfaces to the body. To give amputees control over mechanised artificial limbs, a technique called ‘targeted muscle reinnervation’ allows physicians to connect loose peripheral nerves from the missing original limb to new muscle groups that in turn communicate with the device. For enhancing motor function in healthy people, powered exoskeletons developed by companies such as Cyberdyne in Japan communicate with the wearer through skin-surface electrodes, also accepting input from the brain through indirect but evolutionarily honed channels. In each of these examples, the brain’s natural interactions with the body help the person use the prosthetic, leveraging rather than denying the continuity between brain and body.

The most extreme direction in futuristic brain technology is the drive to achieve immortality through the postmortem preservation of human brains. Two companies now offer to extract and preserve the brains of dying ‘clients’, who do not wish to go gentle into the good night. The organs will be stored in liquid nitrogen until technology advances to the point (now nowhere in sight) where the brain can be restored to function in some form or analysed in sufficient detail to ‘upload’ the mind into a computer. This venture takes the cerebral mystique to its logical endpoint, fully embracing the fallacy that human life is reducible to brain function and that the brain is just a physical embodiment of the soul.

Although seeking immortality through brain preservation does little harm to anything other than a few people’s bank accounts, this fringe pursuit also epitomises why demystifying the brain is so important. The more we feel that our brains encapsulate our essence as individuals, and the more we believe that our thoughts and actions simply emanate from the bundle of flesh in our heads, the less sensitive we will be to the role of the society and environment around us, and the less we will do to nurture our shared culture and resources – whether in the context of criminal behaviour, creativity, mental illness or any other aspect of human life.

The brain is special because it does not distil us to an essence, it unites us to our surroundings in a way a soul never could. If we value our own experiences, we must protect and strengthen the many factors that enrich our lives from both inside and outside, so that as many people as possible can benefit from them now and in the time to come. We must realise that we are much more than our brains.

Alan Jasanoff is professor of biological engineering, brain and cognitive sciences, and nuclear science and engineering at the Massachusetts Institute of Technology. His latest book is The Biological Mind: How Brain, Body, and Environment Collaborate to Make Us Who We Are (2018).

Besma (Bess) Benali, Clinical Social Work/Therapist, MSW, RSW, Counselling Ottawa Nepean. I am trained in Cognitive Behavioural Therapy (CBT), Brief Psychodynamic Therapy, ACT, and mindfulness. Clients come to me because they are struggling and feel like they are trapped in a darkness that no matter what they have tried (and many have tried therapy before) they can’t pull themselves out. I help my clients understand themselves in ways no one has ever taught them before allowing them to see positive changes.

Do psychotropic drugs enhance, or diminish, human agency?

From medication to recreational and spiritual substances, drugs offer us respite from pain, open opportunities for mental exploration, and escape from – or into – altered psychological states. They are our most widely available formal and informal implements for tweaking our mental condition. Consider the cold beer after a hard day at work, the joint before putting the needle on the record, the midday espresso, the proverbial cigarette break, Adderall during finals week, or painkillers to alleviate undiagnosed or chronic pain. Not to mention antidepressants to counter a sense of meaninglessness, and benzodiazepines because everything causes anxiety.

In short, drugs offer our most common path to a sense of psychological health. With a modicum of knowledge, millions of people modify their minds through chemistry every day. Considering the limited resources of time, support networks, money and patience, accepting the positivism of drugs seems more efficient and more feasible than psychodynamic therapy. This shift implies an expectation that there are quick and easy chemical levers into a wide range of mental states.

Drugs are favoured tools to foster our values and amplify or attenuate our gregariousness and productivity. They serve as release valves for labour and social relations. Socially acceptable drugs such as nicotine, caffeine and alcohol are thus embedded into common social practices in public spaces; they are aids to efficiency in coffee-shop work culture and sociability in bars. Accordingly, these practices coincide with the modern structure of the working week: in the morning we become alert, and in the evening we relax. In effect, some drugs are made highly accessible as a form of self-medication for the common self-diagnosed emotional states of stress, boredom, restlessness, anxiety, discomfort, etc.

Psychological medications such as Xanax, Ritalin and aspirin help to modify undesirable behaviours, thought patterns and the perception of pain. They purport to treat the underlying chemical cause rather than the social, interpersonal or psychodynamic causes of pathology. Self-knowledge gained by introspection and dialogue are no longer our primary means for modifying psychological states. By prescribing such medication, physicians are implicitly admitting that cognitive and behavioural training is insufficient and impractical, and that ‘the brain’, of which nonspecialists have little explicit understanding, is in fact the level where errors occur. Indeed, drugs are reliable and effective because they implement the findings of neuroscience and supplement (or in many cases substitute for) our humanist discourse about self-development and agency. In using such drugs, we become transhuman hybrid beings who build tools into the regulatory plant of the body.

Recreational drugs, on the other hand, are essentially hedonic tools that allow for stress-release and the diminishment of inhibition and sense of responsibility. Avenues of escape are reached through derangement of thought and perception; many find pleasure in this transcendence of quotidian experience and transgression of social norms. There is also a Dionysian, or spiritual, purpose to recreational inebriation, which can enable revelations that enhance intimacy and the emotional need for existential reflection. Here drugs act as portals into spiritual rituals and otherwise restricted metaphysical spaces. The practice of imbibing a sacred substance is as old as ascetic and mindfulness practices but, in our times, drugs are overwhelmingly the most commonly used tool for tending to this element of the human condition.

In this historical moment, drugs fuel a culture where human nature is increasingly considered to be controllable through technology. But the essential question is this: do drugs enhance or diminish human agency, the ability to modulate one’s own thought processes?

Whether a drug boosts attention, tamps down inhibitions or deranges the senses in service of euphoria, use can become ingrained and can spiral out of control until one can be said to be addicted to the effects of the drug. The overuse of recreational drugs and socially acceptable stimulants seems to negate, distort or inflate one’s sense of agency, at which point an individual becomes dependent on drugs to cope in professional and social situations. In these cases, drugs, in the long term, are indeed counter-productive tools: they both occlude agency and compromise self-development.

Psychopharmacology implies that distinct mental illnesses are somehow natural kinds of personality formations defined by neurochemical profiles. For instance, in claiming that I have attention deficit hyperactivity disorder (ADHD) I am contextualising all my behaviours within a totalising abnormality that requires a pharmaceutical cure – a treatment beyond the capacities of my introspection and social support network. Practitioners prescribing such drugs in such a scenario are de facto technicians of the mind. They are easing our pain, but they are also dispensing cultural tools that allow us to selectively reduce or augment our sense of personal agency and power to set our own path.

One question to ask then is: How many individuals have found, through these tools, a sweet spot that blends augmentation of the will and alleviation of pain? If the number is large, then drugs fall into the same category as cars, electric guitars and mobile phones; tools that, if used judiciously, can ameliorate our quality of life. From that perspective, drugs are just one of many tools, including the tool of talk therapy, that serve to secure an appropriate sense of agency. And yet a somewhat worrisome consideration arises – maybe maintaining a sense of agency is not the best indicator of the appropriateness of a given tool. In our transhuman future, we are likely to abandon the psychodynamic tools of self-actualisation for cocktails offering the illusion of agency and escape.

Rami Gabriel is associate professor of psychology in the Department of Humanities, History, and Social Sciences at Columbia College Chicago. He is the author of Why I Buy: Self, Taste, and Consumer Society in America (2013).

Dr. Kevin Groves is a Clinical Psychologist Austin, Texas. Kevin is also a family therapist and group counselor. Dr. Groves graduated with honors in 1989 and has more than 29 years of diverse experiences.

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How to Recover From Heartbreak

Use “negative reappraisal,” and understand you have work to do—time alone may not be enough.

Melissa and J.J. met on the finish line of an obstacle course race. “We were both winded and covered in mud yet we still managed to flirt. It felt weirdly authentic,” Melissa told me in our first psychotherapy session. “He was into triathlons and obstacle courses like I was. We had very similar lifestyles.” Melissa and J.J. moved in together after eight months. A year and a half into the relationship, Melissa began raising the issue of marriage. J.J. didn’t feel ready. Soon thereafter, he broke up with her.

Melissa was a wreck. She cried for days and could barely function at work, “I’ll never find a better match for me. It was the best relationship I ever had.” Melissa came to see me after several months had passed and J.J. was still all she could think about. “Aren’t my feeling supposed to fade?” She asked me. “Why does it still feel so painful?”

We’ve been experiencing heartbreak for millennia and yet most of us still use the same coping and recovery mechanisms we did thousands of years ago, time, social support, and unfortunately, substances (e.g., alcohol, drugs, food). Despite recent advances in our scientific understanding of how we are impacted by heartbreak, little has changed in how we go about recovering from this emotionally devastating experience. As I describe in my book How to Fix a Broken Heart, the biggest mistake we make is that we go on “autopilot” and assume the only thing we can do to recover is give it time. Yes, time helps, as does social support, but new studies are verifying that there are all kinds of other steps we can and should take to soothe the emotional pain we feel and expedite our recovery.

A recent study in the Journal of Experimental Psychology examined cognitive and behavioral strategies for recovering from heartbreak. The premise of the study was that to recover from heartbreak we need to diminish our feelings of love for our ex-partner. While that might seem terribly obvious, consider that heartbreak often makes most of us do the opposite: We enact thoughts and behaviors that actually reinforce our love feelings (e.g., stalking our ex on social media, reliving our best moments, pouring over old images and video of happy times). The goal of the study was to examine three kinds of emotional regulation strategies to see which of them would help heartbroken subjects reduce their love feelings.

In the first condition, subjects focused on negative reappraisals of their ex-partner (e.g., by responding to prompts about their ex’s annoying habits). In the second condition they were asked to reframe their loving feelings as less problematic (e.g., by endorsing prompts such as ‘It’s okay to love someone I’m no longer with’). The last condition used distraction (e.g., questions about the subjects’ favorite food) to get the participants’ mind off their heartbreak. The researchers found that only negative reappraisals were truly effective in reducing love feelings. However, doing so did increase feelings of unpleasantness.

Unfortunately, it is those very feelings of “unpleasantness” that make it challenging to use negative reappraisals as a way to recover from heartbreak. We might accept, on an intellectual level, that by focusing on our ex’s faults we’re doing something important but it can still feel wrong (unpleasant), unbalanced, unfair, and even disloyal.

As a clinician, I’ve found that there are two things we can do to minimize these feelings of unpleasantness and thus feel freer to practice negative reappraisals of our ex. First, we need to frame the task differently. Specifically, we need to consider that when we are heartbroken, our mind is likely to bombard us with highly idealized snapshots, memories and thoughts both about our ex and about our relationship. We tend to remember only the best times and our ex’s best qualities. In other words, our mind is already creating unbalanced and inaccurate perceptions that are highly skewed to the positive. Therefore, our introduction of negative reappraisals does not create an imbalance, it corrects an existing one.

Second, negative reappraisals should include not just our perceptions and memories of our ex but of the relationship as well. We tend to idealize the relationship just as much as we do the person and think almost exclusively of the good times and the happy moments. We are far less likely to consider the compromises we had to make, the fights that hurt our feelings or frustrated us, or our unmet emotional needs. People often grieve both the person and the relationship itself—the experience of being a couple, having a significant other, the companionship and partnering. Therefore, it is necessary to address idealized perceptions of the relationship by introducing negative reappraisals of our couplehood, as well as of our ex as a person, in order to more effectively reduce feelings of attachment and love.

If you are trying to get over heartbreak, make a list of the person’s faults as well as of the shortcomings of the actual relationship and to keep that list on their phone. Whenever you find yourself having idealized thoughts and memoires, whip out your phone and read a few reminders in order to balance your perceptions and remind yourself that your ex was not perfect and neither was the relationship.

One crucial aspect of recovery from heartbreak that was not covered in the current study is that breakups leave all kinds of voids in our lives. Our social circle gets diminished, our activities change, our physical space changes (e.g., their ‘stuff’ is no longer there), some of the things we did as couples we no longer do, and the list goes on. A significant part of the emotional pain we feel after a breakup is related to these other losses, the ripple effects that go beyond the loss of the actual person. Finding ways to recognize these voids and fill them is an important task of recovery from heartbreak and one that is often neglected.

Heartbreak is a form of grief and loss that can cause insomnia, changes in appetite, depression, anxiety, and even suicidal thoughts and behavior and as such it should be taken very seriously, as should our efforts to recover. However, to do so, we have to assert control and consciously and willfully prevent ourselves from making mistakes that will set us back (like staying in touch or trying to be friends while we’re still heartbroken) and encourage ourselves to take steps that might feel unpleasant or counter-intuitive, but that will ultimately diminish our emotional pain and expedite our recovery.

By Guy Winch, a psychologist, speaker and author. His books have been translated into 25 languages and his two TED Talks have been viewed over 10 million times. His new book, How to Fix a Broken Heart (TED Books/Simon & Schuster, 2018), covers both pet loss and romantic heartbreak.

Christiane Blanco-Oilar, Ph.D. offers compassionate psychological services for individuals and Couples Therapy Boca Raton. I enjoy working with individuals and couples going through life transitions, relationship challenges or identity exploration, or those experiencing grief and loss, depression, anxiety, postpartum depression and eating disorders. My goal is to help you recognize, understand and have compassion for how you may have developed less-than-ideal ways of dealing with specific areas of your life.

Sociocultural Approach

Introduction to the sociocultural approach and an exploration of how our culture influences the way in which we learn and think.

Psychology is a broad area of study with several theories and schools of thought that help us understand and make sense of human behavior. Perception, behavior, and personality are just a few aspects that psychologists study. Some psychologists choose to study abnormal behavior whilst others attempt to understand why we think the way we do and there are even those who attempt to distinguishes us as humans from other animals.

Sociocultural approach
A common method of explaining what makes and defines us as individuals is the application of sociocultural approach. This approach emphasizes the influence of the society that we living on our learning process.

According to the sociocultural approach, cultural factors such as language, art, social norms and social structures can play a significant role in the development of our cognitive abilities.1

Vygotsky: father of the sociocultural approach
A pioneer of the sociocultural approach was the Soviet psychologist Lev Semyonovich Vygotsky (1896-1934), who became interested in developmental psychology and helped to change the face of the field. He proposed that interactions made by children can shape and influence both the way in which they perceive the world and their cognitive processes. The way children learn and develop varies from culture to culture and is sometimes specific to each individual society. While the resulting cognitive processes may be unique to each culture, the way in which they are handed down from generation to generation is often similar.

Vygotsky cites three methods which are used to teach children skills. These tools are imitative learning, instructed learning, and collaborative learning.

A central tenet of Vygotsky’s studies is that children learn behavior and cognitive skills by dealing with more experienced people, such as teachers or older siblings, using one or more of these three learning methods.2

Vygotsky goes on to explain that in order for the sociocultural theory to work, you need four basic principles.

Key principles of Vygotsky’s sociocultural theory
Whilst there are more than four parts central to this theory and the approach psychologists use in studying an individual, it is easy to identify the core components that function within the theory. Development of a child is contingent upon learning. As explained, learning is a crucial part of passing down culture ideas from parents to children.

By doing so, the child also acquires cognitive skills that are specific to his or her culture.

As a result, it is simple to see the second core principle; that a person’s language is crucial to their mental development.

While animals may possess a form of rudimentary language, often consisting of more basic signals, it is humans’ linguistic abilities that distinguishes from other animals and has helped to create a society full of art and thought. Therefore, the developmental progress of a child can not be considered without also taking into consideration the child’s upbringing and social context.

If a child is reared in a creative culture, the thought process and cognitive abilities of that child will surely reflect that influence. Most interesting though, is that children are capable of creating their own knowledge through experience and cultural tools. This knowledge is then referenced later on in life.

The Zone of Proximal Development
One key element of Vygotsky’s sociocultural approach is his idea of a Zone of Proximal Development. Commonly abbreviated as ZPD, the Zone of Proximal Development is a way to gauge a child’s ability to learn and grow. Vygotsky believed that the ZPD was a far better way to gauge a child’s intelligence than through the standard academic testing, which can often fail to account for cultural differences with regards to learning.

At the core of Vygotsky’s Zone of Proximal Development, there is the area containing the cognitive abilities which we have acquired so far in life. At an earlier age, these are limited. As we travel further outwards from this core, we reach the outer reaches of the zone, which represents the potential of the human mind. This inner potential can be realized through social learning situations.

Wood, Bruner and Ross (1976) expanded on Vygotsky’s theory, adding the concept of scaffolding.3 This terms refers to the activities and environment that more knowledgeable people may provide to someone younger, in order to assist their cognitive abilities. Such people may include parents, caregivers, teachers and older siblings or peers. Scaffolding may include playing games, role playing, singing (to encourage language acquisition) and other social situations where cognitive abilities may be nurtured.

In an attempt to understand cognitive processes, several psychologist have applied Vygotsky’s work have began to look not only at an individual’s biological makeup, but also at the culture and society which surround and inform the individual.

For many years, researchers have been attempting to explain behavior, memory, and cognition in biological terms. With Vygotsky’s work as a guide, researchers are now using a dual approach to understand what makes and shapes a person’s reality and identity. Researchers are taking the social background, language, beliefs, and other cultural and social influences into consideration instead of regarding the mind as nothing more than a collection of neurons and synapses.

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The Bifold Model
Many studies into memory have taken onboard the sociocultural approach. A common example of how the approach works is by comparing a human’s memory with that of an animal. An animal’s memory as we understand it is reactionary. A mouse, for example, lives in the present and only associates an object to a memory when it sees that object. An animal’s mind may be unable to unlock experiences independently of the events it is experiencing at that moment.

So, a mouse can recognize a predator when approached by one and can act accordingly, but can not recall another predator, such as a snake, if one has not been present. Language provides us with the ability to recall experiences without them having being immediately first-hand.4 An individual can see the word ‘watermelon’ and not only recall what a watermelon is, but how one tastes and maybe a pleasant memory of eating one.

Vygotsky pointed out in his book Thought and Language that children at an early age vocalize actions and thought processes, speaking out loud their reasoning. As children get older that vocalization is internalized and becomes ‘inner speech’.5 We see children talking to themselves at early ages as they carry out mundane tasks. It is believed that they are forming recall abilities, that will then be internalized later in life. Trying to remember what one did yesterday would involve a series of prompts, starting with common events such as the commute to work. This will then lead a person to recall what was on the radio and the color of the car in front of them on their morning drive.

Language is crucial for this ability to recollect information, and is also one of the major building blocks of our cultures and societies. It is language, many believe, that elevated humans from a primitive species to a one that would one day dominate the world.

With the sociocultural approach in mind, researchers have begun to look over the course of human history to see how language has shaped and defined entire societies. The results are somewhat surprising, with several anthropologists claiming that our more complex emotions, such as love and loyalty, are really learned behaviors that we have come to associate with those words, and are not ingrained behavior that is hard-wired into our brains.

Sociocultural theory on a smaller scale
In order to see how the sociocultural approach can be applied, we can look at Muzafer Sheriff’s infamous Robbers Cave Experiment.6 Two groups of boys formed different factions and cultures and were then brought together in conflict. Eventually, the groups of boys made peace with each other, but by studying their cognitive behavior during the early part of the experiment, one can use Vystogsky’s theory to study the underlying reasons why the groups felt so antagonistic towards one another. It was, after all, ingrained in their culture.

The sociocultural approach provides researchers and psychologists with a more informed view and understanding of the motivations which cause a person to behave in a particular way. Instead of relying on biological factors alone, the approach promises to paint a more vivid picture of the human mind through a wider understanding of how we acquire cognitive abilities at an early age. In the years since English translations popularised Vygotsky’s proposed Zone of Proximal Development, many psychologists have expanded upon his theory.

The sociocultural approach looks at how a person’s experiences, influences and culture help shape why they act the way they do.

The theory was developed by Lev Semyonovich Vygotsky in the 1930s.
Vygotsky claims that there are three cultural tools which children use to inform their cognitive abilities.

Human’s ability to recall information is a result of our understanding of complex language.
The bifold model takes into account both social and cultural influences as well as biological factors.

By Psychologist World

The Psychology of Happiness

The psychology behind happiness – how positive affect is quantified and what influences happiness.

Just how happy are you? Do you ever wish for a life that brought more moments to be joyful?

Happiness is often an elusive experience – people will go to great lengths for a fleeting moment of happiness. Even the U.S. Declaration of Independence, written in 1776, asserts the right to “Life, Liberty and the pursuit of Happiness”.

But what precisely is happiness – how can it be quantified, and is there any measurable benefit to possessing a happy mindset over that of a more stoic realist?

“Happiness is a mystery like religion, and should never be rationalized.”
G.K. Chesterton, English author (1874-1936)

Happiness is a subjective experience – what brings elation to one person will not necessarily satisfy another – but from a psychological viewpoint, we must be able to quantify this state of mind in order to understand it.

When we discuss happiness, we are referring to a person’s enjoyment or satisfaction, which may last just a few moments or extend over the period of a lifetime. Happiness does not have to be expressed in order to be enjoyed – it is an internalized experience, varying in degrees, from mild satisfaction to wild euphoria.

Psychologists often refer to happiness as positive affect – a mood or emotional state which is brought about by generally positive thoughts and feelings. Positive affect contrasts with low moods and negativity, a state of mind described as negative affect in which people take a pessimistic view of their achievements, life situation and future prospects.

Quantifying Happiness
With positive affect being subjective and relative to the individual, can happiness be measured? The United Nations seems to believe that it can, and releases the World Happiness Report, which ranks countries by the self-reported happiness of its citizens.

In 2016, the report listed Denmark as the happiest nation, followed by Switzerland and Iceland. The US was the 13th happiest country with the UK ranking 23rd. Nordic countries feature prominently as being amongst the happiest societies in the world (Helliwell, Layard and Sachs, 2016).1

The World Happiness Report measured happiness levels using the Cantril Ladder, a scale devised by U.S. psychologist Hadley Cantril (1906-1969). Participants are asked to imagine a ladder with 10 rungs, with rung number 1 representing the worst life imaginable, working upto the optimal life represented by the ladder’s highest rung. They are then asked to identify the step number that they feel reflects their life situation, either at present, in the past or how they envisage it to be in the future (Cantril, 1965).2

The four happiest countries identified by the World Happiness Report placed themselves at 7.5 or higher on the Cantril Ladder (Helliwell, Layard and Sachs, 2016).1

Given that these countries are highly developed and prosperous, it is easy to assume that positive affect is linked to wealth. A common wish in our modern age is to possess more money: wealth can signify success and increases a person’s purchasing power, giving them choices that they might not have been able to make before. But can money buy happiness?

It’s a question that troubles not only psychologists, but economists, too. Richard Easterlin, a professor of economics at the University of Southern California, noticed a strange paradox involving money and happiness. Should a positive correlation exist between the two, we might expect citizens of developed countries to be happier than those of less prosperous nations.

Easterlin discovered that this is not the case – rich people within countries tend to be happier than the poorest in the same country, but overall, more prosperous countries are no happier than their poorer counterparts. These findings, known as the Easterlin paradox, contradict popular assumptions that wealthy people enjoy happier lives.

A study of lottery winners and victims of serious accidents delved further into the link between money and happiness. The happiness of 22 winners of large lottery prizes was compared to that of both controls and 29 people who had been paralysed as a result of an accident. The level of happiness experienced by winning the lottery had numbed people to the smaller joys of everyday live – a resistance the researchers described as “habitation”, as only more significant events could bring the winners joy (Brickman, Coates, Janoff-Bulman, 1978).3

The results of these two studies suggest that money alone cannot bring people lasting happiness.

Why it Matters: Benefits of Happiness
Happiness signifies an increased enjoyment of life, which is of course beneficial in itself. But beyond this obvious advantage, are there any further gains to be had from increased happiness?

One study looked at wide-ranging research into happiness to better understand the link between happiness in successful people.

Researchers suggested that there may be a causal link between positive affect and success – that success not only brings happiness, but that a person who is happy has an higher chance of achieving success than somebody experiencing negative affect (Lyubomirsky et al, 2005).4

The findings of this research support another, earlier, study by Daubman and Nowicki (1987) which artificially induced positive affect in participants in a series of experiments by subjecting them to watching comic films and providing them with sweets.

Subjects were then timed whilst they completed an exercise in creative problem-solving. The researchers found that those in a state of positive affect were able to solve the problems quicker than those in a neutral state or those experiencing negative affect (Daubman and Nowicki, 1987).5 Positive affect prior to success, it appears, boosts our intuitive abilities and enables us to achieve more.

Do Happier People Live Longer?
Can happiness lead to a healthier, longer life? Koopmans et al (2010) conducted a 15-year longitudinal study into the happiness of elderly people, known as the Arnhem Elderly Study. They found higher levels of happiness in those who lived longer.6

But does happiness lead to a longer life or does good health and longevity give people reason to be happier? The researchers also accounted for the participants’ levels of physical activity and found that, once exercise was accounted for, the link between happiness and life span was insignificant. This indicates that happiness may lead to increased physical activity, which in turn can be beneficial.

Indeed, a 2011 study suggested that exercise in sedentary males could be increased by first boosting their positive affect levels (Baruth, 2011).7

Encouraging Happiness
Book store shelves are awash with self-help books claiming to nurture happiness – but is positive affect something that we can nurture, or as the World Happiness Report emphasises, is influenced by our environment and life circumstances, often beyond our control?

Let’s look at some factors which can influence and encourage positive affect:

Acts of Kindness
Contradicting the idea that possessions can bring happiness, giving to others may in fact be more beneficial in terms of positive affect. Stephen Post (2005) noted that, whilst citizens in the US and Europe are more wealthy than previous generations, we are no happier as a result. Post emphasizes the personal benefit that acts of altruism – selfless giving or assistance – can provide (Post, 2005).8

The effect of selflessness on happiness was further supported by a 2008 experiment in which participants were given a gift of $5 or $20 and instructed to either spend it on themselves or on other people. Whilst the amount of money received had no notable effect on happiness, participants who gave away the money experienced elevated positive affect following the experiment (Dunn et al, 2008).9

Familial relationships and friendships affect happiness and can also be impacted by a person’s levels of positive affect. Our ability to make friends often affects our self-esteem – unsurprisingly, people with extrovert personalities have been to found to enjoy higher levels of happiness than introverts (Argyle and Lu, 1990).10

A 20-year study of interpersonal relationships demonstrated just how important the happiness of a person’s friends and family is to their own wellbeing.

Between 1983 and 2003, James Fowler and Nicholas Christakis looked relationships between close relatives and found that the happiness of a friend or close family member who lives up to a mile away from a person can boost their prospects of happiness by around 25%.

The study also suggests that the contagiousness of happiness is not limited to direct relationships: it can influence the happiness of people by up to 3 degrees of separation from the original individual (Fowler and Christakis, 2008).11

Spousal relationships can be of particular influence on happiness levels. A study across 17 countries found that marriage does tend to lead to increased levels of happiness. Cohabiting also boosts happiness but by a lesser degree than marriage. The research emphasises the secondary effects of matrimony, such as the emotional and financial support provided by a partner, may explain this change rather than the act of marriage itself (Stack and Eshleman, 1998).12

Self-Determined Happiness
Positive affect might be influenced by external factors in our everyday life, but if people yearn for more happiness, can they bring it about themselves? Schütz et al (2013) studied the habits and happiness of people whose affect levels varied. The study observed a number of ways in which some people were able to proactively nurture their own happiness:13

The self-fulfilling participants showed significantly higher results than all other profiles on the direct attempts strategy, suggesting that in order to increase their happiness the self-fulfilling individuals are more prone to directly attempt to smile, get themselves in a happy mood, improve their social skills, and work on their self-control.

Schütz et al, 2013 via PeerJ

Pretending to be happy through outward expressions of happiness, it appears, may have led the individuals to internalise this joy.

Maintaining an optimistic mindset can also bear further benefits. Brissette and Scheier (2002)14 found that college students who started the semester with a sense of optimism were more able to cope with stressful events and felt that they had better social support even when their friendship network had not increased.

By Psychologist World

Besma (Bess) Benali, Clinical Social Work/Therapist, MSW, RSW, Counselling Ottawa Nepean. I am trained in Cognitive Behavioural Therapy (CBT), Brief Psychodynamic Therapy, ACT, and mindfulness. Clients come to me because they are struggling and feel like they are trapped in a darkness that no matter what they have tried (and many have tried therapy before) they can’t pull themselves out. I help my clients understand themselves in ways no one has ever taught them before allowing them to see positive changes.

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The Characteristics of Adult Children of Alcoholics

You’ll likely identify with these traits if you grew up around alcoholism

If you grew up in an alcoholic home, you’re probably familiar with the feeling of never knowing what to expect from one day to the next. When one or both parents struggle with addiction, the home environment is predictably unpredictable. Argument, inconsistency, unreliability, and chaos tend to run rampant. Children of alcoholics don’t get many of their emotional needs met due to these challenges, often leading to skewed behaviors and difficulties in properly caring for themselves and their feelings later in life.

It’s not any wonder. If you were never given the attention and emotional support you needed during a key developmental time in your youth and instead were preoccupied with the dysfunctional behavior of a parent, how would you know how to get your needs met as an adult? Furthermore, if you lacked positive foundational relationships, it may be difficult to develop healthy, trusting interpersonal relationships later on.

Children of alcoholics often have to deny their feelings of sadness, fear, and anger in order to survive—and since unresolved feelings will always surface eventually, they often manifest during adulthood. The advantage to recognizing this is that you’re an adult now and no longer a helpless child. You can face these issues and find resolution in a way you couldn’t back then.

These Characteristics Resonate With Children of Alcoholics
Many children of alcoholics develop similar characteristics and personality traits. The late Dr. Janet G. Woititz outlined 13 characteristics of adult children in her 1983 landmark book, Adult Children of Alcoholics, which she noted often apply to other dysfunction families as well.

Dr. Jan, as she is known, was a best-selling author, lecturer, and counselor who was also married to an alcoholic. Based on her personal experience with alcoholism and its effect on her children, as well as her work with clients who were raised in dysfunctional families, she discovered that these common characteristics are prevalent not only in alcoholic families but also for those who grew up in families where there were other compulsive behaviors, such as gambling, drug abuse or overeating.

Children who experienced parents with chronic illness, strict religious attitudes, foster care and other dysfunctional systems also often identify with these characteristics, Woititz said.

  • Adult children of alcoholics guess at what normal behavior is.
  • Adult children of alcoholics have difficulty following a project through from beginning to end.
  • Adult children of alcoholics lie when it would be just as easy to tell the truth.
  • Adult children of alcoholics judge themselves without mercy.
  • Adult children of alcoholics have difficulty having fun.
  • Adult children of alcoholics take themselves very seriously.
  • Adult children of alcoholics have difficulty with intimate relationships.
  • Adult children of alcoholics overreact to changes over which they have no control.
  • Adult children of alcoholics constantly seek approval and affirmation.
  • Adult children of alcoholics usually feel that they are different from other people.
  • Adult children of alcoholics are super responsible or super irresponsible.
  • Adult children of alcoholics are extremely loyal, even in the face of evidence that the loyalty is undeserved.
  • Adult children of alcoholics are impulsive. They tend to lock themselves into a course of action without giving serious consideration to alternative behaviors or possible consequences. This impulsively leads to confusion, self-loathing and loss of control over their environment. In addition, they spend an excessive amount of energy cleaning up the mess.

Now, that doesn’t mean that everything on this list will apply to you. But it’s likely that at least some will.

The Laundry List
Before Dr. Jan’s book was published, an individual adult child of an alcoholic, Tony A., published in 1978 what he called “The Laundry List,” another list of characteristics that can seem very familiar to those who grew up in dysfunctional homes.

Tony’s list has been adopted as part of the Adult Children of Alcoholics World Service Organization’s official literature and is a basis for the article, “The Problem,” published on the group’s website.

Other Traits of an Adult Child of an Alcoholic
According to Tony A’s list, many adult children of alcoholics can:

Become isolated
Fear people and authority figures
Become approval seekers
Be frightened of angry people
Be terrified of personal criticism
Become alcoholics, marry them or both
View life as a victim
Have an overwhelming sense of responsibility
Be concerned more with others than themselves
Feel guilty when they stand up for themselves
Become addicted to excitement
Confuse love and pity
‘Love’ people who need rescuing
Stuff their feelings
Lose the ability to feel
Have low self-esteem
Judge themselves harshly
Become terrified of abandonment
Do anything to hold on to a relationship
Become “para-alcoholics” without drinking
Become reactors instead of actors

When It Comes to Relationships, ACoAs May Run Into Trouble
Many adult children of alcoholics lose themselves in their relationship with others, sometimes finding themselves attracted to alcoholics or other compulsive personalities, such as workaholics, who are emotionally unavailable.

Adult children may also form relationships with others who need their help or need to be rescued, to the extent of neglecting their own needs. If they place the focus on the overwhelming needs of someone else, they do not have to look at their own difficulties and shortcomings.

Often, adult children of alcoholics will take on the characteristics of alcoholics, even though they have never picked up a drink: Exhibiting denial, poor coping skills, poor problem solving, and forming dysfunctional relationships.

Support for Adult Children of Alcoholics
If you identify with the 13 other characteristics outlined by Dr. Woititz, or “The Laundry List” by Tony A., you might want to take the Adult Children Screening Quiz to get an idea of how much you may have been affected by growing up in a dysfunctional home. You will find more detailed descriptions of these characteristics in Dr. Jan’s book, Adult Children of Alcoholics.

Many adult children find that seeking professional treatment or counseling for insight into their feelings, behaviors, and struggles helps them achieve greater awareness of how their childhood shaped who they are today. This is often overwhelming in the beginning, but it can help you learn how to express your needs and cope with conflict in new and constructive ways.

Others have found help through mutual support groups such as Al-Anon Family Groups or Adult Children of Alcoholics. You can find a support group meeting in your area or online meetings for both Al-Anon and ACOA.

By Buddy T, Reviewed by Steven Gans, MD

Adult Children of Alcoholics World Service Organization, “The Laundry List – 14 Traits of an Adult Child of an Alcoholic,” (Attributed to Tony A., 1978). Accessed November 2010.
Woititz, Janet G. Adult Children of Alcoholics, 2010 Expanded Edition.
Woititz, Janet G. “The 13 Characteristics of Adult Children,” The Awareness Center.

Diane Gaston utilizes an approach to therapy that emphasizes all aspects of the individual, including the psychological, emotional, spiritual, and physical. I specialize in PTSD trauma therapy long beach working with those who have affected and held back by past trauma and/or adverse life events. I also work individually and with couples who wish to improve their relationships.

Nutrition Coaching and Anxiety

How getting your health in check can also lessen the symptoms of anxiety.

Did you know that what you eat can seriously help (or hurt) your anxiety disorder? Really. The healthy functioning of your brain, central nervous system, and endocrine system is essential to maintaining healthy energy levels and a healthy mood, making it much less likely for you to feel anxious. Poor nutrition can lead to symptoms such as depression, low energy, poor sleeping patterns, diminished concentration, or addictive behaviors. Furthermore, for many people, things like caffeine and alcohol illicit negative physical and emotional responses such as nervousness, shaking, or irritability. Working to wean yourself off of these substances while working on improving your nutrition, in general, can help you reduce the above symptoms and as a result, your anxiety significantly.

So how do you eat and what do you do to make sure your anxiety stays in check?

Stabilize your blood sugar to avoid mood swings by eating smaller meals, less sugar and eating more often

Eat whole foods with mood-boosting properties such as fish, nuts, and leafy vegetables.

Choose foods with high antioxidant properties like green tea and dark chocolate as well.

Load up on calming products such as chamomile tea, lavender essential oils, or the amino acid L-lysine.

Keep a food journal focusing specifically on how different foods affect your moods.

Work on balancing your hormone levels to help support a calm and more positive mood.

Learn how caffeine, alcohol, or nicotine affect your mood and how you use them in times of stress so you can better understand how to live without these addictive substances.

Eating to maintain your overall health can be difficult depending on your knowledge of food and cooking, the amount of time you have to prepare meals and your ability to handle additional issues such as depression, work/life balance, and health problems. The best way to break through these issues and come out the other side with health and less anxiety? Hire a nutrition coach! A nutrition coach is a health expert that can help you navigate the world of eating right to stave off anxiety. They can help you choose the correct foods, monitor your calorie intake and help you understand your symptoms to ensure that you are selecting foods that work with your body. They can work in tandem with your therapist to help you with maintaining your health so you can adequately manage both the acute and long-term effects of anxiety. A nutrition coach can also make it easier to work through common symptoms of antidepressants such as fatigue or weight gain. A coach can also help you ease into a workout plan which may make it easier to cope with anxiety and live a full, healthful life.

Generally, better nutrition is often thought of as a complementary therapy when it’s being used to help treat anxiety. Getting your nutrition in check will do amazing things for your mood overall, but it shouldn’t replace medications or talk therapy unless suggested by your therapist.

Dr. Jeffrey Ditzell is a Psychiatrist in New York City and offers nutrition coaching in the New York City area.

Hypnotherapy – A powerful tool for overcoming addiction

Can this be just what I need to live an addiction-free life?

If you or a loved one is suffering from addiction, finding the right cure may be a long and challenging journey. It may include ups and downs, successes and failures. You may experience the need to try various avenues such as medication, psychotherapy, rehab, and more. Usually, a combination of interventions is the best way to get the most comprehensive long-term addiction care. If you’re working to overcome an addiction and need some additional help, an important avenue to explore is the complementary therapy of hypnotherapy. Hypnotherapy can be an excellent way to help overcome addiction and provide you with the tools to maintain a well balanced and addiction free life. Curious to learn more? Keep reading to get a better idea of how hypnotherapy can work for you.

Hypnotherapy is a practice that guides relaxation, intense concentration, and focused attention to achieve a heightened state of awareness that is sometimes called a trance or a meditative state. The person’s attention is so focused while in this state that anything going on around them is temporarily blocked out or ignored. In this naturally occurring state, a person may focus his or her attention on specific thoughts or tasks with an end goal in mind. This practice is guided by a trained a licensed hypnotherapist that will use their expertise to help you overcome the pull of addiction. Hypnotherapy is best used as a companion therapy, working together with psychotherapy or medications to relieve symptoms and change the addiction mindset to help enact lasting change. It can help reduce anxiety, get to the root causes of addiction or even help you to perceive an awareness of pain differently; significantly reducing the uncomfortable sensations of withdraw.

Hypnotherapy is a fantastic treatment for patients with addiction for two main reasons: First, hypnotherapy is a drug-free means of wellness which is an essential consideration for anyone dealing with addiction issues. Second, it relies on relaxation, meditation, and inner strength, all incredibly important skills for those with addiction to master. Often, the desire to use a drug stems from acute stress, anxiety or overwhelm and working through these issues with the help of the positive coping mechanisms learned during hypnotherapy sessions is incredibly useful.

Clinical hypnosis is most beneficial for those who are highly motivated to overcome a problem, especially when they are paired with a professional that’s both trained in hypnosis and their specific condition. Finding a professional that can help guide you through hypnotherapy while also being trained in treating addiction can be the best way to achieve long-term wellness.

Do you think that hypnotherapy is an excellent option to help you overcome your issues with addiction? Do you think it’s the last piece of the puzzle to end your dependence for good? If so, ask your therapist if adding this practice can be just what you need to break the cycle of addiction and live a healthy well-balanced life.

By, Francis Killory, Hypnotherapist Seattle, offering Clinical Hypnotherapy, Hypnosis with Certified Medical Support. Hypnosis is a state of consciousness used by a licensed Hypnotherapist to perform Hypnotherapy and induce a hypnotic state.

Medication Management

Finding ways to make sure you’re healthy and safe both now and in the future.

Polypharmacy is the term used for taking multiple medications for different conditions. This practice is most often a need in older adults or those with complex medical conditions. No matter what medications you take, it’s imperative that you have a good handle when to take them, how to take them and how to keep track of your dosage. Due to age, a hectic schedule, advanced illness or even a medication’s side effects, keeping track of what you need to take when can be a challenge.

Mastering medication management is a necessary step towards wellness and not doing so can adversely affect your health both now and in the future. So how do you ensure that you are managing your medication properly? Continue reading to learn more.

Think practical:
Easy to implement solutions are often most effective due to their simplicity. Having trouble remembering what to take? Use a daily pill sorter so you only have to pay attention to your regimen once a week while you’re sorting them.

Forgetting to take your medicine? Set an alarm on your phone or put your pill bottle in your shoe so you can’t leave home without taking your dose. Simple strategies and repetition can be the best ways to ensure that you’re taking your medicine when you should.

Make a list:
Create and maintain an up to date medication list. A list should contain the drug name, dosage, dosing frequency, and reason for taking the drug. Bring this list with you to every doctor’s appointment or to the pharmacist when you pick up your prescriptions. Providing this information to your caregivers is imperative so they can ensure that your medication won’t cause any adverse effects or unhealthy drug interactions.

Ensure age and weight appropriate doses:
The dosage of certain medications may change with age and weight so when being prescribed a new medication, make sure that your dose is appropriate for you. Especially as you age, the way you metabolize medications changes so dosage amounts or medication time may need to change to account for this difference.

Ask for help:
If you’re having trouble managing your medications don’t feel like you have to do it alone. Ask a family member, friend or medical professional for assistance. Even having a friend send a text message to you once a day checking to make sure you took your pills may be all you need to stay on track. Get a second opinion: No two providers are alike. One may prescribe multiple medications in high doses and others may prescribe fewer. It never hurts to get a second opinion regarding your medications and your health in general, especially if you don’t feel well or are having trouble with one or many of your medications. It’s your responsibility to properly manage your (or a child or aging parent’s) medication properly. If you’re diligent, ask questions and are honest about the side effects you’ll be well on your way to leading a healthy life.

Dr. Jeffrey Ditzell is a Psychiatrist in New York City and offers Psychiatric Consultations in the New York City area.

OCD Disorder Can help Foster Acceptance

In 2015 Target Stores released a clothing item during their Christmas season that caused a lot of controversy. The red, white and green sweater sold online and in retail locations read “OCD Obsessive Christmas Disorder.” Shortly after this item was released many people on social media reacted harshly. Some said that it was trivializing mental illness and making light of a severe condition. Others, most being those who have OCD, found it to be lighthearted and funny. The public outcry and differences in opinion show that this clothing item sparked a debate about mental disease acceptance as a whole. Ultimately, Target chose to keep the item on the shelves and continued selling it throughout the Christmas season.

This is not the first time that mental illness has been mocked in popular culture and it certainly won’t be the last. Conditions like depression, anxiety, and most often OCD are at times mocked or spoken about in a tongue-in-cheek way. We’re all bound to hear or see instances of this from time to time. Instead of getting upset and rushing to social media to profess your anger, the best way to combat the negative talk associated with mental illness is to become more knowledgeable about the subject. Keep reading below to learn more about OCD and how it affects a sufferers’ daily life.

Obsessive Compulsive Disorder (OCD) is defined as a chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that they have the urge to repeat over and over. It’s not just a case of being overly organized or particular; it has to deal with habitual thoughts, rituals, or worries that interfere with everyday life. Obsessions are repeated thoughts or urges that cause anxiety. Some common symptoms include fear of germs, aggressive feelings or the need to have things in symmetrical order. Compulsions are repetitive behaviors that people feel like they need to do in response to obsessive thoughts.

Common compulsions include excessive handwashing, compulsive counting, or organizing and reordering things in a particular way. OCD is common and affects people of all ages, most being diagnosed before they turn 18. The cause of OCD is unknown, but risk factors include having a family member with OCD, abuse or trauma at a young age, or certain brain abnormalities. OCD is typically treated with medication or psychotherapy and may be seen more often in people with other mental disorders such as anxiety and depression.

OCD is a difficult disorder to have to deal with as it can affect so many parts of one’s daily life. It’s exhausting and takes a lot of work to deal with. So, the next time that you or a friend comment about how you’re “so depressed” because your favorite show is ending or how you have OCD because you like to keep your house tidy, consider the differences between being sad or particular and suffering from a mental illness. Being compassionate for others (and maybe passing on the Target shirt) is the first step to truly understanding them.

Besma (Bess) Benali, Clinical Social Work/Therapist, MSW, RSW, Counselling Ottawa Nepean. I am trained in Cognitive Behavioural Therapy (CBT), Brief Psychodynamic Therapy, ACT, and mindfulness. Clients come to me because they are struggling and feel like they are trapped in a darkness that no matter what they have tried (and many have tried therapy before) they can’t pull themselves out. I help my clients understand themselves in ways no one has ever taught them before allowing them to see positive changes.

This article about counselling Ottawa was created here.

Using Mindfulness to Help with Depression

How to use this time trusted skill to ease your depression from within.

Daily life tends to get overwhelming.Incredible demands of your time coupled with the knowledge that you should be doing more makes it easy to feel overwhelmed. If you’re dealing with depression, the stressors of daily life can quickly become too much. How do you find balance in a crazy world? How do you calm mind in a way that can help you deal with your depression? The practice of mindfulness may be the key to helping you handle it all.

The practice of mindfulness-based stress reduction can help you learn how to calm your mind and body to help you cope depression and all of the frustrating symptoms that accompany it. When learning how to use mindfulness to help treat depression, it’s important to first understand what mindfulness is and isn’t. Being mindful isn’t “zoning out” or “turning off” but rather the act of being present in the moment. Being mindful is being able to be aware of what’s going on around you without letting your mind wander to that fact that your house is a mess or your teenager is stressing you out. Mindfulness enables you to experience the present without regretting the past or worrying about the future; actions that contribute to your overall levels of stress, anxiety and ultimately depression. Most importantly, mindfulness is intentional and active. Despite it sounding so simple, it isn’t particularly easy to achieve. It’s human nature always to be thinking ahead and planning for your next step. However, the process of mindfulness gives you the ability to live in the moment. Ultimately, you need to ensure that you’re controlling your mind, and your mind isn’t controlling you. This skill lets you handle stress better so when something is overwhelming, you’re able to process it quickly and easily.

This practice is particularly helpful as a way to help treat depression as it trains your brain to be more resilient and focused at the most important times. Another incredible benefit of mindfulness is the fact that its effects are cumulative. The same way that running gets easier the more that you do it, practicing mindfulness get easier the more you do it as well.

Not sure how to begin your mindfulness practice? Start with your next meal. Turn off the television, put your phone away and just eat. Notice how the dish looks, the way the food is placed on the plate. Note the smell of the food, the colors and the textures of what you’re eating. Pay attention to the tastes and how they change throughout the meal. Finally, notice the way the meal makes you feel. Satiated? Nostalgic? Full? Happy? Practicing mindfulness in simple ways can help you learn how to use it when you’re feeling overwhelmed or clouded by depressive thoughts.

Mindfulness is most useful when it’s being coupled with other depression mitigation techniques like Cognitive Behavioral Therapy and anti-depressant medication. Adding mindfulness to your treatment plan can help you feel in control in the most chaotic moments.

Mollie Busino, LCSW, Director of Mindful Power, Counseling Hoboken. Mollie has had extensive training in Cognitive Behavioral Therapy, Rational Emotive Therapy, and Mindfulness. Her work focuses on Anxiety, Depression, Anger Management, Career Changes, OCD, Relationship, Dating Challenges, Insomnia, & Postpartum Depression and Anxiety.

What it means to self-harm

There are over 3 million cases of self-harm each year. Learn more about what that means and how to work through it.

Self-harm defined:

Self- harm has many synonyms including deliberate self-harm, self-injury, non-suicidal self-injury or self-poisoning. It is defined as the intentional, direct injuring of the body tissue without suicidal intentions. The most common form of self-harm is using a sharp implement to cut one’s skin, but it can take many other forms. Burning, scratching, hitting body parts, interfering with wound healing (dermatillomania), hair pulling (trichotillomania) or the ingestion of toxic substances are also considered self-harm behavior. Behaviors associated with substance abuse and eating disorders usually aren’t classified as self-harm as the tissue injuries that result from these disorders usually isn’t intentional. However, the boundaries of these disorders aren’t well defined, and one ailment can creep into the other, making them hard to diagnose and treat effectively.

Suicide and Self-Harm:

Suicide isn’t the intention of self-harm, but the relationship between self-harm and suicide is a complicated one. Self-harm can be potentially life-threatening, and many of those who are suicidal also self-harm, but classifying those who self-harm as suicidal is largely inaccurate.

Who and Why:

Self-harm is a common symptom of borderline personality disorder and is also common in those with depression, anxiety disorders, substance abuse, eating disorders, and post-traumatic stress disorder. The motivations for self-harm vary widely. Some use it as an escape or coping mechanism for intense feelings of anxiety or depression. It’s often associated with trauma, including emotional or sexual abuse. Self-harm is most common between the ages of 12 and 24 and is more common in females. Adolescents between the ages of 12 and 15 are five times more likely to demonstrate self-harm activities. Unfortunately, due to societal pressures and increased stress, teens and young adults have been engaging in self-harm at a higher rate in the last decade.

Due to the prevalence of this practice in adolescents, teens and young adults, it’s important to be mindful of a child’s stress levels and coping mechanisms in order to help find healthy ways to react to stressful situations.

How to cope:

If the self-harm episodes are related to anxiety or depression, therapy, antidepression medication or stress reduction techniques can be used to help lessen the desire to self-harm. If the self-harm is related to increased societal pressures, efforts should be taken to monitor social media activity and participate in self-care.

Self-harm is a complex condition that has numerous causes and can look different in various cases. No matter what form it takes, it’s a condition that needs to be taken seriously as it can be masking other conditions or unhealthy behaviors. The most important thing to remember is that if you or someone you know is self-harming, help is available. It’s a condition that can be overcome with the help of a therapist.

Dr. Jeffrey Ditzell is a Psychiatrist in New York City and specializes in issues involving anxiety depression and adult ADHD. Ketamine Infusion Therapy is one of the many treatments Dr. Ditzell offers to treat a variety of mental health issues.

Working Through Humiliation

Everyone experiences it, no one likes it, but only the best know how to come back from it.

Whether actual or assumed, big or small, humiliation can wreak havoc on your life. Everyone at some point has been utterly humiliated for one reason or another. The feeling of humiliation is distressing, intensively painful, and frustratingly long lasting; creeping back into your stream of consciousness just as you think you’ve recovered from it. Right when it happens, humiliation can be incredibly stressful and make you feel helpless. However, there are ways to work through it and come out the other side a more resilient and self-assured individual.

How to work through humiliation:

View each crisis as an opportunity: Humiliation often stems from feelings of inadequacy or lack of preparation. Maybe you were underprepared for a job interview or utterly undertrained for the 5k you promised yourself you’d do great in. Whatever the humiliation stems from, being able to reframe it as an opportunity to do better can help you get over the feelings of distress.

Seek solace in the comfort of friends: Being able to find a support group or talk to friends about your humiliation is an incredible way to help move past it. Simply talking through your problems with trusted pals or a support group is a beautiful way to become more resilient and emotionally stable.

Look ahead: Looking past your feelings of humiliation and focusing on your opportunities ahead can help distract you and allow those distressing feelings to fade. Every situation looks better once some time has passed. Looking forward while working through humiliation can be a positive way to conquer the negative feelings associated with this emotion.

Only hide out if you need to: When something humiliating happens, its easy to want to curl up into a ball and hide away from everyone you know. Despite this sounding like a great idea, hiding out from your friends or family after a humiliating event occurs can increase feelings of regret, shame, or depression to levels that may be difficult to deal with. Lay low for awhile if you feel like you need to, but be aware that staying away from the support of your loved ones for too long can be a bad idea.

The best advice? Be kind to yourself. Any humiliating event probably feels much worse to you than anyone else who experienced it. Generally, humans are kind and are much more willing to overlook embarrassing moments than you might expect. Knowing that all humans are flawed, and you’re just like everyone else is an excellent way to help cope with any feelings of humiliation you may have. Once you realize that you’re just human and sometimes, humiliating events just “happen,” you’re much more likely to react appropriately and recover quickly.

A final note: If you’re experiencing humiliation, dread, stress, and issues regarding your self-worth it’s best to talk to a therapist about these emotions. You may have underlying anxiety or depression issues that a therapist can help you with.

Dr. Dimitra Takos is a Newport Beach Psychologist specializing in the treatment of adolescents and adults suffering from depression, anxiety, and trauma-and stressor-related disorders.

Depression – Medication Explained

Depression is not a one-size-fits all mental disorder. There are many types of depression including major depression, persistent depressive disorder, bipolar disorder, seasonal affective disorder, psychotic depression, peripartum (postpartum) depression, premenstrual dysphoric disorder and situational depression. It is impractical to expect then that one treatment plan will be effective across all types of depression. A thorough evaluation by a psychologist or psychiatrist will help pin point the specific type of depression so that a specific treatment plan may be developed.

Patients with mild depression may positively respond to strategies that do not include medication. Lifestyle changes for example, including exercising moderately three times per week, have been proven by research to diminish the symptoms of depression. Other strategies include educating oneself about the disorder and avoiding isolation by spending time with trusted friends and family. Talk therapy may also prove to be effective. While these approaches may provide gradual incremental improvement for milder forms of depression, more severe depression may require prescription medications.

Depression is a complex mental disorder and it is not fully understood. However medical science has identified several underlying causes as follows: sexual or physical abuse, grief, drug or alcohol abuse, genetics and unexpected life events. Thyroid disorders and diseases of the endocrine system (hormones) can also cause depression. Chronic illness, including heart disease, kidney disease and diabetes may also contribute to depression. Recognizing the complexity of depression is not difficult; nor is it difficult to understand that use of antidepressants for the treatment of depression must be carefully supervised by a properly trained medical professional. An understanding by the patient as to how the chemistry of antidepressants work may be helpful.

Our brains are composed of complex communication circuits and chemicals called neurotransmitters. Neurotransmitters allow the chemical transmission of signals from one nerve cell to another nerve cell. You may have heard these chemicals referred to as serotonin, dopamine or norepinephrine. Serotonin is found in the brain, bowl and blood platelets. It is believed by some medical scientists to be our body’s primary “mood regulator” and an imbalance of serotonin may lead to depression. At this time science is unsure if decreased levels of serotonin cause depression or if depression causes a decreased level of serotonin. In either case, the relationship has been established and represents the basis of how antidepressants work.

You may also have heard certain antidepressants referred to as SSRIs, selective serotonin reuptake inhibitors. SSRIs are thought to minimize depression by increasing levels of serotonin. Said another way, they enhance nerve cell function by blocking the reabsorption (reuptake) of serotonin in the brain making more serotonin available. This class of antidepressants targets (selects) serotonin and allows the buildup of serotonin between nerve cells thereby affecting emotion and depression.

Antidepressants such as SSRI’s can take two to four weeks to produce effects. They may also cause side effects which may decrease in time. A licensed psychiatrist or psychologists can explain both benefits and potential side effects. In all cases, close supervision by your treatment provider is necessary, and if you are prescribed medication, do not stop taking the medication without first consulting with your health care provider.

Carolyn Ehrlich LCSW, CGP specializes in Relationship Counseling NYC. I increase your self- awareness and help you gain more insight into your inner-life. We’ll work together so you can get more out of every day and meet any challenge life throws at you.

What Is Social Psychology?

How understanding the way couples interact can help us learn about society as a whole.

Have you ever changed the way you acted when you were in a group? Let a popular opinion change the way you thought? Or even observed the changes people experience when they’re put in positions of power? All of these topics and more are related to Social Psychology and can have a significant impact on individual and interpersonal behaviors. Taking an in-depth look at the science of social psychology can help explain why people do what they do and the implications of those actions.

Social Psychology is a researched based field that aims to explain how the thoughts and actions of individuals are influenced by the thoughts and actions of other human beings they interact with. Different people shape our experiences and the people that are around us at any given time can affect the choices we make.

Social psychology looks at a wide range of social topics, including:
Group behavior
Social perception
Power dynamics
Nonverbal behavior
Couples Counseling

Having a better understanding of how people interact can help us understand the world in which we live.

Social Psychology vs. Sociology:

These two disciplines are often confused as they are very similar. Both Social Psychology and Sociology look at social behavior but sociology looks at it in a broader cultural level. Sociology focuses on the influence of institutions and cultures on human behavior whereas Social Psychology focuses more on interpersonal relationships and how individual people or groups of people affect social situations.

Social Psychology’s influence:

Since popular concepts such as social loafing and the crowd mind were introduced in the late 1800s, Social Psychology has shaped our understanding of how individuals interact with the world. Despite the earliest ideas of this science taking shape from the writings of Plato, Social Psychology really solidified itself after World War II. Events such as the Holocaust helped Social Psychologists understand the effects of social pressures, conformity and obedience and why people can be coerced into following orders to such an extreme level. This event coupled with a few groundbreaking social experiments were the cornerstone of Social Psychology as we know it today.

The Milgram Obedience Experiment:

One of the most well known Social Psychology experiment was organized by scientist Stanley Milgram and was conducted to help understand obedience and power dynamics. It took place in the1960s and was created to help understand why so many people would follow and support Hitler during the Holocaust. A group of men were tasked with asking their “students” questions and has to administer an electric shock when a wrong answer was given. The “students” were in on the experiment, and no actual shock was given, but they acted as if they were in pain and eventually began pleading and begging with the subjects to make the shocks stop. Each time the men paused they were urged by the study’s administrator to press on, eventually being told that “It is absolutely essential that you continue.” and “You have no other choice; you must go on.” Despite the fact that they believed that they were hurting the “students” 65% of the men consented to authority and administered the maximum shock. This was astonishing to Milgram as he believed that his authority wouldn’t have had as much influence on the subjects. This experiment was paramount in helping scientists understand the horrors of the Holocaust.

So the next time you experience “group think” in a meeting or see a teenager engage in dangerous behavior just to impress their friends, know that Social Physiology is at hand. Learning how this powerful science effects us is the cornerstone of understanding how we operate as a society.

Christy Weller, Psy.D., Couples Counseling Boulder. I bring a genuine curiosity, a kind appreciation of where you have been, and a non-judgmental stance so that you feel comfortable exploring your story and making sense of it. I tailor my work to each client and I’m trained in both short-term and long-term therapies.

Carrying and Coping with Loss

Unfortunately, loss is a part of life for everyone. Whether it’s a close friend, a relative, or even a certain situation, we’ll all have to deal with some type of loss at some point. The hard part is that we all respond to it, and deal with it differently.

There are healthy ways of coping and dealing with loss – that doesn’t necessarily mean it’s any easier for some people than others, but some people are better able to carry it with them and get through their lives. For others, loss can feel like a crushing defeat. It can take over your life and make you feel as though the walls are closing in around you.

It’s perfectly normal to grieve and feel a sense of loss when the situation is appropriate. But, when it starts to completely take over your life and feels impossible to deal with, it’s time to work on how to get through it for good.

Whether you feel angry, confused, hurt, lost, or even guilty, we can help you to focus on your future without feeling the constant weight of your personal loss. In the meantime, let’s take a look at a few helpful tips that can guide you through your grief.

Don’t Keep It Inside

One of the best ways to deal with grief is to talk to someone about it. It might sound cliché at first, and there’s a good chance you won’t want to ‘burden’ anyone with your feelings, but you can’t let yourself be held back by those thoughts. Confiding in someone can make a big difference, whether it’s a family member, friend, or even a professional in mental health.

Keep a Routine

If you already had a daily routine, try to keep it in tact. Doing ‘normal’ daily things can make coping easier and make life feel somewhat balanced again. You can also develop a new routine. Something as simple as waking up at the same time each day to go for a walk can make a difference.

Take Care of Yourself

Eating well, getting enough sleep, and even exercising can help to make the feelings of loss seem less daunting. When your mind and body are taken care of, your emotions will be, too. The stress that comes with loss can also make you feel exhausted, so don’t be afraid to fight that exhaustion by getting enough sleep.

Don’t Use Negative Substitutes

Out of the many ways to cope with loss, one of the worst things you can do is try to fill that void with something negative. Unfortunately, many people turn toward things like alcohol, gambling, or other harmful vices. Dealing with loss can take time, and there are healthy ways to get through it. Trying to find a ‘quick fix’ in order to numb the pain might work for a short period of time, but it can easily lead you down a destructive path.

Again, the best thing you can do when dealing with loss is to talk it out with someone. If you’re not comfortable sharing your feelings and emotions with friends or a family member, we can help when it comes to listening and providing guidance for the future.

Counselling Burnaby Vancouver, Via Counselling & Consulting. Burnaby Counsellor Shari Wood, M.Ed., R.C.C. dedicated to helping clients begin their personal therapeutic journey. A Clinical Counsellor, specializing in helping people overcome self-doubt and build healthy relationships.

How to Recognize and Get Past Negative Coping Mechanisms

We all cope with things like grief and stress differently. Life tends to throw a lot of things our way, and how we respond to each situation can greatly affect the next ‘chapter’ in what we do. Some negative coping mechanisms may not seem like such a big deal: Perhaps you reach for a pint of ice cream when you’re stressed out. Or, maybe you need a drink to take the edge off.

When these coping mechanisms start to turn into regular habits, or things we turn to in dependency whenever we get stressed, bigger problems can occur. Unfortunately, you may not see your coping skills as negative until they’ve already become a bigger issue. Let’s dive deeper into what negative coping actually looks like. Once you recognize the patterns, you can choose to take control of your life again and practice positive coping habits instead.

Negative Self-Talk

Getting down on yourself about things easily is an easy way to shift the blame of a problem you may be dealing with. You can almost use talking down on yourself as a type of ‘excuse’ for whatever you’re going through, but it doesn’t make the problem go away and certainly won’t make you feel better. If you find yourself criticizing the things you do, or simply the way you are, you could be falling into a poor coping habit.

Drinking, Smoking, and Drugs

If you’ve never been an avid drinker or smoker before, but you turn to these substances in times of stress or grief, it’s important to take a closer look at why. Many people who don’t want to face negative situations will look for outlets that either make them feel ‘numb,’ or as though they can avoid that particular situation for awhile. Avoidance will likely only make the problem worse, as it continues to build up and never gets resolved.

Becoming Aggressive

Stress or grief can weigh heavily on anyone. While some people’s response is sadness and proneness to depression, other people tend to act out in anger and aggression. If you find that you have a ‘short fuse’ when you’re going through a stressful time, it could be your own negative way of dealing with things. This could include anything from yelling at friends, family members, or your children, to becoming violent at times. Take stock of your aggression when you’re going through a stressful situation.

What Are Some Positive Coping Habits?

There are plenty of additional negative coping mechanisms to consider. Everything from your eating habits (overeating or undereating) to taking risks (driving too fast in your car) can come into play. They are different for everyone. The important thing is to recognize how you respond, as an individual, so you can better determine if you’re coping in a healthy way or not.

On the other side of things, there are multiple ways to cope in a healthy and positive manner.

This includes things like:
Going out with a friend
Spending time with a pet
Doing something that makes you laugh
Being creative

One of the best things you can do to ensure you’re coping effectively is to seek out some type of counsel if you can’t do it on your own. If negative coping mechanisms have turned into habits, getting the right kind of help can make a big difference.

We’re happy to work with you to build on the positive coping habits you can create for yourself. It can take time and a little extra effort, but by working together, we can make sure the stressful situations you deal with regularly can be handled in a healthy and appropriate manner. Not only will you start to feel better about how you handle stress, but you’ll undoubtedly notice the positive impact these changes can have on your life.

Anna M. Hickey, Counseling Macomb, works with couples and families struggling with relationship issues